Guideline No. 470: Nicotine and Pregnancy

OBJECTIVE: To provide evidence-informed recommendations for the screening, management, and cessation of nicotine use during pregnancy and the postpartum period. TARGET POPULATION: Women who are pregnant or planning a pregnancy who use nicotine-containing products, including combustible tobacco, electronic cigarettes and smokeless tobacco. OPTIONS: Screening approaches, behavioural counselling interventions, pharmacologic therapies, harm-reduction strategies, and health system interventions for nicotine cessation. OUTCOMES: Improved maternal and neonatal outcomes, reduced nicotine exposure during pregnancy, improved cessation rates for nicotine-containing products, and prevention of postpartum relapse. BENEFITS, HARMS, AND COSTS: Implementation of these recommendations may improve smoking cessation rates during pregnancy and reduce adverse maternal and neonatal outcomes. Potential harms include increased clinical time requirements and resource utilization for cessation programs. EVIDENCE: Evidence was identified through comprehensive literature reviews addressing key clinical questions related to nicotine exposure, screening, cessation interventions, electronic cigarettes, and postpartum relapse prevention. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE: This guideline is intended for health care professionals involved in the care of pregnant individuals and those planning pregnancy, including obstetricians, family physicians, midwives, nurses, nurse practitioners, and other health professionals providing prenatal and postpartum care. It may also be relevant to public health practitioners, smoking cessation specialists, and policy makers involved in maternal and child health. SOCIAL MEDIA ABSTRACT: Nicotine use in pregnancy remains a major preventable cause of adverse maternal and neonatal outcomes. This SOGC guideline recommends routine screening, behavioural counselling as first-line therapy, cautious use of NRT or other pharmacotherapy when needed, and continued postpartum support to reduce relapse. SUMMARY STATEMENTS: RECOMMENDATIONS.