Skip to main content

Advertisement

SpringerLink
Log in

Does the Use of Nicotine Replacement Therapy During Pregnancy Affect Pregnancy Outcomes?

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives Although nicotine replacement therapies (NRT) may assist with smoking cessation, little is known about the safety of NRT use during pregnancy. Our purpose was two-fold: to determine characteristics of women prescribed or recommended NRT during pregnancy and to investigate whether NRT prescription/recommendation was associated with adverse pregnancy outcomes using data from the 2004 Pregnancy Risk Assessment Monitoring System. Methods Smoking and NRT referral was self-reported by 5,716 women. Information on pregnancy outcomes was obtained from birth certificates. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results Smokers <35 years of age and of Hispanic, Non-Hispanic Black, and Asian/Pacific Islander race/ethnicity were less likely to be prescribed or recommended NRT during pregnancy. After adjustment for age, marital status, education, and race/ethnicity, women recommended NRT had twice the risk of low birthweight as compared to nonsmokers (OR = 1.95, 95% CI: 1.10, 3.46) while smokers had 1.31 times the risk of low birthweight (95% CI: 0.92, 1.87). Results for preterm birth were similar after adjustment for the same confounding variables (NRT: OR = 2.04, 95% CI: 1.14, 3.63 and smoking: OR = 1.09, 95% CI: 0.74, 1.61). Conclusions Risks of low birthweight and preterm birth were highest for women prescribed or recommended NRT. These findings may be related to frequency of maternal smoking. While heavier smokers may be more likely to be recommended NRT, they also may have the most difficulty with cessation. Greater efforts should be made to ensure that these women do successfully cease smoking.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. US Department of Health and Human Services. (2001). Women and Smoking: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General; Washington D.C.

  2. Centers for Disease Control, Prevention. (2004). Smoking during pregnancy-United States, 1990–2002. MMWR, 53, 911–915.

    Google Scholar 

  3. Oncken, C. (1996). Nicotine replacement therapy during pregnancy. American Journal of Health Behavior, 20, 300–304.

    Google Scholar 

  4. Oncken, C. A., Pbert, L., Ockene, J. K., Zapka, J., & Stoddard, A. (2000). Nicotine replacement prescription practices of obstetric and pediatric clinicians. Obstetrics Gynecology, 96, 261–265. doi:10.1016/S0029-7844(00)00905-4.

    Article  PubMed  CAS  Google Scholar 

  5. Centers for Disease Control and Prevention. (2006). Maternal and infant health: Smoking during pregnancy. Available from http://www.cdc.gov/reproductivehealth/TobaccoUsePregnancy/index.htm. Retrieved October 17, 2006.

  6. US Department of Health and Human Services. (2006). Healthy people 2010. Available from http://www.healthypeople.gov. Retrieved October 17, 2006.

  7. Walsh, R. A., Redman, S., & Adamson, L. (1996). The accuracy of self-report of smoking status in pregnant women. Addictive Behaviors, 21, 675–679. doi:10.1016/0306-4603(95)00097-6.

    Article  PubMed  CAS  Google Scholar 

  8. Kranzler, H. R., & Oncken, C. A. (2003). Pharmacotherapies to enhance smoking cessation during pregnancy. Drug and Alcohol Review, 22, 191–202. doi:10.1080/09595230100100633.

    Article  PubMed  Google Scholar 

  9. Benowitz, N. L., & Dempsey, D. A. (2001). Risks and benefits of nicotine to aid smoking cessation in pregnancy. Drug Safety, 24, 277–322. doi:10.2165/00002018-200124040-00005.

    Article  PubMed  Google Scholar 

  10. Prevention and early detection: Guide to quitting smoking. (2006). American Cancer Society http://www.cancer.org/docroot/PED/content/PED_10_13X_Guide_for_Quitting_Smoking.asp. Retrieved October 17, 2006.

  11. Drake, J. A., Jordan, T., & Price, J. H. (2006). Obstetricians and gynecologists’ perceptions and use of nicotine replacement therapy. Journal of Community Health, 31, 60–175.

    Google Scholar 

  12. Pregnancy Risk Assessment Monitoring System 2000–2003 Surveillance Report. (2003). Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, 2003.

  13. Raatikaninen, K., Heinonen, S., & Huurinainen, P. (2006). Smoking in early gestation or through pregnancy: A decision crucial to pregnancy outcome. Preventive Medicine, 1–5.

  14. Henriken, T. B., Kesmodel, U.,Wisborg, K., Olsen, S. F., & Secher, N. J. (2001). Exposure to tobacco smoke in Utero and the risk of stillbirth and death in the first year of life. American Journal of Epidemiology, 154, 323–327.

    Google Scholar 

  15. Meyers, M. B., Jonas, B. S., & Tonascia, J. A. (1976). Perinatal events associated with maternal smoking during pregnancy. American Journal of Epidemiology, 103, 464–476.

    Google Scholar 

  16. Hotham, E. D., Gilbert, A. L., & Atkinson, E. R. (2005). Case studies of three pregnant smokers and their use of nicotine replacement therapy. Midwifery, 21, 224–232. doi:10.1016/j.midw.2004.12.008.

    Article  PubMed  Google Scholar 

  17. Hotham, E. D., Gilbert, A. L., & Atkinson, E. R. (2006). A randomized-controlled pilot study using nicotine patches with pregnant women. Addictive Behaviors, 31, 641–648. doi:10.1016/j.addbeh.2005.05.042.

    Article  PubMed  Google Scholar 

  18. Maldonado, G., & Greenland, S. (1993). Simulation study of confounder selection strategies. American Journal of Epidemiology, 138, 923–936.

    PubMed  CAS  Google Scholar 

  19. Ogburn, P. L., Hurt, R. D., Croghan, I. T., Schroeder, D. R., Ramin, K. D., Offord, K. P., & Moyer, T. P. (1999). Nicotine patch use in pregnant smokers: Nicotine and cotinine levels and fetal effects. American Journal of Obstetrics and Gynecology, 181, 736–743. doi:10.1016/S0002-9378(99)70521-1.

    Article  PubMed  CAS  Google Scholar 

  20. Benowitz, N. L. (1991). Nicotine replacement therapy during pregnancy. JAMA, 266, 3174–3177. doi:10.1001/jama.266.22.3174.

    Article  PubMed  CAS  Google Scholar 

  21. Coleman, T., Britton, J., & Thornton, J. (2004). Nicotine replacement therapy in pregnancy: Is probably safer than smoking. BMJ, 328, 965–966. doi:10.1136/bmj.328.7446.965.

    Article  PubMed  Google Scholar 

  22. Oncken, C. A., Hatsukami, D. K., Lupo, V. R., Lando, H. A., Gibeau, L. M., & Hansen, R. J. (1996). Effects of short-term use of nicotine gum in pregnant smokers. Clinical Pharmacology and Therapeutics, 59, 654–661. doi:10.1016/S0009-9236(96)90005-3.

    Article  PubMed  CAS  Google Scholar 

  23. Benowitz, N. L., Jacob, P., & Dempsey, D. (2002). Accelerated metabolism of nicotine and cotinine in pregnant smokers. The Journal of Pharmacology and Experimental Therapeutics, 301, 594–598. doi:10.1124/jpet.301.2.594.

    Article  PubMed  Google Scholar 

  24. Oncken, C. A., Hardardottir, H., Hatsukami, D. K., Lupo, V. R., Rodis, J. F., & Smeltzer, J. S. (1997). Effects of transdermal nicotine or smoking on nicotine concentrations and maternal-fetal hemodynamics. Obstetrics and Gynecology, 90, 569–574. doi:10.1016/S0029-7844(97)00309-8.

    Article  PubMed  CAS  Google Scholar 

  25. Hansen, R., Luck, W., Nau, H., & Steldinger, R. (1985). Extent of nicotine and cotinine transfer to the human fetus, placenta, and amniotic fluid of smoking mothers. Developmental Pharmacology and Therapeutics, 8, 384–395.

    PubMed  Google Scholar 

  26. Kapur, B., Hackman, R., Selby, P., Klein, J., & Koren, G. (2001). Randomized, double blind, placebo-controlled trial of nicotine replacement therapy in pregnancy. Current Therapeutic Research, 62, 274–278. doi:10.1016/S0011-393X(01)80011-4.

    Article  CAS  Google Scholar 

  27. Lindblad, A., & Marsal, K. (1987). Influence of nicotine chewing gum on fetal blood flow. Journal of Perinatal Medicine, 15, 304–310.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Denise D’Angelo, the CDC PRAMS research proposal coordinator, the PRAMS Working Group: Alabama – Albert Woolbright, PhD; Alaska – Kathy Perham-Hester, MS, MPH; Arkansas – Mary McGehee, PhD; Colorado – Alyson Shupe, PhD; Delaware – Charlon Kroelinger, PhD; Florida – Jamie Fairclough, MPH; Georgia – Carol Hoban, MS, MPH; Hawaii – Sharon Sirling; Illinois – Theresa Sandidge, MA; Louisiana – Joan Wightkin; Maine – Kim Haggan; Maryland – Diana Cheng, MD; Massachusetts – Hafsatou Diop, MD, MPH; Michigan – Violanda Grigorescu, MD, MSPH; Minnesota – Jan Jernell; Mississippi – Vernesia Wilson, MPH; Missouri – Venkata Garikapaty, MSc, MS, PhD, MPH; Montana – JoAnn Dotson; Nebraska – Jennifer Severe-Oforah; New Jersey – Lakota Kruse, MD; New Mexico – Eirian Coronado; New York State – Anne Radigan-Garcia; New York City – Candace Mulready-Ward, MPH; North Carolina – Paul Buescher, PhD; North Dakota – Sandra Anseth; Ohio – Lily Tatham; Oklahoma – Dick Lorenz; Oregon – Kenneth Rosenberg, MD; Pennsylvania – Kenneth Huling; Rhode Island – Sam Viner-Brown, PhD; South Carolina – Jim Ferguson, DrPH; South Dakota – Christine Rinki, MPH; Texas – Eric Miller, PhD; Tennessee – David Law, PhD; Utah – Laurie Baksh; Vermont – Peggy Brozicevic; Virginia – Michelle White; Washington – Linda Lohdefinck; West Virginia – Melissa Baker, MA; Wisconsin – Katherine Kvale, PhD; Wyoming – Angi Crotsenberg; as well as the CDC PRAMS Team, Applied Sciences Branch, Division of Reproductive Health.

Author information

Authors and Affiliations

  1. Department of Public Health Sciences, The University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223-0001, USA

    Kimberly H. Gaither, Larissa R. Brunner Huber & Michael E. Thompson

  2. Department of Biology, The University of North Carolina at Charlotte, Charlotte, NC, USA

    Yvette M. Huet-Hudson

Authors
  1. Kimberly H. Gaither
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Larissa R. Brunner Huber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael E. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yvette M. Huet-Hudson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly H. Gaither.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gaither, K.H., Huber, L.R.B., Thompson, M.E. et al. Does the Use of Nicotine Replacement Therapy During Pregnancy Affect Pregnancy Outcomes?. Matern Child Health J 13, 497–504 (2009). https://doi.org/10.1007/s10995-008-0361-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-008-0361-1

Keywords

Search

Navigation