Clinical, Educational and Health Psychology, University College London, London, UK; National Centre for Smoking Cessation and Training (NCSCT), London, UK.
Drug Alcohol Depend. 2013 Oct 1;132(3):660-4. doi: 10.1016/j.drugalcdep.2013.04.017. Epub 2013 May 13.
There is an urgent need to find better ways of helping pregnant smokers to stop. Randomized controlled trials (RCTs) have not detected an effect of nicotine replacement therapy (NRT) for smoking cessation in pregnancy. This may be because of inadequate dosing because of faster nicotine metabolism in this group. In England, many pregnant smokers use single form and combination NRT (patch plus a faster acting form). This correlational study examined whether the latter is associated with higher quit rates.
Routinely collected data from 3880 pregnant smokers attempting to stop in one of 44 Stop Smoking Services in England. The outcome measure was 4-week quit rates, verified by expired-air carbon monoxide level<10 ppm. Outcome was compared between those not using medication versus using single form NRT (patch or one of the faster acting forms), or combination NRT. Potential confounders were intervention setting (specialist clinic, home visit, primary care, other), intervention type (one-to-one, group, drop-in, other), months pregnant, age, ethnicity and occupational group in multi-level logistic regressions.
After adjustment, combination NRT was associated with higher odds of quitting compared with no medication (OR=1.93, 95% CI=1.13-3.29, p=0.016), whereas single NRT showed no benefit (OR=1.06, 95% CI=0.60-1.86, p=0.84).
Use of a combination of nicotine patch and a faster acting form may confer a benefit in terms of promoting smoking cessation during pregnancy. While this conclusion is based on correlational data, it lends support to continuing this treatment option pending confirmation by an RCT.
迫切需要找到更好的方法来帮助孕妇戒烟。随机对照试验（RCT）并未发现尼古丁替代疗法（NRT）对妊娠戒烟有效果。这可能是由于该组人群中尼古丁代谢更快，导致剂量不足。在英国，许多孕妇使用单一形式和组合 NRT（贴片加更快起效的形式）。这项相关性研究检验了后者是否与更高的戒烟率有关。
从英国 44 个戒烟服务机构中尝试戒烟的 3880 名孕妇的常规收集数据。结局测量是 4 周的戒烟率，通过呼出的一氧化碳水平<10ppm 来验证。将不使用药物的孕妇与使用单一形式 NRT（贴片或更快起效形式之一）或组合 NRT 的孕妇进行比较。多水平逻辑回归分析潜在的混杂因素包括干预设置（专科诊所、家访、初级保健、其他）、干预类型（一对一、小组、随时参与、其他）、妊娠月数、年龄、种族和职业群体。
调整后，与未使用药物相比，联合使用 NRT 与更高的戒烟几率相关（OR=1.93，95%CI=1.13-3.29，p=0.016），而单一 NRT 则没有益处（OR=1.06，95%CI=0.60-1.86，p=0.84）。
使用尼古丁贴片和更快起效形式的组合可能会在促进怀孕期间戒烟方面带来益处。虽然这一结论基于相关性数据，但它支持继续这种治疗选择，等待 RCT 的确认。
