Letters

Nicotine patches and pregnancy

I read with interest your Motherisk Update article, “Nicotine replacement therapy in pregnancy,”1 which appeared in the October 2001 issue. Dr Koren’s discussion revolved around the study by Wisborg et al.2 The nicotine patches that were used in this study contained only a very low dose of nicotine (only 15 + 10 mg), and were used for only very short courses (3 weeks each), and for only 16 hours daily! I am unhappy that this article was cited as evidence against the efficacy of nicotine replacement therapy for these reasons: the generalizability of this study is highly questionable, and this point should have been expressed more clearly in your article.

Despite my negative comment, I urge you to continue your excellent work, which has helped me so much in the past.

—Stephen DiTommaso, MD, CCFP, FCFP Montreal, Que CLSC des Faubourgs University of Montreal Centre de recherche et aide aux narcomanes (CRAN, methadone clinic) by e-mail

References

1. Koren G. Nicotine replacement therapy during pregnancy [Motherisk Update]. Can Fam Physician 2001;47:1971-2.
2. Wisborg K, Henriksen TB, Jespersen LB, Secher NJ. Nicotine patches for pregnant smokers: a randomized controlled study. Obstet Gynecol 2000;96:967-71.

Response

I wish to thank Dr DiTommaso for his interest and kind words. I concur that the dose of nicotine in the patch used in the Danish study was too low. In my Update, I explicitly say “Perhaps these women need more intense therapy than the therapy used in the Danish study.… It is possible that, because they are rapid metabolizers of nicotine, pregnant women need higher doses of nicotine in the patch than those given to non-pregnant women.”

The main outstanding issue is, of course, the safety of the patch during pregnancy. Until better data on fetal safety of the low dose are available, it will be difficult to justify increased doses of nicotine.

—Gideon Koren, MD, FRCPC Director, The Motherisk Program

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