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NICE Underpinning Review
Smoking during pregnancy is associated with a variety of health risks for mother and baby. In addition, there are questions around the effectiveness of e-cigarettes – a comparatively new technology – during pregnancy. This review aims to establish whether NRTs and e-cigarettes are effective, cost effective and safe.
Due to these potential harms, cessation rather than harm reduction is the focus of interventions during pregnancy. Reducing harm through cutting down prior to quitting, smoking less, or abstaining from smoking temporarily have uncertain health benefits in and of themselves, and may be mainly beneficial because they may make people more likely to quit in the future. Pregnancy is a short period of time and so emphasis is placed on moving directly to cessation in order that benefits start to be realised for both baby and mother during pregnancy.
The quantitative part of this review was primarily completed by the Cochrane Pregnancy and Childbirth Group (PCG) and the Cochrane Tobacco Addiction Group (TAG) in October 2019 for NICE (Claire 2020c ). The qualitative part of this review was completed in October 2019 for NICE by Campbell (2019). Throughout, figures and sections of text have been taken directly from Cochrane work, or had minor amendments to wording, and are presented here in the standard NICE format.
This evidence review supports recommendations 1.20.6 to 1.20.8 and 1.20.10, the research recommendation on nicotine replacement therapy and e-cigarettes and pregnancy, and the research recommendation on the views of pregnant women and health professionals on the use of e-cigarettes in pregnancy.