With ambiguous messages surrounding nicotine replacement therapy in pregnancy, Aussie experts have tried to pin down the best advice

Smoking cessation experts and public health physicians from the University of Newcastle in NSW have reviewed research and current guidelines on the use of nicotine replacement therapy for smoking cessation.

Their research, published this week in the MJA, has concluded that NRT in pregnancy is safer than smoking and therefore should be offered to all pregnant women who smoke, but there is a need for further research to assess the safety and efficacy of higher dosages of NRT in pregnancy.

Currently, RACGP guidelines recommend initiating NRT in pregnant women who are motivated to quit smoking and have been unsuccessful without medication.

However, a recent survey of Australian GPs and obstetricians revealed a full quarter (25%) of participants stated they never prescribe NRT during pregnancy.

“Ambiguous messages may be contributing to the low NRT prescribing rates and, therefore, it is important to provide a clear practical message to health practitioners and women,” say the authors.

Their narrative review found that animal models indicate that prenatal nicotine exposure damages the developing brain and causes developmental anomalies in the lungs.

Meanwhile several observational and randomised controlled studies have found no significant increased risks for NRT use during pregnancy.

While the research isn’t totally conclusive on the issue, NRT is still safer than smoking and should be offered by clinicians as an option to all pregnant women who smoke, the authors argue.

“Clinicians need to offer pregnant women the option of receiving NRT in a timely fashion if they cannot quit smoking on their own,” researchers say.

“Nicotine may not be completely safe for the pregnant mother and fetus, but it is always safer than smoking.

“The most important guidance for NRT in pregnancy is to use the lowest possible dose that is effective.

“To be effective, women should be instructed to use as much as needed to deal with cravings.”

The Quitline service is also underutilised across Australia and more needs to be done to increase its acceptability and usability, they add.

The article provides a risk-versus-benefit framework and practical approaches to initiating and managing NRT during pregnancy – read more here.