[CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy-Short Text]

Safety of Nicotine Replacement Therapy during Pregnancy: A Narrative Review

BACKGROUND

Smoking during pregnancy is a public health problem worldwide and the leading preventable cause of fetal morbidity and mortality and obstetric disease. Although the risk of tobacco-related harm can be substantially reduced if mothers stop smoking in the first trimester, the proportion of women who do so remains modest; therefore, the treatment of smoking in pregnant women will be the first therapeutic measure that health professionals should adopt when providing care to pregnant women. The recommendation of nicotine replacement therapy during pregnancy remains controversial due to the potential effects on the health of the fetus.

PURPOSE

The aim of this review was to provide an overview of human studies about the use of nicotine replacement therapy during pregnancy, evaluating the efficacy and safety of the different formulations.

METHODS

The electronic databases PubMed and EMBASE were searched from May 2012 to May 2022. A total of 95 articles were identified through database searching using a combination of keywords. Out of 79 screened articles and after the removal of duplicates, 28 full-text articles were assessed for eligibility and 12 articles were finally included for review.

RESULTS

Although demonstrated to be effective in adult smokers, evidence in support of NRT in pregnant women is limited. The results of the apparent safety of the use of NRT during pregnancy contradict the FDA classification of the different NRT formulations. Faster-acting formulations seem to be the safest and even most beneficial forms for the offspring.

CONCLUSIONS

NRT is not completely harmless for the fetus or for the mother; however, if an adequate assessment of the risk-benefit binomial is made, its use during pregnancy to aid in quitting smoking does seem appropriate. It is necessary to establish individual recommendations on the formulation and dose to be used during pregnancy based on individual nicotinic needs.

Domestic Exposure to Chemicals in Household Products, Building Materials, Decoration, and Pesticides: Guidelines for Interventions During the Perinatal Period from the French National College of Midwives

INTRODUCTION

We are exposed to numerous pollutants inside our homes. The perinatal period represents a particular window of vulnerability during which these exposures can have negative health effects over a more or less long term. The objective of this article is to formulate guidelines for health care professionals and intended for parents to reduce exposure to chemical pollutants at home, based on the scientific literature and already existing guidelines.

METHODS

We have followed the methodological procedures set forth by the French authority for health (HAS) to establish guidelines to limit exposure to pollutants in homes. This narrative review of the scientific literature was conducted with two principal objectives: (1) to identify priority substances emitted within homes and that have a reprotoxic potential and (2) to identify measures to limit exposure to these residential pollutants. The guidelines were developed from the data in the literature and from advice already made available by diverse institutions about environmental health during the perinatal period.

RESULTS

Domestic pollutants are numerous and come from both common (that is, shared, eg, painting, cleaning, and maintenance work) and specific (use of household pesticides) sources. Numerous pollutants are suspected or known to produce developmental toxicity, that is, to be toxic to children during developmental stages. Removing some products from the home, protecting the vulnerable (ie, pregnant women and young children) from exposure, and airing the home are among the preventive measures proposed to limit exposure to these chemical substances.

CONCLUSION

Health care professionals can provide advice to parents during the perinatal period to diminish exposure to household pollutants. The lack of interventional studies nonetheless limits the level of evidence for most of these recommendations.

Nicotine Replacement Therapy during Pregnancy and Child Health Outcomes: A Systematic Review

Tobacco smoking in pregnancy is a worldwide public health problem. A majority of pregnant smokers need assistance to stop smoking. Most scientific societies recommend nicotine replacement therapy (NRT) during pregnancy but this recommendation remains controversial because of the known fetal toxicity of nicotine. The objective of this systematic review was to provide an overview of human studies about child health outcomes associated with NRT use during pregnancy. The electronic databases MEDLINE, the Cochrane Database, Web of Science, and ClinicalTrials.gov were searched from the inception of each database until 26 December 2020. A total of 103 articles were identified through database searching using combination of keywords. Out of 75 screened articles and after removal of duplicates, ten full-text articles were assessed for eligibility and five were included in the qualitative synthesis. NRT prescription seems to be associated with higher risk of infantile colic at 6 months as in case of smoking during pregnancy, and with risk of attention-deficit/hyperactivity disorder. No association between NRT during pregnancy and other infant health disorders or major congenital anomalies has been reported. Well-designed controlled clinical trials with sufficient follows-up are needed to provide more information on the use of NRT or other pharmacotherapies for smoking cessation during pregnancy on post-natal child health outcomes.