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Obstetrics & Gynecology 2008;112:859-867
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Nicotine Gum for Pregnant Smokers

A Randomized Controlled Trial

Cheryl Oncken, MD, MPH1,2, Ellen Dornelas, PhD1,3, John Greene, MD2,4, Heather Sankey, MD5, Allen Glasmann, MD2,6, Richard Feinn, PhD7 and Henry R. Kranzler, MD8

From the Departments of 1Medicine and 2Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut; the 3Division of Preventive Cardiology and the 4Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, Connecticut; the Department of Obstetrics and Gynecology, 5Baystate Medical Center, Springfield, Massachusetts, and 6the Hospital of Central Connecticut, Southington, Connecticut; and the Department of Psychiatry, 7Yale University School of Medicine, New Haven, Connecticut, and 8University of Connecticut School of Medicine, Farmington, Connecticut.

OBJECTIVE: To estimate the safety and efficacy of treatment with 2-mg nicotine gum for smoking cessation during pregnancy.

METHODS: Pregnant women who smoked daily received individualized behavioral counseling and random assignment to a 6-week treatment with 2-mg nicotine gum or placebo followed by a 6-week taper period. Women who did not quit smoking were instructed to reduce the number of cigarettes smoked by substituting with gum. Measures of tobacco exposure were obtained throughout the study.

RESULTS: Participants in the nicotine (nequals;100) and placebo (nequals;94) groups were comparable in age, race/ethnicity, and smoking history. Biochemically validated smoking-cessation rates were not significantly higher with nicotine gum compared with placebo (after 6 weeks of treatment: 13% compared with 9.6%, P=.45; at 32–34 weeks of gestation: 18% compared with 14.9%, P=.56). Using a completer analysis, nicotine gum significantly reduced the number of cigarettes smoked per day (nicotine gum: –5.7 [standard deviation (SD)=6.0]; placebo: –3.5 [SD=5.7], P=.035), and cotinine concentration (nicotine gum: –249 ng/mL [SD=397]; placebo: –112 ng/mL [SD=333]; P=.04). Birth weights were significantly greater with nicotine gum compared with placebo (3,287 g [SD=566] and 2,950 g [SD=653], respectively, P<.001). Gestational age was also greater with nicotine-replacement therapy than with placebo (38.9 weeks [SD=1.7] and 38.0 weeks [SD=3.3], respectively; P=.014).

CONCLUSION: Although nicotine gum did not increase quit rates, use of nicotine gum increased birth weight and gestational age, two key parameters in predicting neonatal wellbeing.

CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00115687

LEVEL OF EVIDENCE: I






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