Effects of nicotine patch or nasal spray on nicotine and cotinine concentrations in pregnant smokers.

OBJECTIVE To examine the short-term effects of the nicotine patch or nasal spray on measures of nicotine exposure, withdrawal symptoms, and on maternal and fetal heart rates in pregnant smokers. METHODS We measured nicotine/cotinine concentrations and maternal and fetal heart rates during an 8-h monitoring session while smoking and again after 4 days of nicotine patch (15 mg/16 h), nasal spray (recommended regimen of 24 doses per day), or placebo treatment. Nicotine withdrawal symptoms were assessed daily. RESULTS Twenty-one subjects, who smoked an average of 17 cigarettes per day, completed both monitoring sessions. Nicotine concentrations decreased from baseline smoking concentrations in all groups (p = 0.002). Percent change in cotinine concentration differed across groups (reduction = 77% with placebo, 70% with nasal spray, and 48% with patch; p = 0.029). Maternal heart rate decreased in the placebo and nasal spray groups compared with the patch group (p = 0.021). The baseline fetal heart rate decreased in the placebo group throughout the second monitoring session, but increased slightly in the patch and nasal spray groups. The treatment by time interaction was marginally significant (p = 0.052). Daily, cigarette craving decreased more in the patch versus the other groups (p = 0.025). CONCLUSIONS Nicotine patch and nasal spray reduce maternal nicotine exposure compared with smoking and may be effective for smoking cessation.