Titre : | Pharmacological interventions for promoting smoking cessation during pregnancy (Review) (2020) |
Auteurs : | R. CLAIRE ; C. CHAMBERLAIN ; M. A. DAVEY ; S. E. COOPER ; I. BERLIN ; J. LEONARDI-BEE ; T. COLEMAN |
Type de document : | Article : Périodique |
Dans : | Cochrane Database of Systematic Reviews (n°3, 2020) |
Article en page(s) : | CD010078 |
Langues: | Anglais |
Discipline : | TRA (Traitement et prise en charge / Treatment and care) |
Mots-clés : |
Thésaurus mots-clés ARRET DU TABAC ; SEXE FEMININ ; GROSSESSE ; TABAC ; SEVRAGE ; PHARMACOTHERAPIE ; INTERVENTION ; SUBSTITUTS NICOTINIQUES ; BUPROPION ; COMPARAISON ; EFFICACITE ; VARENICLINE ; E-CIGARETTE |
Résumé : |
What is the issue?
Smoking during pregnancy harms women and infants. However, many women who smoke struggle to stop whilst pregnant. Medication for smoking cessation reduces the intensity of cravings, meaning that people trying to stop smoking are more likely to succeed in the long term. Providing pregnant women who smoke with these treatments could help them to stop smoking and have a positive impact on both their own health and the health of their infants. Why is this important? Medications commonly used to help people to stop smoking include nicotine replacement therapy (NRT), bupropion, and varenicline. Electronic cigarettes containing nicotine are also used by some who smoke to help avoid smoking. However, the safety and effectiveness of smoking cessation drugs and electronic cigarettes in pregnant women is unknown. We searched for studies looking at how good these aids were at helping pregnant women stop smoking and how safe they were when used during pregnancy. What evidence did we find? We searched for evidence on 20 May 2019 and identified 11 randomised studies (studies in which participants are assigned to one of two or more treatment groups using a random method) that enrolled a total of 2412 women. Nine studies tested NRT used alongside counselling to stop smoking, whilst the other two studies tested bupropion. Low-quality evidence suggests that NRT combined with behavioural support might help women to stop smoking in later pregnancy more than behavioural support alone. Medication trials often use placebos, that is tablets or patches that look like the drug but do not actually include it, so that each comparison group has equal expectation of success and there is a fairer test of the benefits of the medicine itself. When just the higher-quality, placebo-controlled trials were analysed, the evidence suggested that NRT was more effective than placebo NRT. There was no evidence that either nicotine patches or fast-acting NRT (such as gum or lozenge) was more effective than the other. Low-quality evidence suggests that bupropion may be no more effective than placebo in helping women quit smoking later in pregnancy. We found no trials investigating other smoking cessation pharmacotherapies or electronic cigarettes. There was insufficient evidence to conclude whether NRT had either positive or negative impacts on rates of miscarriage, stillbirth, preterm birth (less than 37 weeks), mean birthweight, low birthweight (less than 2500 g), admissions of babies to neonatal intensive care, or newborn deaths. However, in one trial where infants were followed until two years of age, those infants born to women who had been randomised to NRT were more likely to have healthy development. Similarly, it is unclear whether bupropion had a positive or negative impact on birth outcomes. Studies that looked at whether women used their stop smoking medications as instructed found that use was generally low, and the majority of women used little of the NRT they were given. What does this mean? More research evidence is needed, in particular placebo-controlled trials that test higher doses of NRT, encourage women to use sufficient medication, and follow infants into childhood. Furthermore, more studies are required investigating the effect and safety of bupropion, electronic cigarettes, and varenicline for giving up smoking during pregnancy. |
Domaine : | Tabac / Tobacco / e-cigarette |
Sous-type de document : | Revue de la littérature / Literature review |
Affiliation : | University of Nottingham, Division of Primary Care, Nottingham, Nottinghamshire, UK |
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