WEDNESDAY, Feb. 29 (HealthDay News) -- Nicotine patches don't
seem to be of much use in helping pregnant women quit smoking, a
new study finds.
Dr. Tim Coleman, of the Centre for Tobacco Control Studies at
the University of Nottingham in England, and colleagues assigned
1,050 women who were 12 to 24 weeks pregnant to one of two groups.
Members of one group received behavioral smoking cessation support
and wore a nicotine patch, while the other group received the
counseling but wore a patch that looked like the real thing but did
not contain nicotine.
Women given the active nicotine patch had higher quit rates
(about 21 percent) during the first month of the study than women
in the placebo group (nearly 12 percent). But by delivery, both
groups' quit rates were about the same -- 9.4 percent for those
wearing the real patch and 7.6 percent for those wearing the
look-alike, not a statistically significant difference.
One possible reason: Many of the women discontinued wearing the
patch. Only a little more than 7 percent of women assigned to the
nicotine-replacement therapy and fewer than 3 percent given the
placebo used the patch for more than a month, the study authors
Nicotine replacement therapy -- which can include patches, gum
or nasal sprays -- has been shown to help people who aren't
pregnant quit smoking, according to background information in the
article. But the same doesn't appear to be true in pregnant women,
"The nicotine patch improved short-term but not long-term quit rates," said Dr. Cheryl Oncken, a professor of medicine, obstetrics and gynecology at the University of Connecticut School of Medicine in Farmington, Conn., who wrote an accompanying editorial. "The other significant finding is that there was low compliance. Women didn't really take the patch for any period of time. So you really can't tell from this data whether it's safe or effective for use in pregnancy."
The study is published in the March 1 issue of the
New England Journal of Medicine.
The U.S. Centers for Disease Control and Prevention does not
recommend nicotine replacement in pregnant women, and ob-gyns
typically use it as a last resort -- only when women are unable to
quit on their own or with counseling, said Dan Jacobsen, a nurse
practitioner at the Center for Tobacco Control at the North
Shore-LIJ Health System in Great Neck, N.Y.
Safety concerns are one reason nicotine replacement isn't used
all that often, Jacobsen said.
Smoking during pregnancy is associated with low birth weight
babies, which can impact their growth and development throughout
life. Smoking has also been associated with miscarriage, stillbirth
and sudden infant death syndrome.
But the nicotine itself may affect the fetus. A study in the
March issue of
Pediatrics by researchers in the Netherlands found that
exposure to nicotine -- either from cigarettes or nicotine
replacement therapy -- was associated with a significantly
increased risk of colic.
Colic, which usually starts when a baby is a few weeks old, is
when an infant cries excessively and inconsolably for at least
three hours a day, more than three days a week, for more than three
Experts believe nicotine may alter serotonin receptors in the
Other research suggests that pregnant women clear nicotine from
their bodies more rapidly, Jacobsen said. That may make the normal
dosing in a nicotine patch (15 milligrams daily) insufficient to
quell cravings, he suggested.
Higher levels of nicotine than the standard dose might be the
answer for pregnant women, but such a study would raise safety
concerns, Jacobsen noted.
For her part, Oncken said, it would be useful to know whether
women in the study started smoking again, and then quit using the
patch; or if they quit using the patch and then started smoking
again. Knowing which came first would help determine whether future
smoking-cessation efforts should focus on encouraging women to
continue to use nicotine replacement therapy, or that the
medication itself (the nicotine) just doesn't help pregnant women
alleviate the urge to smoke.
Either way, Jacobsen said, "nicotine replacement doesn't seem to
be the answer for pregnant women. In certain patients, maybe. But
we need to work with them individually to try to help them
He also noted that the women in the study appeared to be very
addicted smokers -- more than half had their first cigarette within
15 minutes of waking, an indication of how nicotine dependent
people are, and about 92 percent had their first cigarette within
an hour of waking, Jacobsen said.
The women smoked an average of a pack a day; three-quarters had
a partner who smoked; and the average age of having left school was
"The demographics tend to suggest this is a more addicted group," Jacobsen said.
March of Dimes has more on the dangers of smoking
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