Nicotine replacement therapy … - Carlos A ... - Entretiens du Carla

Effective
treatments for
Smoking
Cessation in
pregnancy
A Cochrane review summarised evidence
for the effectiveness of smoking cessation
programmes delivered outside of routine
ante-natal care finding that these reduce
rates of smoking late pregnancy by around
6% (relative risk 0.94, 95% CI 0.93 - 0.95) (9).
Ante natal smoking cessation programmes
also reduced the incidences of low birth
weight and pre-term birth by approximately
20% from baseline levels (9).
Trials included in the review tested varied
behavioural interventions which were
underpinned by different psychological
theories and it is not possible to say which of
programmes’ individual behavioural
components were effective. Most trials
employed cognitive/behavioural strategies
to encourage cessation, but two which used
social support and reward approaches
caused bigger reductions in smoking rates
(approximately 23%). In contrast,
programmes based around the “stages of
change” theory were not effective.
The Cochrane review also pooled data
from three trials which, at that time, had
investigated the impact of nicotine
replacement therapy (NRT) for smoking
cessation in pregnancy and found no
evidence that this was effective (pooled RR
for cessation in later pregnancy 0.94: 95% CI
0.89, 1.00). Given that smoking cessation
programmes delivered alongside their
routine ante-natal care are effective, these
should be offered to all pregnant women
and any. Pharmacological smoking cessation
aids should only be provided in addition to
these.
37
Using medicinal
nicotine in
pregnancy
Although behavioural treatments for
smoking cessation in pregnancy work,
women who use these need to be motivated
enough to set aside significant amounts to
attend treatment and it is not likely that
those smokers who are very negative about
the benefits of stopping smoking will do so.
Consequently, it is important to find other
smoking cessation treatments which are safe
and effective but which are also more likely
to be used by recalcitrant smokers. One such
potential treatment which has been
recommended for use in pregnancy is
nicotine replacement therapy (NRT) (10).
Over 100 trials of NRT in non-pregnant
subjects have consistently demonstrated
that, irrespective of NRT formulation used,
this is more effective than placebo for
smoking cessation and increases the chances
of a smoker achieving abstinence in any one
quit attempt by around 80% (RR 1.77 [95%
CI 1.66, 1.88]) (11). Additionally, the impact
of NRT appears to be independent of the
amount or intensity of support provided, the
treatment duration or the setting in which
this is offered. If effective, therefore, NRT
could be an acceptable alternative treatment
for pregnant women who cannot or will not
attend for support with smoking cessation.
Although there is very little evidence for
either the effectiveness or safety of NRT
when used for smoking cessation in
pregnancy, many smoking cessation experts
believe that use of NRT in pregnancy is
preferable to smoking (12). They argue that,
although toxic, nicotine is a substance which
pregnant women would receive anyway if
they continued to smoke and that when it is
delivered by NRTs nicotine is not
accompanied by the numerous over known
tobacco smoke toxins. Additionally, it has
also been argued that because, outside of
Recommendations during pregnancy - Tim Coleman
(7) Bolling K. Infant
Feeding Survey 2005:
Early Results. 2006.
http://www.ic.nhs.uk/pu
bs/breastfeed2005, The
National Health Service
Information Centre for
Health and Social Care.
(8) Owen L, Penn G.
Smoking and pregnancy:
A survey of knowledge
attitudes and behaviour,
1992-1999. 1999.
London, Health
Development Agency.
Ref Type: Report
(9) Lumley J, Oliver SS,
Chamberlain C, Oakley
L. Interventions for
promoting smoking
cessation during
pregnancy.[update of
Cochrane Database Syst
Rev. 2000; (2): CD001055;
PMID:
10796228].Cochrane
Database of Systematic
Reviews 2004; (4):
CD001055.
(10) Benowitz NL,
Dempsey DA,
Goldenberg RL, Hughes
JR, Dolan-Mullen P,
Ogburn PL et al. The use
of pharmacotherapies
for smoking cessation
during pregnancy. Tob
Control 2000; 9 Suppl 3:
III91-III94.
(11) Silagy C, Lancaster
T, Stead L, Mant D,
Fowler G. Nicotine
replacement therapy for
smoking cessation.[see
comment][update of
Cochrane Database Syst
Rev. 2002;(4):CD000146;
PMID: 12519537].
Cochrane Database of
Systematic Reviews
2004; (3): CD000146.