Gould, Gillian S., and McEwen, Andy (2013) An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial. Medical Journal of Australia, 198 (1). pp. 23-24.

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Abstract

[Extract] We comment on practical aspects of the approach to maternal Indigenous smoking raised in the study by Eades and colleagues.

Pregnant smokers face barriers to quitting; however, we believe some additional barriers are systemic, including excessive caution in prescribing nicotine replacement therapy (NRT). Guidelines for maternal smoking cessation recommend an unassisted attempt before considering NRT. There is no agreed definition of a "failed quit attempt", or for how long a pregnant woman should persist unaided before NRT is tried. In this study, two failed attempts were a prerequisite. In a practice setting, this may be overcautious; intermittent NRT is considered less hazardous than continued smoking in pregnancy. If a pregnant woman is unable to abstain for 2–3 days, an accelerated option of intermittent NRT should be considered, to keep up momentum with the quit attempt. The attendance rate dropped from 64% at 3–5 days to 35% at 7–10 days — perhaps lost opportunities for initiating pharmacotherapy. The article does not detail the type of NRT (oral or transdermal), dosage, duration of treatment, compliance rates, or the management of side effects. These aspects would be of interest to smoking cessation practitioners.

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