Smoking cessation drugs in pregnancy: are they safe?

Smoking is bad, smoking while pregnant is very bad , because we subject the baby we carry in the belly to the toxic substances we inhale.

You should never smoke at any time in your life, but if a woman (or couple) smokes, she should stop a few months before trying to get pregnant.

Unfortunately, many women become pregnant when they are still smoking. Some stop immediately as soon as they have a positive test, others fail with the risk of repercussions on the pregnancy and on the health of the child.

Smoking cessation drugs

There are ways to quit smoking, there are help groups, there is hypnosis to quit smoking . Last resort, drugs.

Until now, there were very few studies examining the safety of using smoking cessation drugs during pregnancy to draw any conclusions. Now however, the new research conducted by the University of New South Wales (UNSW) in Sydney, seeks to shed light on this delicate issue.

According to research, women who take specific smoking cessation drugs during pregnancy do not put their babies at a higher risk of adverse outcomes such as premature birth (compared to women who continue to smoke). Notably, one of the drugs studied was also shown to reduce the risk of adverse pregnancy outcomes.

A study of over 100,000 women

It is always assumed that smoking cessation during pregnancy reduces the risk of adverse perinatal outcomes, such as premature births or small-for-gestational-age babies.

However, women who have high levels of nicotine addiction are not necessarily able to quit, even if they are aware of the potential negative consequences on the health of the child they are carrying.

Can drugs be used during pregnancy to help these women quit smoking? This is the question scholars have asked themselves.

The University of Sydney study analyzed data from nearly 100,000 women who smoked during pregnancy , comparing the birth outcomes of women who used smoking cessation drugs (particularly varenicline, bupropion, or nicotine (NRT)) with those who did not use them.

Of these female smokers:

  • 233 were exposed to bupropion,
  • 1057 were exposed to varenicline
  • 330 were respectively exposed to nicotine replacement therapy (NRT)

Using the available data, they looked at  the rate of pregnancy complications and adverse health outcomes for children of women who were given one of the medicines during pregnancy.

These data were then compared with the health outcomes of babies born to women who were smokers but had not received quit medications.

It was seen that none of the three smoking cessation drugs, which were taken by pregnant women, increased the risk of adverse outcomes for mothers and children.

Notably, one of them, varenicline, reduced the rate of some of these adverse outcomes. So babies born to smoking mothers who used varenicline during pregnancy were less likely to be premature or be small for gestational age than babies born to smoking mothers.

But be careful because not all that glitters is gold! For varenicline specifically, the study also looked at the risk of major birth defects, also known as birth defects .

Nearly 3% of babies exposed to varenicline in the first trimester had a congenital anomaly, compared with 3.5% of babies not exposed to any smoking cessation therapy.

Another study published on the same day showed that children born to women who smoked during pregnancy or used nicotine replacement therapy (NRT) had an increased risk of developing psoriasis. The Danish study was published in the Journal of the American Academy of Dermatology .

These are all extremely important data that must be taken into consideration when deciding whether to use a smoking cessation medicine.

More research is needed

Giving up smoking is one of the most important things a mother can do to improve her baby’s health , and this research provides more evidence to aid decision-making for pregnant women who have difficulty giving up cigarettes.

As for each medicine, also in this case an evaluation of the risk-benefit ratio is made and up to now, for varenecline now we have much more information to be able to choose.

Prior to this study, it was not known whether varenicline had any benefits during pregnancy.

The researchers agree that this new evidence, particularly involving varenicline, provides the impetus for continued research to study the risk of other effects that could not be measured in this study.

This is information about the risk of additional outcomes such as miscarriage, specific birth defects, and the long-term development of children. These data would allow women and their doctors to weigh the benefits against the full range of potential risks.

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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