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There is insufficient evidence to assess whether NRT is effective or ineffective in pregnancy. Evidence on the use of bupropion and varenicline in pregnant smokers is too limited to draw conclusions on efficacy.

A review of the use of smoking cessation pharmacotherapy during pregnancy found eight trials, enrolling 2199 participants, investigating nicotine replacement therapy (NRT). The pooled result showed a beneficial effect but when restricted to unbiased, placebo controlled trials the effect was no longer apparent. There was no evidence that the use of NRT had either a positive or negative effect on birth outcomes. However, one large, good quality trial found that infants of two years of age born to women randomized to NRT had higher rates of ‘survival without developmental impairment’. No studies were found investigating the efficacy of varenicline in pregnant smokers, and only one very small study investigating bupropion (N=11) was included in the review. Therefore, no conclusions can be drawn on the use of bupropion and varenicline for smoking cessation in pregnancy. The risks of NRT in pregnancy are outlined in the safety section.

Coleman T, Chamberlain C, Davey MA, Cooper SE, Leonardi-Bee J. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD010078. DOI: 10.1002/14651858.CD010078.

Cooper S, Lewis S, Thornton JG, et al. The SNAP trial: a randomised placebo-controlled trial of nicotine replacement therapy in pregnancy--clinical effectiveness and safety until 2 years after delivery, with economic evaluation. Health Technol Assess 2014; 18: 1-128

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