Nicotine Replacement Therapy: Pregnancy (Manchester Guidance)

In December 2005, the Committee on Safety of Medicines (CSM) and Medicines and Healthcare Regulatory Authority (MHRA) removed some of the contraindications, cautions and restrictions on NRT use. Consequently, all NRT products can now be used by pregnant and breastfeeding women.

In summary

Ideally, pregnant women should stop smoking without using NRT but, if this is not possible, NRT may be recommended to assist a quit attempt as it is considered that the risk to the fetus of continued smoking by the mother outweighs any potential adverse effects of NRT.

The decision to use NRT should be made following a risk-benefit assessment as early in pregnancy as possible. The aim should be to discontinue NRT use after 2 – 3 months. Intermittent forms of NRT are preferable during pregnancy although a patch may be appropriate if nausea and/or vomiting are a problem. If patches are used they should be taken off before going to bed at night.

Manchester Stop Smoking Service welcomes this change, and recommends that:

1. All pregnant women should be encouraged to stop smoking.
2. Women should be assisted to make a plan to stop and to set a quit date
3. The quit date should be recorded on a Manchester Stop Smoking Service monitoring form.
4. Weekly follow up should be offered and an appointment should be made with the intermediate or with a Stop Smoking Service Specialist Advisor.
5. If a woman wants to use NRT it should be explained that ideally, pregnant women should stop smoking without using NRT but, if this is not possible, NRT may be recommended to assist a quit attempt as it is considered that the risk to the fetus of continued smoking by the mother outweighs any potential adverse effects of NRT i.e. It is probably safer to use NRT and quit than to continue smoking.
6. It should be explained that it is important not to exceed the recommended dose of nicotine.
7. The pregnant woman should sign the ‘Informed consent form for using nicotine replacement therapy in pregnancy’ (PREG/NRT1)*. This should be kept by the intermediate.
8. A ’Request for nicotine replacement therapy: pregnancy’ letter (PREG/NRT2)* should be filled in and given to the woman to take to a pharmacy on the Manchester NRT pharmacy scheme, where she will be given 2 weeks’ NRT. A maximum of 3 requests may be made at 2 week intervals (so that the woman receives a total of 6 weeks’ NRT).
9. A letter should be sent to the woman’s GP (PREG/NRT3)* to inform of her use of NRT.
10. The monitoring form filled and returned to Manchester Stop Smoking Service 4 weeks after the quit date.
11. Should the woman need further NRT after 6 weeks, she will need to ask her GP for a prescription.

Guidance issued by Manchester Stop Smoking Service January 2006

* All available to Manchester intermediate trained midwives & Sure Start Children’s Centre staff from Manchester Stop Smoking Service 0161 205 5998