(156) The Impact of Nicotine Replacement Therapy on Maternal-Neonatal Outcomes and Smoking Cessation in Pregnant Women: A Systematic Review and Meta-Analysis
Background: Maternal smoking during pregnancy can lead to severe neonatal & obstetric outcomes. Nicotine replacement therapy (NRT) is a commonly used intervention for smoking cessation, but its use in pregnancy is still controversial. This systematic review and meta-analysis is aimed to evaluate the efficacy and safety of NRT in pregnant smokers with a specific focus on neonatal outcomes.
Objectives: To assess the impact of NRT on maternal-neonatal outcomes, and smoking cessation in pregnant women.
Methods: A comprehensive search of multiple databases like PubMed, Cochrane CENTRAL, Google Scholar, Scopus, and ClinicalTrials.gov was performed to identify eligible studies from the inception to 31st January 2023. A combination of keywords, MeSH terms, and entry terms on Nicotine Replacement Therapy, Smoking, and Pregnancy was used in combination with Boolean operators. All randomized controlled trials (RCTs) investigating the efficacy and maternal or neonatal outcomes of NRT in pregnant women compared with placebo or active comparator were included in the study. The Fixed or Random-effects model was used based on the heterogeneity identified using the I² statistic and Cochran's Q test.
Results: Out of 131 non-duplicate research articles identified through database searching, a total of 20 high-quality studies with 11,052 patients, were included in this study. NRT was significantly associated with an increased risk of neonatal deaths (OR=2.89; 95% CI [1.18, 7.07]; P=0.02), low birth weight (OR=1.32; 95% CI [1.08, 1.62]; P=0.007), and cesarean delivery (OR=1.35; 95% CI [1.02, 4.21]; P=0.0005). On the other hand, NRT reduced the risk of congenital abnormalities (OR=0.62; 95% CI [0.41, 0.95]; P=0.03), assisted vaginal delivery (OR=0.72; 95% CI [0.55, 0.95]; P=0.02), and premature rupture of membrane (OR=0.29; 95% CI [0.13, 0.68]; P=0.004). Additionally, smoking cessation (OR=2.08, 95% CI [1.02, 4.21]; P=0.04) was found to be significantly higher in the NRT group compared to the control.
Conclusions: The use of NRT in pregnant women is associated with both benefits and risks. NRT was found to increase the risk of neonatal deaths, low birth weight, and cesarean delivery, but it was also associated with a reduced risk of congenital abnormalities, assisted vaginal delivery, and premature rupture of membranes. Moreover, NRT was found to be effective in increasing smoking cessation among pregnant women compared to the control group. These findings highlight the importance of careful consideration of the potential risks and benefits when deciding to use NRT during pregnancy and the need for individualized smoking cessation plans for pregnant women.
