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Nicotine replacement therapy in pregnancy

BMJ 2004; 328 doi: (Published 22 April 2004) Cite this as: BMJ 2004;328:965
  1. Tim Coleman, senior lecturer in general practice (,
  2. John Britton, professor of epidemiology,
  3. Jim Thornton, professor of obstetrics and gynaecology
  1. Division of Primary Care, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH
  2. Division of Respiratory Medicine, University of Nottingham, Nottingham City Hospital, Nottingham NG5 1PB
  3. Division of Obstetrics and Gynaecology and Child Health, University of Nottingham, Nottingham City Hospital, Nottingham NG5 1PB

    Is probably safer than smoking

    Smoking harms unborn children. It increases the risk of growth restriction, preterm birth, miscarriage, and perinatal death,1 2 but despite this over a quarter of pregnant women in the United Kingdom smoke.3 Pregnancy motivates a minority to stop for at least part of the pregnancy, but most start again after giving birth.3 Compared with women who manage to stop, those who continue are younger and less educated; more likely to be single and in manual occupations;4 and much less likely to perceive smoking as a risk to their baby.3 Reducing smoking in pregnancy is an obvious health priority, but progress has been slow.3

    Non-pregnant smokers are most likely to quit if offered a combination of behavioural support and pharmacotherapy with either nicotine replacement therapy5 or bupropion.6 The addition of pharmacotherapy increases quit rates obtained with behavioural support by 1.5-fold to 2-fold. Behavioural support is also effective in pregnancy,7 but is usually provided alone because of concerns that drugs may harm the fetus.8 This is understandable for bupropion, which is an avoidable drug, …

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