A Health Technology Assessment led by WIPH authors finds that e-cigarettes are probably more effective than nicotine patches in helping pregnant smokers quit, and that using e-cigarettes may also reduce the incidence of low birthweight in babies born to pregnant smokers. Advice to smokers already includes a recommendation to switch from smoking to e-cigarettes, but this research shows that the recommendation can now also be extended to pregnant smokers.
In a Randomised Controlled Trial in England and Scotland, 1140 daily smokers who were 12-24 weeks’ pregnant and motivated to stop smoking were allocated to either e-cigarettes or nicotine patches. Participants received support calls prior to and on their target quit date, and weekly for the next month.
E-cigarettes were not significantly more effective than nicotine patches in the primary analysis, but regular use of e-cigarettes in the patches arm was more common than use of nicotine replacement products in the e-cigarette arm (17.8% v 2.8%). When e-cigarettes use in the patches arm was accounted for, e-cigarettes were almost twice as effective as patches in all abstinence outcomes. Rates of adverse events and adverse birth outcomes were similar in the two study arms, but participants in the e-cigarette arm had fewer infants with low (<2500g) birthweight (9.6% vs. 14.8%). Researchers believe this was probably because e-cigarettes were more effective in reducing the use of conventional cigarettes.
Author Peter Hajek said: ‘E-cigarettes seem more effective than nicotine patches in helping pregnant women to quit smoking and because of this, they seem to also lead to better pregnancy outcomes. The evidence-based advice to smokers already includes, among other options, a recommendation to switch from smoking to e-cigarettes. Such a recommendation can now be extended to smokers who are pregnant as well.’
The study was funded by the NIHR Health Technology Programme.
Helping pregnant smokers quit: a multi-centre randomised controlled trial of electronic cigarettes versus nicotine replacement therapy. Dunja Przulj, Francesca Pesola, Katie Myers Smith, Hayden McRobbie, Tim Coleman, Sara Lewis, Christopher Griffith, Robert Walton, Rachel Whitemore, Miranda Clark, Michael Ussher, Lesley Sinclair, Emily Seager, Sue Cooper, Linda Bauld, Felix Naughton, Peter Sasieni, Isaac Manyonda, Peter Hajek. Health Technology Assessment, vol 27, no 13. 2023 HTA 15/57/85
DOI 10.3310/AGTH6901