Pharmacological and Electronic Cigarette Interventions for Smoking Cessation in Pregnancy: A Systematic Review and Network Meta-Analysis
Author(s)
Phiyanuch Thimkorn, PharmD, M.Pharm1, Kansak Boonpattharatthiti, PharmD1, Ployvarin Wiangkaew, PharmD2, Chimbun Booncharoen, PharmD2, Panitnan Chaipitak, PharmD2, Chuanchom Thananithisak, PharmD, PhD2, Teerapon Dhippayom, PharmD, PhD1.
1The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand, 2Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
1The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand, 2Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
OBJECTIVES: Tobacco smoking during pregnancy has detrimental effects on both mothers and fetuses. In addition to behavioral therapy, nicotine replacement therapy (NRT) is recommended in pregnant women, whereas the use of other medications and electronic cigarette (E-cigarette) remains controversial. We aimed to assess the clinical effects of pharmacological treatment and E-cigarette in supporting smoking cessation during pregnancy.
METHODS: We searched PubMed, EMBASE, CENTRAL, and EBSCO Open Dissertations from inception to December 2024. Randomized controlled trials (RCTs) evaluating the effects of any pharmacotherapy or E-cigarette use on smoking cessation during pregnancy were included. Title/abstract screening was performed in duplicate, with ChatGPT as one reviewer and two human researchers serving as the second reviewers. The quality of included RCTs was evaluated using the Cochrane risk of bias tool for randomized trials (RoB2). The pooled effects were measured using a random-effects model.
RESULTS: Eleven RCTs (n=4,065) were included, six had a high risk of bias. Compared to usual care, the chance of smoking abstinence was higher with combined nicotine patch and gum (RR 3.22; 95% CI: 1.40-7.39) and e-cigarettes (RR 1.81; 95% CI: 1.11-2.93). The birthweight from mothers who received nicotine gum is higher than usual care (MD 337.00 g.; 95%CI: 103.18-570.82), nicotine patch (MD 281.30 g.; 95%CI: 22.26-540.33) and combined nicotine patch and gum (MD 369.00 g.; 95%CI: 67.49-670.51). Additionally, nicotine gum was associated with a reduced risk of preterm birth compared to usual care (RR 0.39; 95% CI: 0.17-0.91).
CONCLUSIONS: The combination of a nicotine patch and gum is effective in helping pregnant women quit smoking, as well as E-cigarette. Nicotine gum may offer additional benefits by improving birthweight and reducing the risk of preterm birth. However, more high-quality RCTs with a longer treatment duration and biochemical confirmation of smoking cessation are still required to confirm sustained smoking cessation.
METHODS: We searched PubMed, EMBASE, CENTRAL, and EBSCO Open Dissertations from inception to December 2024. Randomized controlled trials (RCTs) evaluating the effects of any pharmacotherapy or E-cigarette use on smoking cessation during pregnancy were included. Title/abstract screening was performed in duplicate, with ChatGPT as one reviewer and two human researchers serving as the second reviewers. The quality of included RCTs was evaluated using the Cochrane risk of bias tool for randomized trials (RoB2). The pooled effects were measured using a random-effects model.
RESULTS: Eleven RCTs (n=4,065) were included, six had a high risk of bias. Compared to usual care, the chance of smoking abstinence was higher with combined nicotine patch and gum (RR 3.22; 95% CI: 1.40-7.39) and e-cigarettes (RR 1.81; 95% CI: 1.11-2.93). The birthweight from mothers who received nicotine gum is higher than usual care (MD 337.00 g.; 95%CI: 103.18-570.82), nicotine patch (MD 281.30 g.; 95%CI: 22.26-540.33) and combined nicotine patch and gum (MD 369.00 g.; 95%CI: 67.49-670.51). Additionally, nicotine gum was associated with a reduced risk of preterm birth compared to usual care (RR 0.39; 95% CI: 0.17-0.91).
CONCLUSIONS: The combination of a nicotine patch and gum is effective in helping pregnant women quit smoking, as well as E-cigarette. Nicotine gum may offer additional benefits by improving birthweight and reducing the risk of preterm birth. However, more high-quality RCTs with a longer treatment duration and biochemical confirmation of smoking cessation are still required to confirm sustained smoking cessation.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD114
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)