Women's use of nicotine replacement therapy in pregnancy—a structured review of the literature

Understanding Pregnant Smokers' Adherence to Nicotine Replacement Therapy During a Quit Attempt: A Qualitative Study

BACKGROUND

Pregnant smokers may be offered nicotine replacement therapy (NRT) alongside behavioral support to assist with a quit attempt. Yet trials of NRT have found adherence to be low among pregnant women, and this has made it difficult to determine the efficacy of NRT. The aim of this study is to understand the experience of pregnant women who use NRT but discontinue this early or do not use the medication as recommended.

METHODS

Semi-structured telephone interviews were conducted with 14 pregnant smokers who had recently been prescribed NRT, but self-reported poor NRT adherence or discontinuing treatment prematurely. Data were transcribed and analyzed using inductive thematic analysis

RESULTS

There were four main themes identified; expectations of NRT, experience of using NRT, safety concerns and experience of using e-cigarettes. Some women intentionally used NRT to substitute a proportion of their cigarette intake and smoked alongside. Most women smoked while using NRT. Women who underutilized NRT did so as they experienced side effects, or were concerned that using NRT instead of smoking could actually increase their nicotine exposure and potential for increased nicotine dependence or fetal harm. Most women spoke about the use of e-cigarettes as a smoking cessation method but only a few had actually experienced using them during pregnancy.

CONCLUSION

Many women underused NRT but simultaneously smoked. Challenging negative perceptions about NRT and educating women further about the risks of smoking may encourage them to use NRT products as recommended.

IMPLICATIONS

These findings add to the research surrounding the efficacy of NRT during pregnancy by providing insight into how pregnant women use NRT during a quit attempt and how this may influence adherence. It may assist health professionals to support pregnant smokers by increasing their understanding about the differing ways in which women use NRT and help them address concerns women may have about the safety of NRT.

Provision of smoking cessation support for pregnant women in England: results from an online survey of NHS Stop Smoking Services for Pregnant Women

BACKGROUND

Smoking during pregnancy is a major public health concern and an NHS priority. In 2010, 26% of UK women smoked immediately before or during their pregnancy and 12% smoked continuously. Smoking cessation support is provided through free at the point of use Stop Smoking Services for Pregnant women (SSSP). However, to date, little is known of how these services provide support across England. The aim of this study was to describe the key elements of support provided through English SSSP.

METHODS

SSSP managers were invited to participate in this survey by email. Data were then collected via an online questionnaire; one survey was completed for each SSSP. Up to four reminder emails were sent over a two month period.

RESULTS

86% (121 of 141) of services completed the survey. Responding services were, on average, larger than non-responding services in terms of the number of pregnant women setting quit dates and successfully quitting (p < 0.01). In line with the 2010 NICE guidelines, Stop Smoking in Pregnancy and following Childbirth, one in five SSSP identified pregnant smokers using carbon monoxide (CO) testing and refer via an opt-out pathway. All services offered nicotine replacement therapy (NRT) to pregnant women and 87% of services also offered dual therapy NRT, i.e. combination of a patch and short acting NRT product.. The 2010 NICE guidelines note that services should be flexible and client-centred. Consistent with this, SSSP offer pregnant women a range of support types (median 4) including couple/family, group (open or closed) or one-to-one. These are available in a number of locations (median 5), including in community venues, clinics and women's homes.

CONCLUSIONS

English Stop Smoking Services offer behavioural support and pharmacotherapy to pregnant women motivated to quit smoking. Interventions provided are generally evidence-based and delivered in a variety of both social and health care settings.

Challenges and enablers to smoking cessation for young pregnant Australian women: a qualitative study

BACKGROUND

Western Australian (WA) perinatal statistics indicate an 8 percent decrease in smoking by pregnant women from 1999 to 2009. Despite the success of cessation interventions, the incidence of tobacco smokers among young pregnant women remains a cause for concern. To inform development of an appropriate suite of interventions, a qualitative study was undertaken to gain insight into the perceived challenges and enablers young pregnant women encounter when attempting to modify their smoking.

METHOD

A hypothetical scenario and interview questions were used: if a young pregnant woman decided to decrease or stop her smoking 1) what could assist her, and 2) what are the challenges that she would need to overcome? Thematic analysis was conducted. Our sample included English-speaking pregnant women recorded as a smoker, 16 to 24 years of age, and attending antenatal services at a public maternity hospital.

RESULTS

Thirty-six women participated in an interview. "Habit" was noted as the key theme under perceived challenges and incorporated three subthemes: learn to deal with stress; the urge for a smoke; and not being left out. Concern over the health of their baby emerged as the main theme and enabler to change behavior. Four subthemes were extracted around keeping their baby healthy: getting the facts; you need someone; something you can take to help; and keeping your mind off it.

CONCLUSIONS

Our findings highlight the complex issues around smoking for young pregnant WA women. Insight into these challenges and enablers may inform development of more suitable interventions to address the unique needs of this group of pregnant women.

Pregnant Māori Smokers’ Perception of Cessation Support and How It Can Be More Helpful

This study aimed to investigate the perception of smoking cessation services and products by pregnant Māori (New Zealand's Indigenous people) smokers and identify how these can be improved. Semi-structured face-to-face interviews were conducted with 60 pregnant Māori smokers. Most of the women (82%) had been advised to stop smoking, but few (21%) felt influenced by the advice. In addition, the women in this study felt that health provider support needed to be more encouraging, understanding and more readily available. Many (78%) had come across smokefree pamphlets, but few had read them. Only four women had been given a booklet specifically aimed at pregnant Māori women. Several women thought that the promotion of smokefree pregnancies needed to be aimed at the whole whānau (extended family). The main conclusions were that motivation to quit could be enhanced by delivery of a clear, consistent and repeated message from multiple sources, backed up with effective, supportive and encouraging services and education resources about risks and smoking cessation options. Primary health care interventions delivering a range of services need to be flexible – for example, by visiting pregnant women in their home – and need to target the whole expectant whānau, instead of focusing on pregnant women in isolation.

Exploring the views of women on using nicotine replacement therapy in pregnancy

OBJECTIVE

to explore women's views surrounding the use of nicotine replacement therapy (NRT) to aid smoking cessation.

DESIGN AND SETTING

a qualitative approach using semi-structured interviews undertaken on 10 pregnant women in a semi-rural area of England.

FINDINGS

the two main themes that emerged from the study were that NRT was an important component in stopping smoking, but this was in conjunction with support given by the midwife advisor. Both themes appeared to be equally important to the women in aiding their attempts at smoking cessation. Also, the importance of tailored interventions should not be dismissed when aiding women in smoking cessation.

CONCLUSIONS

exploring the views of women enabled the researchers to gain a greater understanding of the problems and achievements that women encountered when using NRT as an aid to stop smoking during pregnancy. The study also demonstrated that smoking cessation strategies can be successful if they are tailored to the individual needs of each woman, taking into account her dependency, domestic circumstances and willingness to change.

IMPLICATIONS FOR PRACTICE

the findings of this study add to the available research surrounding the efficacy of NRT in pregnancy. There is little evidence that the views of pregnant women have been taken into account prior to this study; as such, this report offers a different dimension to the available evidence. Although these findings could be adopted and utilized by practitioners, there is still the need for further research in this area on a larger scale.