Background Smoking in pregnancy increases the risk of foetal and maternal problems; therefore reducing smoking in pregnancy is a public health priority. In 2005, licensing arrangements for nicotine replacement therapy (NRT) in the United Kingdom were broadened such that NRT could be prescribed to pregnant smokers. However, little is known about trends and uptake of NRT by pregnant women. We aimed to quantify annual trends of NRT uptake in and around pregnancy and variation in prescribing by maternal characteristics.
Methods In The Health Improvement Network primary care database we identified all pregnancies from 2000 to 2010 in women aged 15–49 years and used READ codes to determine women’s smoking status. NRT prescriptions were identified in all women during three time periods: up to 9 months before conception, during pregnancy, and up to 9 months after delivery. Annual proportions of pregnancies where NRT was prescribed were calculated and variations by age and socio-economic deprivation were assessed using logistic regression.
Results Women were classified as smokers in 19% of 227,552 pregnancies identified in 215,703 women. NRT was prescribed in 4,827 of all pregnancies which represented a prescribing prevalence of 9% of pregnancies in smokers and 2% of pregnancies overall. The rate of NRT prescribing was approximately 50% lower 9 months before and after pregnancy, compared to during pregnancy. There was a gradual increase in the annual rate of prescribing until 2005, after which the rate became stable. The rate of prescribing during pregnancy in smokers was higher in older age groups such that the rate in 30–35 years age group was 17% higher (95% CI 1.05, 1.31) and the rate in 15–20 year age group was 4% lower (0.85, 1.08) than the rate of prescribing in the 25–30 year age group. The rate of prescribing during pregnancy in smokers also increased with deprivation such that it was 34% (1.16, 1.54) higher in the most deprived group than in the least deprived group. Pregnant smokers with asthma and mental illness were 22% (1.11, 1.34) and (1.38, 1.58) more likely to receive a prescription for NRT respectively as compared to pregnant smokers without these comorbidities.
Conclusion Uptake of NRT is higher during pregnancy compared to time periods outside pregnancy and is higher in smokers from older and more socio-economically deprived groups.