Pharmaceutical strategies for smoking cessation during pregnancy

ABSTRACT

Introduction

Tobacco use is the most preventable cause of death worldwide, with over 7 million deaths per year. Smoking during pregnancy causes harm to the mother, fetus, and can result in problems for the infant from childhood into adulthood. Practitioners should ask all expectant mothers about tobacco use. For expectant mothers who smoke or recently quit, practitioners should advice to quit and provide psychosocial interventions. Rates of smoking during pregnancy differ between geographical locations, with estimates of 10.8% in the UK and 7.2% in the US. Practitioners should provide expectant mothers unable to quit smoking with information about the risks and benefits of pharmacotherapy and use a patient-centered approach to determine the use. Although there is no definitive evidence on birth outcomes, nicotine replacement therapy and bupropion are adequate pharmacotherapies to help those unable to quit.

Areas covered

Herein, this author looks at the various pharmaceutical strategies to help patients cease smoking and provides expert perspectives on the subject.

Expert opinion

Additional research on pharmacotherapy is warranted, especially with varenicline. Practitioners working with pregnant patients should be familiar with the evidence for pharmacotherapy in smoking cessation during pregnancy. This evidence can be difficult to navigate due to conflicting results and limitations with the trials.

KEYWORDS:

• Pregnancy
• smoking cessation
• varenicline
• bupropion
• nicotine replacement therapy
• tobacco
• cigarette
• pharmacotherapy

Article highlights

• Tobacco use causes significant harm during pregnancy to the mother, fetus, and impact on the infant from childhood into adulthood. Psychosocial interventions are first-line to help expectant mothers to quit smoking.

• Conclusive evidence with regards to safety, abstinence rates, or birth outcomes is lacking with pharmacotherapy. Yet, continued smoking has irrefutable evidence on worsened outcomes. Therefore, pharmacotherapy is reasonable for expectant mothers unable to quit after psychosocial interventions.

• Nicotine replacement therapy can be used safety and evidence shows increased abstinence rates during pregnancy, although the evidence is potentially biased.

• Bupropion has shown to reduce overall smoking, nicotine cravings, and withdrawal symptoms and can be considered in patients with underlying psychiatric disorders.

• There is limited evidence for the use of varenicline in smoking cessation during pregnancy, although future use can be promising.

• Thus, due to the increased risk of psychiatric disorder and risk of psychiatric events, including suicidal ideation, practitioners should closely monitor pregnant patients who smoke or recently quit.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.