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  • Principal Investigator: Lisa Szatkowski
  • 1 April 2016 to 31 December 2016
  • Project No: 307
  • Funding round: FR 11

Smoking in pregnancy is still major problem – in the UK in 2010 26% of women smoked at some point during pregnancy and 12% smoked throughout. Each year approximately 175,000 unborn children are exposed to smoking. Smoking during pregnancy increases the risk of miscarriage, stillbirth and prematurity, and has longer-term impacts on children's health. Helping pregnant women to stop smoking will, therefore, improve their health and also that of their unborn child.

Nicotine replacement therapy (NRT) can help smokers quit. However, NRT works less well in smokers who are pregnant compared to non-pregnant smokers. This might be because during pregnancy biological changes mean that standard doses of NRT are less good at reducing withdrawal symptoms and so pregnant women may be more likely to re-start smoking. A higher dose of NRT might increase the chances of pregnant smokers quitting, which might be achieved by prescribing pregnant women 'dual' NRT – a patch to provide a steady background dose of nicotine, and a fast-acting form such as chewing gum or lozenge which women can use to 'top-up' their dose to alleviate withdrawal symptoms.

Varenicline is another medication that increases the chances of quitting smoking. However, although there is no evidence that it is harmful to a growing foetus, varenicline is not currently licensed for use during pregnancy. It is possible though that some women will inadvertently take varenicline before realising they are pregnant.

This study will use GP medical records to investigate how many women in the UK are currently being prescribed dual NRT or varenicline during pregnancy, and will investigate how frequently adverse outcomes occur in these women compared to pregnant smokers who are not prescribed any stop smoking medications. This information will help with planning future studies to test the safety and effectiveness of stop smoking medications during pregnancy.

Amount awarded: £51,500

Evidence synthesis working group

The collaboration will be conducting 18 high impact systematic reviews, under four workstreams.

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