Smoking is linked to adverse outcomes for everyone engaging in this behavior. However, few groups of smokers generate as much urgency and anxiety around treatment on the provider side as pregnant women who smoke.
Certainly, a lot of this angst is related to the well-known adverse outcomes at birth for the unborn child who did not get to choose their fate. On the providers’ side, there is a strong desire to use the most effective therapies to establish abstinence quickly while avoiding any adverse effects of treatment on the unborn.
So, what is most effective for this group of smokers?
A recent systematic review of the literature attempted to answer this question. The authors sought to use published, well-conducted studies to tell us what the most effective treatments are (Vila-Farinas A, et al. Addict Behav. 2023 Sep 3;148:107854). They identified 63 clinical trials enrolling almost 20,000 women.
They observed that the most effective interventions were financial incentives, counseling, and long-acting nicotine replacement therapy [NRT] (i.e., nicotine patches) as opposed to short-acting (i.e., nicotine gum and nicotine inhaler).
Happily, previous studies have shown that there are no differences between NRT and control groups (i.e., placebo) in rates of miscarriage, stillbirth, premature birth, low birth weight, admissions to neonatal intensive care, caesarean section, congenital abnormalities, or neonatal death.
Still, I think that many providers start out with short-acting NRT among pregnant women who smoke and then reserve long-acting NRT if these women are unable to quit. All these women should receive counseling as well.
Clinically, we do not financially incentivize these women; however, such interventions may be provided through public health and health insurance programs.
Pregnancy can be a stressful time for the mother and smoking may help them cope. Ideally, we would build a multi-modal support network around women who are pregnant and smoking with clinical, pharmacologic, and social approaches in the hope of helping them be successful in quitting.
