Nicotine replacement and behavioral therapy for smoking cessation in pregnancy.

Journal Article (Journal Article)

BACKGROUND: This study examines whether adding nicotine replacement therapy (NRT) to cognitive-behavioral therapy (CBT) for pregnant smokers increases rates of smoking cessation. METHODS: An open-label randomized trial (Baby Steps, n=181) of CBT-only versus CBT+NRT (choice of patch, gum, or lozenge; 1:2 randomization) was used. Data were collected from 2003 through 2005; analyses were conducted in 2006 and 2007. Outcomes were biochemically validated self-reported smoking status at 7 weeks post-randomization, 38 weeks gestation, and 3 months postpartum. RESULTS: Women in the CBT+NRT arm were almost three times more likely than women in the CBT-only arm to have biochemically validated cessation at both pregnancy time points (after 7 weeks: 24% vs 8%, p=0.02; at 38 weeks gestation: 18% vs 7%, p=0.04), but not at 3 months postpartum (20% vs 14%, p=0.55). Recruitment was suspended early by an Independent Data and Safety Monitoring Board when an interim analysis found a higher rate of negative birth outcomes in the CBT+NRT arm than in the CBT-only arm. In the final analysis, the difference between the arms in rate of negative birth outcomes was 0.09 (p=0.26), when adjusted for previous history of preterm birth. CONCLUSIONS: The addition of NRT to CBT promoted smoking cessation in pregnant women. This effect did not persist postpartum. More data are needed to determine safety parameters and to confirm the efficacy of NRT use during pregnancy.

Full Text

Duke Authors

Cited Authors

  • Pollak, KI; Oncken, CA; Lipkus, IM; Lyna, P; Swamy, GK; Pletsch, PK; Peterson, BL; Heine, RP; Brouwer, RJN; Fish, L; Myers, ER

Published Date

  • October 2007

Published In

Volume / Issue

  • 33 / 4

Start / End Page

  • 297 - 305

PubMed ID

  • 17888856

Pubmed Central ID

  • PMC3602964

International Standard Serial Number (ISSN)

  • 0749-3797

Digital Object Identifier (DOI)

  • 10.1016/j.amepre.2007.05.006


  • eng

Conference Location

  • Netherlands