Smoking Cessation in Pregnancy: Review of Current Strategies - Abstract
Cigarette smoking in pregnancy is a universal problem that compels us to continuously explore different strategies aimed at increasing high quit rates in this population group. Maternal smoking during pregnancy has been linked to increased risk of obstetric and foetal adverse outcomes. Barriers to quitting are multi-factorial and the approach needs to be versatile and patient specific, taking into consideration the dynamics of ethnicity, psychosocial and socioeconomic status.
The aim of this paper is to highlight the different strategies that have been evaluated looking at ways of enabling pregnant women to quit smoking. Furthermore, smoking cessation in special population groups and global initiatives on smoking regulations are discussed. A database search of Ovid Medline, Pubmed, Embase and The Cochrane Library was undertaken to identify relevant articles. Searches were limited to clinical trials in humans and peer-reviewed articles in English Language, and reference lists were searched for other related articles.
A multimodal approach is necessary to increase chances of smoking cessation
during pregnancy, this encompasses pharmacological and non-pharmacological
measures. The most effective non- pharmacological measures comprise of psychosocial
interventions in the form of cognitive behavioral therapy and motivational strategies.
In the case of pharmacological approaches, Nicotine Replacement Therapy (NRT) has been the most widely researched with studies showing mixed results in relation to the safety profile in pregnancy. As a result, there is currently no definite consensus as to the safety of NRT in pregnancy, part of the reason being issues with small sample sizes in trials and non- adherence to treatment. To date, Bupropion and Varenicline are not safe to use in pregnancy due to the lack of sufficiently powered randomised trials in the pregnant population. Effectiveness of Nicotine Vaccines in humans is still an area of much needed research.