Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial.

Introduction:
This text provides an overview of a randomized controlled trial comparing the efficacy and safety of electronic cigarettes (e-cigarettes) and nicotine replacement therapy (NRT) patches in helping pregnant women who smoke to attain prolonged abstinence from smoking. The study results may contribute to understanding the effects of nicotine on its own in later pregnancy.

Key Points:

* The trial included 1,140 women randomly assigned to either the e-cigarette or NRT arm.
* Participants were predominantly white British, with a median age of 27 years and smoked 10 cigarettes per day.
* The primary outcome was validated prolonged abstinence at the end of pregnancy, which did not differ significantly between the two study arms (6.8% in the e-cigarette arm vs. 4.4% in the NRT arm).
* however, in a pre-specified sensitivity analysis excluding abstinent participants who regularly used non-allocated products, e-cigarettes were significantly more effective than NRT (6.8% vs. 3.6%).
* Self-reported abstinence and validated point prevalence abstinence at the end of pregnancy were also higher in the e-cigarette arm.
* There was no difference in the proportion of non-abstaining women with validated reduction of smoking at the end of pregnancy between the two study arms.
* The overall number of serious adverse events and adverse events was similar in both study arms.
* The incidence of low birthweight (<2,500 g) was significantly lower in the e-cigarette arm (9.6% vs. 14.8% in the NRT arm).

Main Message:
The study suggests that e-cigarettes might help women who are pregnant to stop smoking and have a similar safety profile to nicotine patches. however, further research is needed to confirm these findings, and pregnant women should consult their healthcare providers before using e-cigarettes or NRT patches to quit smoking.

hajek P, Przulj D, Pesola F, et al. Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial. Nature medicine. 2022;28(5):958-964. doi:10.1038/s41591-022-01808-0