by Colette Bouchez
The nicotine patch "OK" for pregnant women -- Especially during third trimester, study shows. Women who just can't quit smoking during pregnancy can now safely turn to nicotine patches for help.
A new study has found this popular anti-smoking strategy is safe for both baby and mom, particularly during the third trimester, which is when most smoking-related complications occur.
"We found that, at the very least, the patches are no more dangerous than cigarettes and certainly appear to be less hazardous, particularly in terms of baby's health," says Dr. Paul Ogburn, lead author and director of maternal-fetal medicine at State University of New York at Stony Brook.
Smoking during pregnancy has been known to dramatically increase the risk of premature delivery and perinatal mortality, says Ogburn. It can also cause low birth weight and, in the mother, a condition known as abruptio placenta -- where the birth sac that nourishes the baby pulls away from the mother's uterus, increasing the risk of miscarriage and premature birth.
While the nicotine patch lets at least one of the potentially harmful chemicals found in cigarettes enter a woman's body, Ogburn believes it's still far less harmful than smoking.
"Nicotine is not the most harmful chemical associated with cigarettes, and if you can avoid all the others you are at least giving your baby some protection," says Ogburn, who presented the study at the recent annual meeting of the Society for Maternal-Fetal Medicine in New Orleans.
At the same conference, investigators from the University of Ottawa in Canada offered new proof that smoking also increases the baby's risk of neural tube defects. This is a serious congenital malformation that often leads to infant death.
Obstetrician Dr. Andrei Rebarber agrees with Ogburn's assessment: "Certainly, if you can avoid the nicotine as well, that would be best; but if you can't stop smoking and you are smoking a lot, then the patch can be a good idea."
The small but significant study involved 21 pregnant women who, despite advice from their doctors, continued to smoke at least 15 cigarettes a day into their third trimester. The women were offered a nicotine patch on the first of a four-day hospital stay, and they continued to use the therapy at home for eight consecutive weeks.
During this same time period, the women underwent weekly ultrasound exams to check on the health of the baby. They were also asked to regularly take an exhalation test, which was used to determine whether they were still smoking.
The final result: Ogburn reports all the babies had normal birth weights. However, all the babies were also born a few weeks premature. Ogburn admits the study did not take into account any damage that may have occurred during the first two trimesters when the women were still smoking. Only eight of the 21 women -- 38 percent -- were smoke-free at the time of delivery.
Still, the study did prove what it set out to accomplish: "That the nicotine patch is safe for pregnant women -- even during the third trimester when the risk of smoking-related complications are highest," says Ogburn.
For Rebarber, the finding is important, but he won't suggest all pregnant smokers look to the patch to help them have a safer pregnancy.
"I think the decision to use the patch must be made on a case-by-case basis," says Rebarber. For the woman who smokes only a few cigarettes a day, he says, continuing to smoke is probably safer than using the patch, which would obviously deliver far more nicotine than she is getting from her cigarettes.
"On the other hand, if she's smoking a lot -- 15 cigarettes a day or more -- as the women in the study were doing, then the patch should be considered," he says.
Still, Rebarber says the first line of defense should always be to stop smoking as naturally as possible before you get pregnant.
Ogburn agrees: "The patch is safe, but it should be reserved for those women who find they cannot quit on their own."
Although other nicotine replacement products, such as nicotine gum, have not been similarly tested, both Rebarber and Ogburn agree the safety profile should be similar to that found with the nicotine patches.