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Smoking cessation - Management
What drug treatment should I prescribe for a woman who is pregnant or breastfeeding to help her stop smoking?

  • Nicotine replacement therapy is recommended for pregnant or breastfeeding women who feel unable or are unlikely to stop smoking without drug treatment.
  • Bupropion and varenicline are not recommended for use in women who are pregnant or breastfeeding.
Basis for recommendation
  • Basis for using nicotine replacement therapy (NRT) in pregnancy:
    • There is a lack of trial data on the benefits and risks of NRT in pregnancy. To eliminate all possible risks from nicotine a women would ideally stop smoking without using NRT.
    • There is expert consensus that replacing smoking with NRT to prevent relapse is justifiable in pregnant women in whom non-pharmacological interventions, such as behavioural counselling, have been unsuccessful because [MHRA, 2005a]:
      • Although there is no direct evidence for it, it is assumed that evidence for the effectiveness for NRT in smoking cessation in the general population is applicable to pregnant women.
      • The risk to the fetus of continued smoking is likely to be greater than any potential risks from NRT because cigarette smoking, in general, delivers more nicotine than does NRT, and it exposes both mother and fetus to many other toxins.
  • Basis for using NRT when breastfeeding:
    • There is a lack of trial data on the benefits and risks of NRT in breastfeeding women. The amount of nicotine the infant is exposed to from breast milk is relatively small and is less hazardous than the second-hand smoke the infant would otherwise be exposed to if the mother continued to smoke [MHRA, 2005a].

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