■关于怀孕期间戒烟药物治疗的安全性存在显著的证据空白,尤其是先天畸形的风险。因此,专业机构建议不要使用伐尼克林和安非他酮,并建议谨慎使用尼古丁替代疗法(NRT)。缺乏对怀孕期间使用戒烟药物疗法的当代估计。
为了量化在怀孕期间和特别是在孕早期使用规定的戒烟药物疗法的个体比例,在4个国家。
■这次回顾展,基于人群的队列研究使用关联出生记录,住院记录,并分发2015年至2020年在新南威尔士州出生的所有怀孕的处方药记录,澳大利亚、新西兰、挪威和瑞典。数据分析于2023年10月和11月进行。
■规定的戒烟药物治疗使用(伐伦尼克林,NRT,和安非他酮)在怀孕期间被定义为从受孕到分娩的天数重叠。
■计算了所有怀孕和孕妇吸烟的使用率。在使用药物治疗的女性中,还计算了怀孕前三个月使用的女性比例。
■在4个国家的1700638例怀孕中,138033(8.1%)的母亲吸烟,729498(42.9%)的年龄小于30岁。伐尼克兰的患病率为0.02%至0.14%,规定的NRT低于0.01%至1.86%,安非他酮低于0.01%至0.07%。在吸烟的孕妇中,药物疗法的使用率高达10倍,在新南威尔士州,伐尼克兰的最高患病率为1.25%,新西兰NRT的11.39%,和0.39%的安非他酮在新西兰。超过90%的使用伐伦克林的个体在妊娠早期使用,使用NRT的人中大约60%,使用安非他酮的人中有80%至90%。
■在这项针对4个高收入国家孕妇的队列研究中,与现行临床指南一致,妊娠期使用伐伦克林和安非他酮的患病率较低,而使用NRT的患病率较高.由于大多数使用发生在孕早期,这些药物有必要提供有关先天性畸形风险的证据.
UNASSIGNED: Significant evidence gaps exist regarding the safety of smoking cessation pharmacotherapies during pregnancy, especially for the risk of congenital malformations. Consequently, professional bodies advise against the use of varenicline and bupropion and recommend caution with nicotine replacement therapy (NRT). Contemporary estimates of the use of smoking cessation pharmacotherapies during pregnancy are lacking.
UNASSIGNED: To quantify the proportion of individuals using prescribed smoking cessation pharmacotherapies during pregnancy and during the first trimester specifically, in 4 countries.
UNASSIGNED: This retrospective, population-based cohort study used linked birth records, hospital admission records, and dispensing records of prescribed medications from all pregnancies resulting in birth between 2015 and 2020 in New South Wales, Australia; New Zealand;
Norway; and Sweden. Data analyses were conducted in October and November 2023.
UNASSIGNED: Prescribed smoking cessation pharmacotherapy use (varenicline, NRT, and bupropion) during pregnancy was defined as days\' supply overlapping the period from date of conception to childbirth.
UNASSIGNED: Prevalence of use among all pregnancies and pregnancies with maternal smoking were calculated. Among women who used a pharmacotherapy, the proportion of women with use during the first trimester of pregnancy was also calculated.
UNASSIGNED: Among 1 700 638 pregnancies in 4 countries, 138 033 (8.1%) had maternal smoking and 729 498 (42.9%) were younger than 30 years. The prevalences ranged from 0.02% to 0.14% for varenicline, less than 0.01% to 1.86% for prescribed NRT, and less than 0.01% to 0.07% for bupropion. Among pregnant individuals who smoked, use of pharmacotherapies was up to 10 times higher, with maximum prevalences of 1.25% for varenicline in New South Wales, 11.39% for NRT in New Zealand, and 0.39% for bupropion in New Zealand. Use in the first trimester occurred among more than 90% of individuals using varenicline, approximately 60% among those using NRT, and 80% to 90% among those using bupropion.
UNASSIGNED: In this cohort study of pregnant individuals in 4 high-income countries, the low prevalence of varenicline and bupropion use during pregnancy and higher prevalence of NRT use aligned with current clinical guidelines. As most use occurred in the first trimester, there is a need for evidence on the risk of congenital malformations for these medications.