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Clinical Summary

Does nicotine replacement therapy during pregnancy up the risk for stillbirth?

Takeaway

  • No significant association was seen between nicotine replacement therapy (NRT) during pregnancy and likelihood of stillbirth compared with non-smoking.
  • The risk for stillbirth was found to be similar among women using NRT and those who smoked.

Why this matters

  • Very little is known about the safety of NRT during pregnancy and the risk for stillbirth.
  • Tobacco smoke which comprises nicotine, carbon monoxide, and nitrogen oxides is known to decrease the foetal blood flow, resulting in foetal growth restriction and placental complications.

Study design

  • Cross-sectional study of 220,630 singleton pregnancies (smokers, n=18,407; NRT group, n=5221; control group, n=197,002).
  • Funding: National Institute for Health Research and others.

Key results

  • Overall, 805 pregnancies resulted in stillbirth, and diabetes was common in pregnancies ending in stillbirth.
  • Average duration of prescription of NRT was 2 weeks, and 80% of the prescriptions were recorded during the first 2 trimesters.
  • In both NRT and smoker groups, the absolute risk for stillbirth was 5/1000 births vs 3.5/1000 births in the control group.
  • After adjustments, the odds of stillbirth in the NRT group was not statistically significant vs control group (OR, 1.35; 95% CI, 0.91-2.00), but the risk was similar to that in the smoker group (OR, 1.41; 95% CI, 1.13-1.77).

Limitations

  • Smoking status was self-reported.

References


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