Centre for Brain and Mental Health, University of Newcastle, Newcastle, NSW
University of Newcastle, Newcastle, NSW.
Med J Aust. 2018 Jan 15;208(1):46-51. doi: 10.5694/mja17.00446.
Nicotine replacement therapy (NRT) is recommended in current Australian clinical guidelines for pregnant women who are unable to quit smoking unassisted. Clinicians report low levels of prescribing NRT during pregnancy, due to safety concerns and low levels of confidence in their ability to prescribe NRT. Animal models show that nicotine is harmful to the fetus, especially for brain and lung development, but human studies have not found any harmful effects on fetal and pregnancy outcomes. Studies of efficacy and effectiveness in the real world suggest that NRT use during pregnancy increases smoking cessation rates. These rates may be hampered by the fact that studies so far have used an NRT dose that does not adequately account for the higher nicotine metabolism during pregnancy and, therefore, does not adequately treat withdrawal symptoms. Further research is needed to assess the safety and efficacy of higher dosages of NRT in pregnancy, specifically of combination treatment using dual forms of NRT. As NRT is safer than smoking, clinicians need to offer this option to all pregnant women who smoke. A practical guide for initiating and tailoring the dose of NRT in pregnancy is suggested.
尼古丁替代疗法（NRT）被推荐用于目前澳大利亚的临床指南中，适用于那些无法自行戒烟的孕妇。临床医生报告说，在怀孕期间开具 NRT 的情况很少，这是由于安全性问题以及他们对开具 NRT 能力的信心不足所致。动物模型表明，尼古丁对胎儿有害，特别是对大脑和肺部发育有害，但人类研究并未发现尼古丁对胎儿和妊娠结局有任何有害影响。在现实世界中对疗效和有效性的研究表明，怀孕期间使用 NRT 可提高戒烟率。到目前为止，由于研究使用的 NRT 剂量不能充分考虑到怀孕期间尼古丁代谢增加的情况，因此不能充分缓解戒断症状，这些戒烟率可能会受到阻碍。需要进一步研究来评估在怀孕期间使用更高剂量的 NRT 的安全性和有效性，特别是使用双重形式的 NRT 的联合治疗。由于 NRT 比吸烟更安全，因此临床医生需要向所有吸烟的孕妇提供这种选择。本文提出了一种在怀孕期间启动和调整 NRT 剂量的实用指南。
