Comparison of saliva cotinine and exhaled carbon monoxide concentrations when smoking and after being offered dual nicotine replacement therapy in pregnancy

Slaich, Bhavandeep; Claire, Ravinder; Emery, Joanne; Lewis, Sarah; Cooper, Sue; Thomson, Ross; Phillips, Lucy; Kinahan-Goodwin, Darren; Naughton, Felix; McDaid, Lisa; Clark, Miranda; Dickinson, Anne; Coleman, Tim

Abstract

Background and Aims
Although English Stop Smoking Services routinely offer dual nicotine replacement therapy (NRT) to help pregnant women quit smoking, little is known about how nicotine and tobacco smoke exposures following this compares with that from smoking. We compared, in pregnant women when smoking and after being offered dual NRT, saliva cotinine and exhaled carbon monoxide (CO) concentrations and numbers of daily cigarettes smoked.

Design and Setting
Secondary analysis of data from three sequential, observational, mixed-methods cohort studies conducted as part of the ‘Nicotine Replacement Effectiveness and Delivery in Pregnancy’ programme. Participants were recruited online or in Nottingham University Hospitals (UK) antenatal clinics between June 2019 and September 2020.

Participants
40 pregnant women, who agreed to try stopping smoking.

Intervention
Participants were offered dual NRT, agreed a smoking quit date and received an intervention to improve adherence to NRT.

Measurements
Saliva cotinine and exhaled CO concentrations and reported number of cigarettes smoked per day.

Findings
There were no differences in saliva cotinine concentrations at baseline and day seven post quit date (n = 20, mean difference = -32.31 ng/ml, 95% confidence interval (CI) = -68.11 to 3.5 ng/ml; P = 0.074, Bayes factor = 0.04). There were reductions in the reported number of cigarettes smoked per day (n = 26, mean difference = -7 cigarettes, 95% CI = -8.35 to -5.42 cigarettes, P ≤0.001) and concurrently in exhaled CO concentrations (n = 17, ratio of geometric means = 0.30 p.p.m., 95% CI = 0.17 to 0.52 p.p.m.; P ≤0.001).

Conclusion
Pregnant women who smoke and are offered dual nicotine replacement therapy (NRT) appear to show no change in their exposure to cotinine compared with their pre-NRT exposure levels but they report smoking fewer cigarettes, as validated by reductions in exhaled carbon monoxide concentrations.

Citation

Slaich, B., Claire, R., Emery, J., Lewis, S., Cooper, S., Thomson, R., …Coleman, T. (2022). Comparison of saliva cotinine and exhaled carbon monoxide concentrations when smoking and after being offered dual nicotine replacement therapy in pregnancy. Addiction, 117(3), 751-759. https://doi.org/10.1111/add.15671

• Journal Article Type: Article
• Acceptance Date: Aug 11, 2021
• Online Publication Date: Aug 23, 2021
• Publication Date: 2022-03
• Deposit Date: Aug 24, 2021
• Publicly Available Date: Aug 24, 2022
• Journal: Addiction
• Print ISSN: 0965-2140
• Electronic ISSN: 1360-0443
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 117
• Issue: 3
• Pages: 751-759
• DOI: https://doi.org/10.1111/add.15671
• Keywords: Psychiatry and Mental health; Medicine (miscellaneous)
• Public URL: https://nottingham-repository.worktribe.com/output/6090031
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/add.15671
• Additional Information: This is the peer reviewed version of the following article: Slaich, B., Claire, R., Emery, J., Lewis, S., Cooper, S., Thomson, R., Phillips, L., Kinahan-Goodwin, D., Naughton, F., McDaid, L., Clark, M., Dickinson, A., and Coleman, T. (2021) Comparison of saliva cotinine and exhaled carbon monoxide concentrations when smoking and after being offered dual nicotine replacement therapy in pregnancy, Addiction, which has been published in final form at https://doi.org/10.1111/add.15671. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.