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Combination nicotine replacement therapy beneficial in pregnancy

Pregnant smokers are more likely to quit on combination nicotine replacement therapy (NRT) than on single NRT, claims a UK study.

The study

Researchers from the University College London analysed routinely collected data from 3,880 pregnant smokers trying to quit in one of the 44 Stop Smoking Services in England from April 2009 to June 2011. Of the 3,880 women, 588 received no medication, 1,166 were on single NRT (a patch or a faster acting form such as gum, lozenge or inhalator) and 2,126 were on combination NRT (trans-dermal patch plus a fast acting form). The main outcome was four-week quit rates, verified by expired-air carbon monoxide levels <10 ppm, as defined by the Department of Health in 2011.

The findings

At four-week follow up, 29.5% of pregnant smokers had stopped smoking for at least two weeks and had an expired CO below 10 ppm, with unadjusted success rates of 16.3% for those without medication compared with 24.8% on single NRT and 35.7% for women using combination NRT.

After adjustments for individual and intervention characteristics, combination NRT had higher odds of quitting than no medication (OR=1.93) while single NRT showed no benefit (OR=1.06).

The sensitivity analysis of only completed cases found that combination NRT had higher odds of success than no medication (OR=2.19) while single NRT was no better than no medication (OR=1.20).

What does this mean to GPs?

The authors comment: ‘This study provides the first evidence to date that NRT may help pregnant smokers to quit, but with the caveat that only combination NRT appears to confer a benefit.’

They conclude: ‘This study found that use of a combination of nicotine transdermal patch and a faster acting form may confer a benefit in terms of promoting smoking cessation during pregnancy. While this conclusion is based on observational data, it lends support to this treatment option pending confirmation by a randomised controlled trial.’

Drug Alcohol Depend 2013; online 20 May