From the Guidelines
Combination of behavioral counseling and pharmacotherapy is the most effective method for smoking cessation during pregnancy.
Key Components of Effective Smoking Cessation
- Behavioral counseling: at least 4 sessions, with a total contact time of at least 91 minutes 1
- Pharmacotherapy: primarily nicotine replacement therapy (NRT)
Evidence Supporting Combination Therapy
A good-quality systematic review found that combination pharmacotherapy and intensive behavioral counseling resulted in higher abstinence rates at 6 months or more compared to control participants (14.5% vs. 8.3%; RR, 1.82 [CI, 1.66 to 2.00]) 1.
Considerations for Pregnant Women
Behavioral interventions, including counseling, feedback, health education, incentives, and social support, have been shown to improve smoking cessation rates and perinatal health outcomes in pregnant women 1.
Limitations of Other Methods
E-cigarettes have not been shown to be effective for smoking cessation in pregnant women, with only limited and inconclusive evidence available 1.
From the Research
Effective Methods for Smoking Cessation during Pregnancy
The most effective methods for smoking cessation during pregnancy include:
- Nurse-managed smoking cessation programs, which have been shown to be beneficial in achieving cotinine-validated abstinence 2
- Nicotine replacement therapy (NRT), which is considered the agent of choice for smoking cessation in pregnancy due to its safety profile compared to other therapies 3
- Counselling, which appears to improve quit rates, especially when used in combination with pharmacological therapy 4
- Behavioural support, which is safe and effective during pregnancy, but may generate a relatively modest reduction in smoking cessation rates 5
Safety and Efficacy of Smoking Cessation Treatments
The safety and efficacy of smoking cessation treatments for pregnant women have been evaluated in several studies, including:
- Low-dose intermittent NRT, which has been found to be a safe treatment modality for women who smoke during pregnancy 6
- NRT in conjunction with behavioural support, which may offer an effective alternative to help pregnant women quit smoking 5
- Pharmacotherapy, which is recommended for women who are heavy smokers and are unable to quit smoking on their own, with NRT being a reasonable first-line drug option 4
Recommendations for Smoking Cessation during Pregnancy
Based on the available evidence, the following recommendations can be made:
- Pregnant women who smoke 5 cigarettes or fewer per day should use behavioural support, and not NRT, to help them quit 5
- Pregnant women with a moderate or high level of addiction may use NRT under the supervision of their physician 5
- A combination of cognitive-behavioural therapy and counselling with NRT is the most effective strategy to achieve smoking cessation during pregnancy 5