Abstract
Further work investigating both the safety and the effectiveness of NRT use in pregnancy for smoking cessation is required. It is regrettable that the two recent trials were both stopped early and not allowed to recruit their target sample sizes, because more information would certainly help clinicians and researchers. Two placebo-controlled trials of NRT in pregnancy are currently underway.13;14 The Nottingham-based SNAP trial has recruited over 810 women and findings on efficacy and safety of NRT should be available in the summer of 2010, whilst the Parisian SNIPP trial should recruit approximately 700 women to a trial which has safety, rather than effectiveness as the primary outcome measure with findings expected in 2011. Consideration of Pauly's work suggests that to adequately assess the safety of NRT, infant and perhaps child outcomes need monitoring after delivery, rather than focussing on immediate birth outcomes.
The recommendations which one can derive from literature remain essentially unchanged; where possible women should be encouraged to stop smoking before conception. However, if women fail to achieve cessation whilst pregnant using behavioural support only, then women may make an informed choice for to try stopping NRT under the guidance of a health professional. It should be noted that the two placebo-controlled trials (i.e. studies with the most robust designs) have both reported more favourable safety outcomes amongst women using NRT compared to those using placebo. Using current evidence, therefore, it is probably safer to use NRT than to continue to smoke during pregnancy and health professionals could recommend its use on these grounds.