The use of nicotine replacement therapy in pregnancy could be considered if first-line measures such as counselling fail, say experts from the National Teratology Information Service, Newcastle. Dr Patricia McElhatton (head of the unit) and colleagues drew this conclusion after recently completing an analysis of the literature examining the effects of smoking and nicotine in pregnancy.
Nicotine replacement therapy is not licensed for use in pregnancy so cannot be "routinely recommended", Dr McElhatton says. Pregnant women who smoke should initially be offered support and advised of the adverse consequences which can occur as a result of smoking in pregnancy. However, providing that foetal nicotine exposure is lower than if the woman had continued to smoke, nicotine replacement could be considered, she says.
On individual therapies, Dr McElhatton comments that gum may be advantageous over patches because continual exposure to nicotine would not occur. This would also be true for inhalator and nasal spray formulations but, if patches were unavoidable, the 16-hour rather than 24-hour type would be preferable. However, because nicotine replacement is unlicensed in pregnancy, there is a lack of safety data from which to draw firm recommendations, she says.
Nicotine replacement therapy is contraindicated in pregnancy with the exception of Nicorette Microtabs which are licensed as a final option, when other measures to quit have failed. Ms Alison Williamson (marketing manager, Nicorette) told The Journal on February 23 that similar licensing of the other products in the Nicorette range would be considered, in discussion with the Medicines Control Agency, when the product licences were due for renewal.