Pregnant woman (illustrative) .
(photo credit: INGIMAGE)
Pregnant women addicted to tobacco who insist they can’t kick the habit – despite the risk to themselves and their babies – should be put on nicotine replacement therapy which is safer than smoking. This is according to a review study in the Medical Journal of Australia led by a Ben-Gurion University of the Negev researcher.
Nicotine replacement therapy (NRT) is a medically approved method of ingesting nicotine to help smokers quit. NRTs come in many forms including adhesive patches, chewing gum, lozenges, nose spray and inhalers containing the addictive chemical.
Studies show that 12% to 20% of pregnant women smoke, putting themselves and their babies at risk, according to the American Pregnancy Association. While nicotine may not be safe for the pregnant mother and fetus, NRT is always safer than smoking, said Dr. Yael Bar-Zeev, head of the BGU Center for Smoking Cessation and Prevention and the study’s author.
“Smoking during pregnancy is the most significant, preventable risk factor for poor maternal and infant health outcomes,” said Bar-Zeev, a public health physician, tobacco-treatment specialist and doctoral candidate at the University of Newcastle in Australia.
Bar-Zeev said that physicians around the world, and especially in the US, report that they do not often prescribe NRT because of their lack of confidence in it and safety concerns – even though guidelines worldwide recommend NRT for pregnant women who have been unable to quit smoking without medication.
“Behavioral counseling combined with medication is the most effective smoking cessation strategy,” she continued. About a quarter of general practitioners and obstetricians never prescribe NRT during pregnancy, according to the Australian study. This could be because prescription instructions such as “only if women are motivated,” “only dispense a two-week supply” or “under close supervision” send mixed messages, said the BGU researcher.
The study’s researchers note that while using NRT during pregnancy improves smoking-cessation rates, they may not adequately account for higher nicotine metabolism during pregnancy and therefore may not adequately treat withdrawal symptoms.
“The most important guidance for NRT in pregnancy is to use the lowest possible dose that is effective,” explained Bar-Zeev. “However, to be effective, women should use as much as needed to deal with cravings.
“Physicians should encourage using oral NRT regularly throughout the day to substitute for cigarettes,” she recommended. For example, a woman smoking 10 cigarettes a day should be instructed to regularly chew one piece of gum every 1.5 hours, even if she is not experiencing a strong craving.
The authors suggest using the “strength of urges to smoke” and the “frequency of urges to smoke” as an indication to initiate or increase an NRT dose. Physicians should also encourage pregnant women to use oral NRT in anticipation of cravings. For example, if a woman will be in an environment where others are smoking, using oral NRT 20 minutes beforehand could help.
According to review sources, while NRT does contain nicotine, it does not have any of the other 7,000 chemicals found in cigarettes, 300 of which are known to be toxic and harmful, and 52 of which are known to cause cancer. Even women who do not quit smoking may improve their baby’s health due to less exposure to these other chemicals.
Additionally, nicotine from NRT is absorbed at a slower rate than nicotine from a cigarette, which means the user receives less nicotine than while smoking. NRT also increases the chances of quitting and remaining smoke-free by 40%.
The researchers recommend more education and training to improve caregivers’ confidence and skills, and development of better referral pathways, including specialized smoking services, to help more pregnant women quit smoking.