Nicotine patches don’t help pregnant smokers

Nicotine patches do not work for pregnant women, and guidelines that recommend this form of treatment for pregnant women who smoke should be revisited, say researchers. In the largest trial so far, women given nicotine patches on top of the usual behavioural counselling were no more likely to quit for good (until delivery) than women given placebo patches (9.4% (49/521) v. 7.6% (40/529); odds ratio (OR) 1.26, 95% confidence interval (CI) 0.82 - 1.96).

The active patches worked better for the first month of the trial (abstinence: 21.3% (111/521) v. 11.7% (62/529); OR 2.05, 95% CI 1.46 - 2.88), but over 90% of the women in both groups stopped using their patches after that. Perhaps the active patches contained too little nicotine to make a noticeable difference to cravings. Pregnant women may need more than the usual 15 mg per 16 hours because nicotine is cleared so fast during pregnancy.

Future trials could test higher doses of nicotine replacement, but this would have to be done carefully, says a linked editorial. Nicotine is a known teratogen in animals. Very poor adherence seems to be the biggest problem, in this and other trials. Now we need to find out why pregnant women who smoke are so much more likely to give up on their treatment than their cigarettes.

Coleman T, et al. N Engl J Med 2012;366:808-818.