Quitting smoking: What works in pregnancy?

Quitting smoking programs can help pregnant women stop smoking. Nicotine replacement therapy is probably not more effective for pregnant women than these kinds of programs. There is not enough good research on the effects that products containing nicotine have on the unborn baby.

When pregnant women smoke, nicotine and other toxins enter the body that restrict the amount of oxygen reaching the unborn baby. This means that smoking in pregnancy increases the risk of a woman having a miscarriage, and the chances of the baby being born too early, or too small or of weighing too little are higher, too. These babies more often have very serious lung complications and other life-threatening problems. You can read more about the problems associated with preterm birth here.

Women are more likely to quit smoking while they are pregnant than at other times. About 4 out of 10 pregnant women (40%) have already quit smoking by the time of their first prenatal visit. Yet even though pregnant women are often highly motivated to quit, it can still be very difficult to reach this goal, and the majority will need help. So a variety of support programs are offered to help pregnant women quit. These programs include offers like education, counseling, or group sessions.

Research on quitting smoking in pregnancy: support can help

To weigh the advantages and disadvantages of different quitting smoking programs, researchers from the Cochrane Collaboration looked for suitable trials and analyzed them. The Cochrane Collaboration is an international network of researchers who work together to systematically assess trials on the effectiveness of health care interventions. So-called randomized controlled trials are the best way of finding out how effective a particular treatment is. You can read more about why this is the case here.

The Cochrane researchers found 72 trials of different types of quitting smoking programs, which included more than 25,000 pregnant women. The Cochrane Collaboration’s analysis shows that various programs can help pregnant women to quit smoking. Statistical analysis of trials with over 10,000 women showed that out of the women who did not get help from a support program or use nicotine replacement therapy (NRT), almost 90 out of 100 (90%) started smoking again before the end of pregnancy. But out of 100 women who participated in some kind of quitting program, about 86 went back to smoking. Put another way: with support from a program, the extra success rate for quitting was around 4 out of 100 women (4%).

Importantly, the Cochrane researchers also found that the babies of mothers who had gotten help to quit smoking by participating in a program were less likely to be born too early or under-developed.

Nicotine replacement therapy in pregnancy: more research is needed

Products like nicotine patches or nicotine chewing gum are used in nicotine replacement therapy. You can read more about this therapy here. During this therapy, nicotine intake is generally lower than while smoking. As with all medication taken during pregnancy, however, the safety of the unborn baby must be considered. The Cochrane researchers reported that some trials indicated that a nicotine replacement therapy could harm some unborn babies. They concluded from this that more research on the safety of nicotine replacement therapies in pregnancy is needed, especially since other quitting programs seem to be just as effective in pregnant women. Even though no trial directly compared nicotine replacement therapy with a different program, the trials on nicotine replacement therapy did not produce a higher success rate than did the trials without the use of medication.

You can read more about different ways of quitting smoking here.


Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)