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​​​​​​​​​​Pregnant and Breastfeeding Women  Overview of Evidence

The following recommendations, and supporting evidence, have been extracted from existing clinical practice guidelines to inform the development of the CAN-ADAPTT Summary Statements. 
CAN-ADAPTT worked with the Guidelines Advisory Committee (GAC) to conduct a literature search (years: 2002-2009) to identify existing clinical practice guidelines (CPGs). Five existing clinical practice guidelines were identified as meeting the high quality criteria set out in the AGREE Instrument. The recommendations contained in these high-quality CPGs have been used as the evidence base for the CAN-ADAPTT guideline development process. Click here to view CAN-ADAPTT’s guideline development process flowchart.

U.S. Department of Health and Human Services Public Health Service (2008)1

Because of the serious risks of smoking to the pregnant smoker and the fetus, whenever possible pregnant smokers should be offered person-to-person psychosocial interventions that exceed minimal advice to quit.  
(Strength of Evidence = A)
Although abstinence early in pregnancy will produce the greatest benefits to the fetus and expectant mother, quitting at any point in pregnancy can yield benefits.  Therefore, clinicians should offer effective tobacco dependence interventions to pregnant smokers at the first prenatal visit as well as throughout the course of pregnancy. (Strength of Evidence = B)

New Zealand Ministry of Health (2007)2

Offer all pregnant and breastfeeding women who smoke multi-session behavioural smoking cessation interventions from a specialist/dedicated cessation service.  (Grade=A) 
All health care workers should briefly advise pregnant and breastfeeding women who smoke to stop smoking.  (Grade = A)
NRT can be used in pregnancy and during breastfeeding following a risk-benefit assessment.  If NRT is used, oral NRT products (for example, gum, inhalers, microtabs and lozenges) are preferable to nicotine patches.  (Grade=C)

Registered Nurses Association of Ontario (2007)3

Nurses implement, wherever possible, intensive intervention with women who are pregnant and postpartum.  (Strength of Evidence = A)

1. U.S. Department of Health and Human Services Public Health Service. (2008, May). Clinical practice guideline: Treating tobacco use and dependence: 2008 update.
2. Ministry of Health. (2007, August). New Zealand smoking cessation guidelines. Wellington: Ministry of Health.
3. Registered Nurses Association of Ontario (RNAO). (2007, March). Integrating smoking cessation into daily nursing practice. Retrieved October 26, 2007 from:​ 

Pregnant and Breastfeeding Women