{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:05:10Z","timestamp":1793397910322,"version":"4.5.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To quantify the proportion of individuals using prescribed smoking cessation pharmacotherapies during pregnancy and during the first trimester specifically, in 4 countries.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Prescribed smoking cessation pharmacotherapy use (varenicline, NRT, and bupropion) during pregnancy was defined as days\u2019 supply overlapping the period from date of conception to childbirth.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 1\u202f700\u202f638 pregnancies in 4 countries, 138\u202f033 (8.1%) had maternal smoking and 729\u202f498 (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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.19245","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T18:23:03Z","timestamp":1719598983000},"page":"e2419245","source":"Crossref","is-referenced-by-count":9,"title":["Smoking Cessation Pharmacotherapy Use in Pregnancy"],"prefix":"10.1001","volume":"7","author":[{"given":"Annelies L.","family":"Robijn","sequence":"first","affiliation":[{"name":"National Drug and Alcohol Research Centre, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duong T.","family":"Tran","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases & Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Donald","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn E.","family":"Cesta","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Furu","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases & Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianne","family":"Parkin","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sallie-Anne","family":"Pearson","sequence":"additional","affiliation":[{"name":"Medicine Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Reutfors","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Zoega","sequence":"additional","affiliation":[{"name":"Medicine Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia"},{"name":"Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Zwar","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alys","family":"Havard","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia"},{"name":"Medicine Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, 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