Safety of Nicotine Replacement Therapy during Pregnancy: A Narrative Review.
cessation
nicotine or derivatives
prenatal exposure
smoking/harm reduction
therapeutic use
Journal
International journal of environmental research and public health
ISSN: 1660-4601
Titre abrégé: Int J Environ Res Public Health
Pays: Switzerland
ID NLM: 101238455
Informations de publication
Date de publication:
23 12 2022
23 12 2022
Historique:
received:
25
11
2022
revised:
17
12
2022
accepted:
20
12
2022
entrez:
8
1
2023
pubmed:
9
1
2023
medline:
11
1
2023
Statut:
epublish
Résumé
Smoking during pregnancy is a public health problem worldwide and the leading preventable cause of fetal morbidity and mortality and obstetric disease. Although the risk of tobacco-related harm can be substantially reduced if mothers stop smoking in the first trimester, the proportion of women who do so remains modest; therefore, the treatment of smoking in pregnant women will be the first therapeutic measure that health professionals should adopt when providing care to pregnant women. The recommendation of nicotine replacement therapy during pregnancy remains controversial due to the potential effects on the health of the fetus. The aim of this review was to provide an overview of human studies about the use of nicotine replacement therapy during pregnancy, evaluating the efficacy and safety of the different formulations. The electronic databases PubMed and EMBASE were searched from May 2012 to May 2022. A total of 95 articles were identified through database searching using a combination of keywords. Out of 79 screened articles and after the removal of duplicates, 28 full-text articles were assessed for eligibility and 12 articles were finally included for review. Although demonstrated to be effective in adult smokers, evidence in support of NRT in pregnant women is limited. The results of the apparent safety of the use of NRT during pregnancy contradict the FDA classification of the different NRT formulations. Faster-acting formulations seem to be the safest and even most beneficial forms for the offspring. NRT is not completely harmless for the fetus or for the mother; however, if an adequate assessment of the risk-benefit binomial is made, its use during pregnancy to aid in quitting smoking does seem appropriate. It is necessary to establish individual recommendations on the formulation and dose to be used during pregnancy based on individual nicotinic needs.
Sections du résumé
BACKGROUND
Smoking during pregnancy is a public health problem worldwide and the leading preventable cause of fetal morbidity and mortality and obstetric disease. Although the risk of tobacco-related harm can be substantially reduced if mothers stop smoking in the first trimester, the proportion of women who do so remains modest; therefore, the treatment of smoking in pregnant women will be the first therapeutic measure that health professionals should adopt when providing care to pregnant women. The recommendation of nicotine replacement therapy during pregnancy remains controversial due to the potential effects on the health of the fetus.
PURPOSE
The aim of this review was to provide an overview of human studies about the use of nicotine replacement therapy during pregnancy, evaluating the efficacy and safety of the different formulations.
METHODS
The electronic databases PubMed and EMBASE were searched from May 2012 to May 2022. A total of 95 articles were identified through database searching using a combination of keywords. Out of 79 screened articles and after the removal of duplicates, 28 full-text articles were assessed for eligibility and 12 articles were finally included for review.
RESULTS
Although demonstrated to be effective in adult smokers, evidence in support of NRT in pregnant women is limited. The results of the apparent safety of the use of NRT during pregnancy contradict the FDA classification of the different NRT formulations. Faster-acting formulations seem to be the safest and even most beneficial forms for the offspring.
CONCLUSIONS
NRT is not completely harmless for the fetus or for the mother; however, if an adequate assessment of the risk-benefit binomial is made, its use during pregnancy to aid in quitting smoking does seem appropriate. It is necessary to establish individual recommendations on the formulation and dose to be used during pregnancy based on individual nicotinic needs.
Identifiants
pubmed: 36612572
pii: ijerph20010250
doi: 10.3390/ijerph20010250
pmc: PMC9819948
pii:
doi:
Substances chimiques
Nicotine
6M3C89ZY6R
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Références
BMJ. 2014 Mar 11;348:g1622
pubmed: 24627552
Addiction. 2021 Feb;116(2):239-277
pubmed: 32621526
Hellenic J Cardiol. 2019 Jan - Feb;60(1):11-15
pubmed: 30296484
J Pharmacol Exp Ther. 2002 May;301(2):594-8
pubmed: 11961061
BMJ Open. 2019 Jul 11;9(7):e024923
pubmed: 31300493
Obstet Gynecol. 2008 Oct;112(4):859-67
pubmed: 18827129
Nicotine Tob Res. 2019 Nov 19;21(12):1706-1710
pubmed: 30165458
Lancet Respir Med. 2014 Sep;2(9):728-37
pubmed: 25127405
MCN Am J Matern Child Nurs. 2021 Sep-Oct 01;46(5):293-298
pubmed: 34162791
Early Hum Dev. 2022 Jan;164:105509
pubmed: 34823165
Gynecol Obstet Fertil Senol. 2020 Jul - Aug;48(7-8):539-545
pubmed: 32289497
Birth Defects Res C Embryo Today. 2016 Jun;108(2):181-92
pubmed: 27297020
BMJ. 2021 Mar 29;372:n160
pubmed: 33781993
Neurotoxicol Teratol. 1993 Jul-Aug;15(4):251-60
pubmed: 8413079
Gynecol Obstet Fertil Senol. 2020 Jul - Aug;48(7-8):559-566
pubmed: 32360705
Toxicol Sci. 2020 Nov 1;178(1):3-15
pubmed: 32766841
F1000Res. 2019 Sep 4;8:1586
pubmed: 32595938
Prev Med. 2015 Sep;78:92-100
pubmed: 26190366
Drug Alcohol Depend. 2013 Oct 1;132(3):660-4
pubmed: 23680076
Addiction. 2015 Nov;110(11):1827-32
pubmed: 26119134
N Engl J Med. 2012 Mar 1;366(9):808-18
pubmed: 22375972
Expert Opin Drug Saf. 2014 Dec;13(12):1721-31
pubmed: 25330815
Int J Environ Res Public Health. 2021 Apr 11;18(8):
pubmed: 33920348
Eur J Obstet Gynecol Reprod Biol. 2005 Jun 1;120(2):146-51
pubmed: 15925042
Cochrane Database Syst Rev. 2015 Dec 22;(12):CD010078
pubmed: 26690977
Addiction. 2022 Mar;117(3):751-759
pubmed: 34427009
Tob Induc Dis. 2019 Aug 02;17:57
pubmed: 31582946
Syst Rev. 2021 Mar 29;10(1):89
pubmed: 33781348
Cochrane Database Syst Rev. 2018 May 31;5:CD000146
pubmed: 29852054
Lancet Glob Health. 2018 Jul;6(7):e769-e776
pubmed: 29859815
Pediatrics. 2015 May;135(5):859-67
pubmed: 25847803
BMJ. 2004 Apr 24;328(7446):965-6
pubmed: 15105300
BMJ Open. 2013 Sep 20;3(9):e003692
pubmed: 24056492
Am J Obstet Gynecol MFM. 2019 Mar;1(1):10-18
pubmed: 31380506
Addiction. 2022 Jun;117(6):1573-1588
pubmed: 34859525
Cochrane Database Syst Rev. 2020 Mar 4;3:CD010078
pubmed: 32129504
Psychopharmacology (Berl). 1983;80(1):93-5
pubmed: 6408679
Pediatrics. 2014 Aug;134(2):e382-8
pubmed: 25049343