Supporting Smoking Cessation in Pregnancy and Breastfeeding – Guideline

About the update process

In late August 2022, Quit commissioned the Royal Women’s Hospital (RWH) Pharmacy Department to update an existing guideline: Supporting smoking cessation during pregnancy - nicotine replacement therapy (NRT) and expand the scope of the guideline. This guideline issues updated guidance on supporting smoking cessation in pregnancy, with the addition of breastfeeding.

Summary of the changes to the key messages:

  • Non-pharmacological interventions such as multi-session behavioural intervention (for example, as delivered by Quitline) are recommended as first-line therapy in pregnancy and breastfeeding. (UPDATED)

  • Nicotine replacement therapy (NRT) in conjunction with behavioural intervention may be considered in women unable to achieve abstinence using non-pharmacological interventions alone or in those with moderate to high nicotine dependence. (UPDATED)

  • Other non-nicotine oral therapies such as bupropion and varenicline are indicated for aiding smoking cessation in the general population, but not currently recommended to be used in pregnancy or breastfeeding due to limited efficacy and safety data. (NEW)

  • Nicotine vaping products (NVPs) for smoking cessation are not recommended in pregnancy or breastfeeding due to limited efficacy and safety data. (NEW)

The smoking cessation clinical pathway was also updated, including incorporation of breastfeeding.

Summary of the guideline development process:

October 2022

Literature review/summarise background information on the following:
  • Use of conventional NRT, other medicines (varenicline and bupropion) and e-cigarettes for smoking cessation in pregnancy and breastfeeding

  • Smoking and drug interactions

  • Current published national and international guidelines.

Search strategy

A literature search utilising Ovid Medline was performed.

The following terms/keywords were included:

“smoking cessation”, “nicotine replacement therapy”, “nrt”, “bupropion”, “varenicline”, “electronic nicotine delivery system”, “electronic cigarette”, “pregnancy”, “pregnant women”, “prenatal care, “breastfeeding”, “lactation”, “milk”.

Only studies in the English language were included.

The literature search around NRT in pregnancy was limited to year 2019 to September 2022 (as a literature review was conducted for the previous version of the guideline).

As the scope of this guideline expanded to include breastfeeding, a search with no limit to September 2022 was conducted.

Due to limited studies found for bupropion, varenicline and e-cigarettes for smoking cessation use in pregnancy and breastfeeding, no specific date range was set.

December 2022 to April 2023

Guideline drafted by RWH.

May 2023

RWH and external expert group review.

June to July 2023

Updates made to guideline based on expert review.

August to November 2023

Guideline finalised with Quit.