{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T19:10:27Z","timestamp":1791486627007,"version":"4.3.4"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013374","name":"School for Primary Care Research","doi-asserted-by":"publisher","award":["524"],"award-info":[{"award-number":["524"]}],"id":[{"id":"10.13039\/501100013374","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>For nonpregnant people unable to quit smoking, the NHS recommends nicotine replacement therapy (NRT) for smoking reduction. This is not recommended during pregnancy due to concerns about higher nicotine intake than smoking alone. We investigated the relationship between daily nicotine dose from NRT and cigarette consumption reported by pregnant women receiving smoking cessation support.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted secondary analysis of data from currently smoking pregnant women, recruited from antenatal clinics (Nottingham University Hospitals, UK) or online between June 2019\u2013September 2020. Participants set a quit date, received a prototype NRT adherence intervention, and reported cigarettes per day (CPD) and daily NRT dose (mg) via smartphone app for 28 days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>388 women were screened, 32 (8%) were eligible and joined the study. 24 (75%) submitted 510 app reports in total. 17 (71%) reported smoking and using NRT concurrently on at least one day, with concurrent use reported on 109 (21%) of app reports.<\/jats:p>\n                  <jats:p>The relationship between daily NRT dose and CPD followed an exponential decay curve of approximately 7%. In multilevel repeated measures modelling using 4 linear splines (knots 17, 40, and 85 mg\/NRT), significant fixed effects of daily NRT dose on CPD were observed for splines 1, 3, and 4. The strongest association was spline 1 (0\u201317 mg\/NRT), where each 10 mg NRT increase was associated with a 0.6 CPD reduction (24% on average).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Among women in a cessation study, many smoked and used NRT concurrently; within these women, daily nicotine dose and heaviness of smoking were inversely related.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>Findings have implications for the design of future interventions intended to reduce harm associated with smoking in pregnancy. They suggest using NRT alongside smoking in pregnancy could help some women reduce the number of cigarettes they smoke per day.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntad140","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T13:04:55Z","timestamp":1691067895000},"page":"212-219","source":"Crossref","is-referenced-by-count":2,"title":["The Relationship Between Reported Daily Nicotine Dose from NRT and Daily Cigarette Consumption in Pregnant Women Who Smoke in an Observational Cohort Study"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8577-216X","authenticated-orcid":false,"given":"Sophie","family":"Orton","sequence":"first","affiliation":[{"name":"School of Medicine, University of Nottingham , Nottingham NG7 2RD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3295-5891","authenticated-orcid":false,"given":"Lisa","family":"Szatkowski","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham , Nottingham NG7 2RD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9790-2796","authenticated-orcid":false,"given":"Felix","family":"Naughton","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of East Anglia , NR4 7TJ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7303-4805","authenticated-orcid":false,"given":"Tim","family":"Coleman","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham , Nottingham NG7 2RD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"N-Ready team:","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miranda","family":"Clark","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham , Nottingham NG7 2RD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Cooper","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham , Nottingham NG7 2RD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Dickinson","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham , Nottingham NG7 2RD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8915-7033","authenticated-orcid":false,"given":"Joanne","family":"Emery","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of East Anglia , NR4 7TJ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Lewis","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham , Nottingham NG7 2RD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5032-2380","authenticated-orcid":false,"given":"Lisa","family":"McDaid","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of East Anglia , NR4 7TJ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3574-6561","authenticated-orcid":false,"given":"Lucy","family":"Phillips","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham , Nottingham NG7 2RD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Thomson","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham , Nottingham NG7 2RD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,8,3]]},"reference":[{"issue":"S2","key":"2024012222455004700_CIT0001","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.1080\/14622200410001669187","article-title":"The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes","volume":"6","author":"Cnattingius","year":"2004","journal-title":"Nicotine Tob Res."},{"issue":"11","key":"2024012222455004700_CIT0002","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1176\/appi.ajp.160.11.1985","article-title":"Maternal smoking during pregnancy and attention deficit hyperactivity disorder symptoms in offspring","volume":"160","author":"Thapar","year":"2003","journal-title":"Am J Psychiatry."},{"issue":"2","key":"2024012222455004700_CIT0003","first-page":"Art. No.: CD001055","article-title":"Psychosocial interventions for supporting women to stop smoking in pregnancy","volume":"2020","author":"Chamberlain","year":"2017","journal-title":"Cochrane Database Syst Rev."},{"key":"2024012222455004700_CIT0004","author":"The NHS Information Centre","year":"2011"},{"key":"2024012222455004700_CIT0005","doi-asserted-by":"crossref","first-page":"Artn 138","DOI":"10.1186\/1471-2458-5-138","article-title":"Socio-demographic factors associated with smoking and smoking cessation among 426,344 pregnant women in New South Wales, Australia","volume":"5","author":"Mohsin","year":"2005","journal-title":"BMC Public Health"},{"issue":"7","key":"2024012222455004700_CIT0006","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1080\/00016340802179814","article-title":"Do pregnant women still smoke? A study of smoking patterns among 261,029 primiparous women in Denmark 1997-2005","volume":"87","author":"Jensen","year":"2008","journal-title":"Acta Obstet Gynecol Scand."},{"issue":"53","key":"2024012222455004700_CIT0007","first-page":"4","article-title":"Smoking during pregnancy--United States, 1990-2002","volume":"39","author":"Centers for Disease Control and Prevention","year":"2004","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"7","key":"2024012222455004700_CIT0008","doi-asserted-by":"crossref","first-page":"e769","DOI":"10.1016\/S2214-109X(18)30223-7","article-title":"National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis","volume":"6","author":"Lange","year":"2018","journal-title":"Lancet Global Health"},{"issue":"1","key":"2024012222455004700_CIT0009","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-7-65","article-title":"Smoking among pregnant women in Cantabria (Spain): trend and determinants of smoking cessation","volume":"7","author":"Palma","year":"2007","journal-title":"BMC Public Health"},{"key":"2024012222455004700_CIT0010","volume-title":"Australia\u2019s Mothers and Babies 2012","author":"Hilder","year":"2014"},{"issue":"3","key":"2024012222455004700_CIT0011","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/003335491312800308","article-title":"Estimates of smoking before and during pregnancy, and smoking cessation during pregnancy: comparing two population-based data sources","volume":"128","author":"Tong","year":"2013","journal-title":"Public Health Rep."},{"issue":"4","key":"2024012222455004700_CIT0012","doi-asserted-by":"crossref","first-page":"442","DOI":"10.3109\/00016341003678450","article-title":"Prenatal tobacco prevention and cessation interventions for women in low- and middle-income countries. Review","volume":"89","author":"Oncken","year":"2010","journal-title":"Acta Obstet Gynecol Scand."},{"key":"2024012222455004700_CIT0013","author":"NHS Digital"},{"key":"2024012222455004700_CIT0014","first-page":"e769","article-title":"National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis","volume-title":"Lancet Glob Health","author":"Lange","year":"2018"},{"key":"2024012222455004700_CIT0015","author":"Office for National Statistics"},{"key":"2024012222455004700_CIT0016","article-title":"Births in Scotland;","author":"National Records of Scotland","year":"2019"},{"key":"2024012222455004700_CIT0017","article-title":"Tobacco Advisory Group of the Royal College of P","volume-title":"Passive Smoking and Children","year":"2010"},{"key":"2024012222455004700_CIT0018","author":"Papadakis","year":"2019"},{"issue":"11","key":"2024012222455004700_CIT0019","doi-asserted-by":"crossref","first-page":"e018746","DOI":"10.1136\/bmjopen-2017-018746","article-title":"Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort","volume":"7","author":"Cooper","year":"2017","journal-title":"BMJ Open."},{"issue":"4","key":"2024012222455004700_CIT0020","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1093\/ije\/dyy110","article-title":"Placental weight and birthweight: the relations with number of daily cigarettes and smoking cessation in pregnancy. A population study","volume":"47","author":"Larsen","year":"2018","journal-title":"Int J Epidemiol."},{"issue":"1","key":"2024012222455004700_CIT0021","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ypmed.2004.04.049","article-title":"Expired air carbon monoxide concentration in mothers and their spouses above 5 ppm is associated with decreased fetal growth","volume":"40","author":"Gomez","year":"2005","journal-title":"Prev Med."},{"issue":"5 Pt 1","key":"2024012222455004700_CIT0022","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/S0029-7844(97)00103-8","article-title":"Smoking in pregnancy, exhaled carbon monoxide, and birth weight","volume":"89","author":"Secker-Walker","year":"1997","journal-title":"Obstet Gynecol."},{"key":"2024012222455004700_CIT0023","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ejogrb.2018.11.020","article-title":"The implications of high carbon monoxide levels in early pregnancy for neonatal outcomes","volume":"233","author":"Reynolds","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"7","key":"2024012222455004700_CIT0024","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1093\/ntr\/ntz151","article-title":"Interest in and use of smoking cessation support across pregnancy and postpartum","volume":"22","author":"Naughton","year":"2020","journal-title":"Nicotine Tob Res."},{"key":"2024012222455004700_CIT0025","article-title":"Tobacco: preventing uptake, promoting quitting and treating dependence","author":"National Institute for Health and Care Excellence (NICE)","year":"2023"},{"issue":"2","key":"2024012222455004700_CIT0026","first-page":"iii","article-title":"\u201cCut down to quit\u201d with nicotine replacement therapies in smoking cessation: a systematic review of effectiveness and economic analysis","volume":"12","author":"Wang","year":"2001","journal-title":"Health Technol Assess (Winchester, England)"},{"issue":"3","key":"2024012222455004700_CIT0027","first-page":"Artn CD010078","article-title":"Pharmacological interventions for promoting smoking cessation during pregnancy","volume":"2020","author":"Claire","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"2024012222455004700_CIT0028","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1111\/add.15185","article-title":"Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis","volume":"116","author":"Taylor","year":"2020","journal-title":"Addiction."},{"issue":"3","key":"2024012222455004700_CIT0029","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/add.14473","article-title":"Comparison of nicotine exposure during pregnancy when smoking and abstinent with nicotine replacement therapy: systematic review and meta-analysis","volume":"114","author":"Hickson","year":"2018","journal-title":"Addiction."},{"issue":"12","key":"2024012222455004700_CIT0030","doi-asserted-by":"crossref","first-page":"2280","DOI":"10.1111\/add.14401","article-title":"Mediators of the effect of nicotine pre-treatment on quitting smoking","volume":"113","author":"Hajek","year":"2018","journal-title":"Addiction."},{"issue":"Suppl 2","key":"2024012222455004700_CIT0031","doi-asserted-by":"crossref","first-page":"S73","DOI":"10.1080\/1462220021000032753","article-title":"Nicotine concentrations with concurrent use of cigarettes and nicotine replacement: a review","volume":"4","author":"Fagerstrom","year":"2002","journal-title":"Nicotine Tob Res."},{"issue":"9","key":"2024012222455004700_CIT0032","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1111\/add.14662","article-title":"Saliva cotinine concentrations in pregnant women who smoke and use nicotine patches","volume":"114","author":"Claire","year":"2019","journal-title":"Addiction."},{"issue":"3","key":"2024012222455004700_CIT0033","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1111\/add.15671","article-title":"Comparison of saliva cotinine and exhaled carbon monoxide concentrations when smoking and after being offered dual nicotine replacement therapy in pregnancy","volume":"117","author":"Slaich","year":"2021","journal-title":"Addiction."},{"key":"2024012222455004700_CIT0034","volume-title":"Open Science Framework","author":"Emery Joanne","year":"2020"},{"issue":"10","key":"2024012222455004700_CIT0035","doi-asserted-by":"crossref","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med."},{"issue":"1","key":"2024012222455004700_CIT0036","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s13104-022-05983-8","article-title":"The development and acceptability testing of an app-based smart survey system to record smoking behaviour, use of nicotine replacement therapy (NRT) and e-cigarettes","volume":"15","author":"Huang","year":"2022","journal-title":"BMC Res Notes."},{"key":"2024012222455004700_CIT0037","volume-title":"Using NRT for smoking reduction in pregnancy; exploration of novel cohort data","author":"Orton","year":"2022"},{"key":"2024012222455004700_CIT0038","volume-title":"Stata Statistical Software: Release 17","author":"StataCorp","year":"2021"},{"key":"2024012222455004700_CIT0039","first-page":"1","article-title":"Multilevel modelling of repeated measures data: Stata practical","volume-title":"LEMMA VLE Module 15","author":"Steele"},{"issue":"suppl 1","key":"2024012222455004700_CIT0040","doi-asserted-by":"crossref","first-page":"S45","DOI":"10.1093\/ntr\/ntq038","article-title":"The reliability and predictive validity of the Heaviness of Smoking Index and its two components: findings from the International Tobacco Control Four Country study","volume":"12","author":"Borland","year":"2010","journal-title":"Nicotine Tob Res."},{"issue":"6","key":"2024012222455004700_CIT0041","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1111\/1471-0528.16553","article-title":"Pregnant women\u2019s use of e-cigarettes in the UK: a cross-sectional survey","volume":"128","author":"Bowker","year":"2020","journal-title":"BJOG: Int J Obstet Gy."},{"issue":"5","key":"2024012222455004700_CIT0042","doi-asserted-by":"crossref","first-page":"e004915","DOI":"10.1136\/bmjopen-2014-004915","article-title":"Longitudinal cohort survey of women\u2019s smoking behaviour and attitudes in pregnancy: study methods and baseline data","volume":"4","author":"Orton","year":"2014","journal-title":"BMJ Open."},{"issue":"10","key":"2024012222455004700_CIT0043","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/0895-4356(95)00020-5","article-title":"Are self-reports of smoking rate biased? Evidence from the Second National Health and Nutrition Examination Survey","volume":"48","author":"Klesges","year":"1995","journal-title":"J Clin Epidemiol."},{"key":"2024012222455004700_CIT0044","doi-asserted-by":"crossref","first-page":"35045","DOI":"10.2196\/35045","article-title":"Comparison of a daily smartphone app and retrospective questionnaire measures of adherence to nicotine replacement therapy within pregnant women: observational study","volume":"7","author":"Emery","year":"2022","journal-title":"JMIR Form Res"},{"key":"2024012222455004700_CIT0045","volume-title":"Millennium Cohort Study First Survey: A Users Guide to Initial Findings","author":"Dex","year":"2004"},{"key":"2024012222455004700_CIT0046","article-title":"Infant feeding survey 2010","volume-title":"Health and Social Care Information Centre","author":"Renfrew","year":"2011"},{"issue":"1","key":"2024012222455004700_CIT0047","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1037\/0278-6133.17.1.6","article-title":"Strategies for analyzing ecological momentary assessment data","volume":"17","author":"Schwartz","year":"1998","journal-title":"Health Psychol."},{"issue":"1","key":"2024012222455004700_CIT0048","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev.clinpsy.3.022806.091415","article-title":"Ecological momentary assessment","volume":"4","author":"Shiffman","year":"2008","journal-title":"Annu Rev Clin Psychol."},{"issue":"9","key":"2024012222455004700_CIT0049","first-page":"CD013183","article-title":"Smoking reduction interventions for smoking cessation","volume":"9","author":"Lindson","year":"2019","journal-title":"Cochrane Database Syst Rev."},{"issue":"6186","key":"2024012222455004700_CIT0050","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1136\/bmj.2.6186.357","article-title":"Self-titration by cigarette smokers","volume":"2","author":"Ashton","year":"1979","journal-title":"BMJ"},{"issue":"6","key":"2024012222455004700_CIT0051","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1111\/j.1360-0443.1993.tb02096.x","article-title":"Self-titration of nicotine: evidence from the Scottish Heart Health Study","volume":"88","author":"Woodward","year":"1993","journal-title":"Addiction."}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntad140\/51248331\/ntad140.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/26\/2\/212\/56333079\/ntad140.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/26\/2\/212\/56333079\/ntad140.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T22:48:09Z","timestamp":1705963689000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/26\/2\/212\/7236495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,3]]},"references-count":51,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,8,3]]},"published-print":{"date-parts":[[2024,1,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntad140","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2,1]]},"published":{"date-parts":[[2023,8,3]]}}}