title: Smoking Cessation Strategies in Pregnancy.
abstract: Although pregnancy often motivates women to quit smoking, 20% to 25% will continue to smoke. Smoking is associated with adverse obstetric and neonatal outcomes such as placental abruption, stillbirth, preterm birth and sudden infant death syndrome, and it is therefore important to motivate women to quit during pregnancy. In this review, we explore the efficacy and evidence for safety of strategies for smoking cessation in pregnancy, including behavioural and pharmacologic therapies. The PubMed, Medline, EMBASE, and Cochrane databases (1990 to 2014) were accessed to identify relevant studies, using the search terms "smoking cessation," "pregnancy," "medicine, behavioural," "nicotine replacement products," "bupropion," and "varenicline." Studies were selected based on the levels of evidence presented by the Canadian Task Force on Preventative Health Care. Based on our review of the evidence, incentives combined with behavioural therapy appear to show the greatest promise for abstaining from smoking in the pregnant population. Nicotine replacement therapy administered in the form of gum may be better than using transdermal forms to avoid high levels of nicotine in the fetal circulation. One small trial demonstrated that bupropion is an effective aid for smoking cessation and that it does not appear to be associated with an increased risk of major congenital malformations. The currently available studies of varenicline in pregnancy are insufficient to provide evidence for the safety or efficacy of its use.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, ON.
authors.forename: Lesley W S
authors.initials: LW
authors.lastname: Leung
authors.affiliation: Department of Obstetrics and Gynecology, Queen's University, Kingston, ON.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Davies
mesh_terms: D016642:Bupropion / Q000627:therapeutic use; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D018722:Nicotinic Agonists / Q000627:therapeutic use; D011247:Pregnancy; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D000068580:Varenicline / Q000627:therapeutic use
chemical_list: D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D016642:Bupropion; D000068580:Varenicline
keywords: behavioural; bupropion; medicine; nicotine replacement products; pregnancy; smoking cessation; varenicline