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Interest in nicotine replacement therapy among pregnant smokers
  1. M Ussher,
  2. R West
  1. Department of Psychology, St George’s Hospital Medical School, London, UK
  1. Correspondence to: Dr Michael Ussher, Department of Psychology, Hunter Wing, St George’s Hospital Medical School, University of London, Cranmer Terrace, London SW17 ORE, UK; m.ussher{at}

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In the UK nicotine replacement therapy (NRT) may now be considered for those pregnant women who cannot otherwise stop smoking.1 However, very little research has been carried out with NRT during pregnancy and the level of interest in using NRT is not known.2 This letter reports the results of a survey to assess the level of interest in using NRT among pregnant smokers.

Across a seven month period pregnant smokers were identified using the patient administration system of a large district general hospital in south west London. Ethical approval was obtained and participants gave verbal consent via the telephone. Women identified as smokers at their first antenatal booking visit were telephoned within one week of this visit and invited to take part in the survey. The interview took place during the initial telephone call or during a further call within 48 hours of the initial call. All statistical tests were two tailed.

Demographic information was obtained from patient records. All the women were asked “Can I just check, are you still smoking at the moment?” (“yes” or “no”). Those still smoking were asked “About how many a day would you say you are smoking at the moment?”, and “Are you thinking at all about stopping?” (“yes” or “no”). Those expressing an interest in stopping were asked “Do you think you might want to stop in the next month, or might you prefer to try a bit later on” and “Would you be interested in receiving some help from the hospital with stopping?” (“yes” or “no”). Women stating an interest in receiving help were asked “Some forms of nicotine replacement therapy (NRT) can now be used by pregnant smokers who feel they wouldn’t be able to stop without it. Would you choose to use NRT to help you to stop smoking?”(“yes” or “no”).

Of the 207 smokers interviewed (fig 1) the large majority were not in professional/managerial occupations (85.0%, 176/207), were white (75.8%, 157/207), and attended their first antenatal booking visit in the hospital (66.7%, 138/207) rather than in the community. The mean (SD) duration of pregnancy was 18.6 (5.6) weeks and the mean (SD) reported number of cigarettes smoked per day was 7.3 (6.1).

Of those women reporting that they were thinking about stopping smoking 44.7% (67/150) expressed an interest in using NRT. Interest in NRT was higher among women who reported smoking more cigarettes per day (analysis of variance (ANOVA): F = 7.6, p = 0.006; mean (SD) cigarettes a day: interested in NRT (n = 67) = 9.5 (6.3), not interested in NRT (n = 83) = 7.1 (4.2)). Following current licensing regulations,1 39.3% (59/150) of the women wanting to stop smoking reported smoking sufficient cigarettes per day (⩾ 10) to be considered eligible for NRT. Interest in using NRT was significantly higher for those smoking at least 10 cigarettes a day (χ2: χ = 5.0, p = 0.03; 10 or more cigarettes a day: interested in NRT = 55.9% (33/59), less than 10 cigarettes a day: interested in NRT = 37.4% (34/91)). Overall, 22% (33/150) of those reporting wanting to stop smoking were both interested in NRT and eligible for NRT.

The results indicate a high level of interest in stopping smoking among pregnant women still smoking following their first antenatal booking and a moderate level of interest in using NRT. Fewer women were recorded as smokers at their first antenatal visit than would be expected from national data.3 This is likely to be because of the high number of Asian women in the local population. Encouragingly, those women who were heavier smokers, and were therefore eligible for NRT, showed most interest in NRT. Around a quarter of the smokers wanting to stop were both eligible for NRT and interested in using NRT. These findings add support to the argument for conducting further trials of NRT for pregnant smokers. The ultimate test of the acceptability of NRT for these women will be the degree to which NRT is utilised.

Figure 1

Participant flow. PAS, patient administration system.



  • Conflicts of interest: Robert West has previously been involved in research and consultancy sponsored by manufacturers of nicotine replacement therapy.