NRT (nicotine replacement therapy) is an effective treatment to help you stop smoking. Examples of NRT have been available worldwide for almost 30 years and considered a good option for pregnancy. The risks associated with exposure to nicotine through NRT is far less than from cigarette smoking.

Level of dependence

When determining if NRT is suitable for you in pregnancy, it's important to assess how 'dependent' you are on nicotine. Mothers who struggle to stop smoking during pregnancy are likely to be highly dependent. Pregnant women who smoke more than 10 cigarettes a day or who smoke within one hour of waking are considered to have significant dependence and would likely benefit from NRT to help you quit.

Managing withdrawal

NRT is used to manage the withdrawal symptoms after you stop smoking. Symptoms of tobacco withdrawal include: craving, irritability, frustration, anger, restlessness, nervous tension, anxiety, feeling of hunger, difficulty concentrating, and problems sleeping. By reducing withdrawal symptoms, NRT increases the chances of someone successfully stopping smoking.

It is preferable for a pregnant women to be smoke and nicotine free. However, for mothers with high dependence and/or who experience withdrawal symptoms and struggle to stop smoking, there is a lower risk associated with NRT use than continuing to smoke. If this is the case, NRT should be used.

During pregnancy, women process nicotine at a faster rate than usual. This means pregnant women who suffer nicotine withdrawal may require a stronger dose of NRT than non-pregnant women.

Combination therapy

If dependence is high, withdrawal symptoms are strong, or if you have previously used NRT unsuccessfully, then combining NRT with other forms of treatment is an option. Please talk to your LMC or Smokefree practitioner about this.

Type of NRT product

Oral products (lozenges and gum) provide an intermittent dose and less nicotine overall than patches. As a result, lozenges and gum are preferred for use during pregnancy.

Oral products are recommended if the desire to smoke is triggered by environmental cues that relate to behaviour (habit), as they can be used to replace the physical action of smoking. Women should breastfeed just before they use oral NRT to ensure the maximum time between NRT use and the next feed.

Patches may be preferred if you experiences nausea or vomiting or if on-going signs of withdrawal are experienced between use of oral products. Patches should be removed before going to bed, and should not be used, if possible, during breastfeeding.

Between 2003 and 2007 in New Zealand, there were 359 SUDI deaths, an average of 90 deaths a year. Babies living in a smoking environment (inhaling second-hand smoke) have double the risk of SUDI than babies living in a smokefree environment. Babies whose mother smoked during pregnancy and continue to smoke after birth are four times more at risk of SUDI than babies whose mothers do not smoke.

Smoking and SUDI factors include: 

• Mother smoking
• Living in a smoking environment
• Sleeping with others
• Sleeping on an inappropriate surface (e.g. not designed for infant sleep)
• Not sleeping on their back, and not clear of possible smothering objects (e.g. soft toys)

Breastfeeding protects against SUDI

Mothers should be encouraged to breastfeed regardless of their smoking status. Breastfeeding has been shown to reduce the risk of SUDI by up to 50%. If their mothers smoke, breastfed babies have better health outcomes than those who are bottle-fed. The benefits of breastfeeding for babies whose mothers smoke include fewer breathing problems and illnesses and better cognitive development.

What effects does smoking have on breastfeeding?

Although breastfeeding a baby is better than bottle feeding, regardless of a mother's smoking status, smoking does have an impact on a mother's breast milk. Smoking affects the amount of milk she produces. Mothers who smoke produce about 20% less breast milk than non-smoking mothers. The breast milk of smoking mothers also contains less fat, which is important for a baby's growth.