E-cigarettes may be better than nicotine patches in helping pregnant women stop smoking and in reducing the risk of low birthweight
E-cigarettes (vapes) may be more effective than nicotine patches for pregnant women trying to quit smoking, research led by Queen Mary University of London and funded by the National Institute for Health and Care Research (NIHR), has found
Smoking in pregnancy can harm developing babies, especially their growth . Current guidelines recommend that pregnant smokers who find quitting difficult should be provided with nicotine replacements products and stop-smoking services usually recommend nicotine patches.
This research published in NIHR Journals Library, suggests that pregnant women should also consider e-cigarettes.
The study included 1,140 pregnant women who were trying to stop smoking who were divided into two groups. Half of the women received e-cigarettes; the other half received nicotine patches. Both approaches were equally safe. The only meaningful difference was that fewer women in the e-cigarette group had children with low birthweight (weighing less than 2,500 grams).
The researchers say this is most likely because e-cigarettes were more effective in reducing the use of conventional cigarettes. Low birthweight has been linked with poor health later in life.
At the end of their pregnancy, women reported whether they had quit. However, some women had quit smoking using a product they were not assigned, mostly women given patches stopping with the help of e-cigarettes they had procured for themselves.
When the researchers looked at successful quitters who only used the treatment they were allocated, almost twice as many women quit with e-cigarettes than with nicotine patches.
The researchers looked at safety outcomes, including low birthweight, baby intensive care admissions, miscarriage, stillbirth, and premature birth.
It is not clear whether nicotine is harmful to developing babies. National Institute of Health and Care Excellence (NICE) states that most health problems are caused by toxins other than nicotine in cigarettes and therefore recommends that nicotine replacement therapy (such as nicotine patches, gum and mouth spray) is considered alongside behavioural support. However, most pregnant women still struggle to quit.
E-cigarettes can be seen as a form of nicotine replacement therapy, but they have an advantage over nicotine gum and patches in allowing smokers to select strength and flavours they like and make the transition to stopping smoking easier. This is most likely why e-cigarettes have been shown more effective than the traditional nicotine replacement therapy in people who are not pregnant.
Peter Hajek, Director of Health and Lifestyle Research Unit, Wolfson Institute of Population Health, Queen Mary University of London said: “E-cigarettes seem more effective than nicotine patches in helping pregnant women to quit smoking and because of this, they seem to also lead to better pregnancy outcomes. The evidence-based advice to smokers already includes, among other options, a recommendation to switch from smoking to e-cigarettes. Such a recommendation can now be extended to smokers who are pregnant as well.’
Ends
Helping pregnant smokers quit: a multi-centre randomised controlled trial of electronic cigarettes versus nicotine replacement therapy.
Health Technology Assessment vol 27 no 10. 2023 HTA 15/57/85
(DOI to come) 10.3310/AGTH6901
Available here after the embargo lifts: https://www.journalslibrary.nihr.ac.uk/hta/AGTH6901/#/abstract
NOTES TO EDITORS:
Contact
Lee Pinkerton
Faculty Communications Officer – Medicine and Dentistry
Queen Mary University of London
Email: l.pinkerton@qmul.ac.uk
Tel: +44 (0) 7985 446 280
About Queen Mary University of London
At Queen Mary University of London, we believe that a diversity of ideas helps us achieve the previously unthinkable.
Throughout our history, we’ve fostered social justice and improved lives through academic excellence. And we continue to live and breathe this spirit today, not because it’s simply ‘the right thing to do’ but for what it helps us achieve and the intellectual brilliance it delivers.
Our reformer heritage informs our conviction that great ideas can and should come from anywhere. It’s an approach that has brought results across the globe, from the communities of east London to the favelas of Rio de Janeiro.
We continue to embrace diversity of thought and opinion in everything we do, in the belief that when views collide, disciplines interact, and perspectives intersect, truly original thought takes form.
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The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by: Funding high quality, timely research that benefits the NHS, public health and social care;
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JOURNAL
Health Technology Assessment
METHOD OF RESEARCH
Randomized controlled/clinical trial
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Helping pregnant smokers quit: a multi-centre randomised controlled trial of electronic cigarettes versus nicotine replacement therapy.
ARTICLE PUBLICATION DATE
1-Aug-2023
Oxycodone prescriptions after delivery not linked to longer-term opioid use compared to codeine prescriptions
Postpartum prescriptions for oxycodone were not associated with increased risk of longer-term opioid use compared to codeine prescriptions, according to new research published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221351.
Over the last 10 years, there has been a shift to fewer codeine prescriptions and an increase in prescriptions for stronger opioids, such as hydrocodone, hydromorphone and oxycodone for patients postpartum.
“This occurred in part because of safety concerns related to the use of codeine while breastfeeding, which have since been questioned,” writes Dr. Jonathan Zipursky, Sunnybrook Health Sciences Centre, ICES and the University of Toronto, Toronto, Ontario, with coauthors. “The consequences of this trend on postpartum health have not been well characterized but are potentially concerning, for several reasons. Principally, patients have a strong expressed preference for oxycodone over other prescription opioids, which may impart a greater potential for nonmedical use.”
To understand whether this emphasis on more potent opioid prescribing is linked to persistent opioid use after giving birth, researchers looked at data on 70,607 individuals who filled an opioid prescription after discharge from an Ontario hospital between 2012 and 2020. More than two-thirds, 49,299 (70%), received oxycodone and 21,308 (30%) received codeine. The majority (56,485 [80%]) had cesarean deliveries.
Compared to codeine, receipt of oxycodone was not associated with persistent opioid use after delivery (relative risk 1.04; 95% confidence interval 0.91–1.20).
In secondary analyses, the researchers found a 60% increase in the risk of persistent opioid use among people prescribed oxycodone compared with codeine after vaginal delivery, but no such association for those who delivered by cesarean. This finding warrants further research to explore why those who deliver vaginally may be at greater risk of using opioids longer term following oxycodone use after delivery. Higher dosages and longer duration of a prescription were also associated with increased risk of persistent opioid use.
“Our findings suggest that initial postpartum prescriptions containing large amounts of [morphine milligram equivalents] might represent an additional risk factor for persistent opioid use. Therefore, limiting the quantity of initial opioid prescriptions might be an additional strategy to reduce the risk of new, persistent opioid use after delivery,” the authors suggest.
JOURNAL
Canadian Medical Association Journal
ARTICLE TITLE
Prescription of oxycodone versus codeine after childbirth and risk of persistent opioid use: a population-based cohort study
ARTICLE PUBLICATION DATE
31-Jul-2023
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