Nicotine replacement therapy for smoking cessation during pregnancy

Yael Bar-Zeev, Ling Li Lim, Billie Bonevski, Maree Gruppetta and Gillian S Gould
Med J Aust 2018; 208 (1): . || doi: 10.5694/mja17.00446
Published online: 4 December 2017


  • Nicotine replacement therapy (NRT) is recommended in current Australian clinical guidelines for pregnant women who are unable to quit smoking unassisted.
  • Clinicians report low levels of prescribing NRT during pregnancy, due to safety concerns and low levels of confidence in their ability to prescribe NRT.
  • Animal models show that nicotine is harmful to the fetus, especially for brain and lung development, but human studies have not found any harmful effects on fetal and pregnancy outcomes.
  • Studies of efficacy and effectiveness in the real world suggest that NRT use during pregnancy increases smoking cessation rates. These rates may be hampered by the fact that studies so far have used an NRT dose that does not adequately account for the higher nicotine metabolism during pregnancy and, therefore, does not adequately treat withdrawal symptoms.
  • Further research is needed to assess the safety and efficacy of higher dosages of NRT in pregnancy, specifically of combination treatment using dual forms of NRT.
  • As NRT is safer than smoking, clinicians need to offer this option to all pregnant women who smoke. A practical guide for initiating and tailoring the dose of NRT in pregnancy is suggested.

  • 1 Centre for Brain and Mental Health, University of Newcastle, Newcastle, NSW
  • 2 University of Newcastle, Newcastle, NSW
  • 3 James Cook University, Cairns, QLD



Yael Bar-Zeev thanks the Hunter Cancer Research Alliance Implementation Flagship program for funding her PhD scholarship.

Competing interests:

Yael Bar-Zeev has received fees for lectures in the past (2012–2015) from Novartis NCH, which distributes NRT in Israel.

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