In reply: Although our trial1 did not decrease quit rates with an intensive intervention, health professionals should continue to deliver appropriate intensive smoking interventions to pregnant Indigenous women.2 Guidelines advise the exercise of caution with the use of nicotine replacement therapy (NRT) in pregnancy,3 given the lack of trial data supporting its use.4 A recent trial of NRT in pregnancy found similar rates of adverse pregnancy and birth outcomes among women who used NRT and those who did not.5 Our study recommended NRT after at least two attempts to quit without NRT. NRT gum was prescribed by the treating doctors, with a preference for intermittent doses rather than continuous low doses through the use of NRT patches, in line with current guidelines.3 Women were provided with a week’s supply of NRT but, for reasons that were not clear, none returned for repeat supplies. The frequency with which NRT was prescribed, provided and used by women was not recorded with sufficient accuracy to allow interpretation. No definite conclusions about the efficacy of NRT can be drawn from our study and further research is necessary.
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