Results from a randomised controlled trial of pregnant smokers who received either nicotine patches or refillable e-cigarettes suggest that e-cigarettes might be more effective for quitting than patches, and that e-cigarettes are as safe as patches in pregnancy.
Some pregnant women, particularly those from disadvantaged socio-economic backgrounds, find it difficult to quit smoking. Nicotine replacement therapy patches are commonly offered to help them quit, but the approach has limited efficacy in this population. E-cigarettes are also used by pregnant women who smoke, but their safety and efficacy in pregnancy have not been clear.
In this trial, 1140 pregnant smokers were recruited from 23 hospital sites in England and one NHS Stop Smoking Service in Scotland. Results showed that the safety profile of both patches and e-cigarettes were similar, but low birthweight was less frequent in the e-cigarette arm. In the unadjusted primary analysis there was insufficient evidence to confidently demonstrate that e-cigarettes are more effective than patches in helping pregnant women to stop smoking, but the effects of e-cigarettes appear to have been masked by e-cigarette use in the nicotine patch arm. When abstinent participants using non-allocated products were excluded, e-cigarettes were markedly more effective than patches in all abstinence outcomes.
Peter Hajek, co-author and Director of the WIPH Health and Lifestyle Research Unit said: “While it is best for pregnant smokers to stop smoking without continuing to use nicotine, if this is difficult, e-cigarettes can help smokers quit, and are as safe as nicotine patches. Many stop smoking services are already using e-cigarettes as an option for smokers generally. Such use can now be adopted in stop-smoking services for pregnant women as well.”
Funding for this study was provided by NIHR and PHE.
Hajek P, Przulj D , Pesola F, Griffiths C, Walton R, McRobbie H, Coleman T , Lewis S , Whitemore R, Clark M , Ussher M, Sinclair L, Seager E, Cooper S, Bauld L, Naughton F, Sasieni P, Manyonda I, Myers Smith K. Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial. Nature Medicine 2022.