Barriers & Facilitators to Nicotine Replacement Therapy in Smoking Cessation during Pregnancy & Post-partum Period

Abstract

Smoking tobacco during pregnancy is associated with a number of pregnancy complications and a range of poor foetal outcome. This review aims to assess barriers and facilitators to the use of nicotine replacement therapy in smoking cessation during pregnancy and the postpartum period. A number of barriers to achieving smoking cessation are emerged from three issue areas: pregnant women, health providers, and organizations. Pregnancy-specific barriers included lack of support, lack of knowledge and awareness about smoking harms, lack of planning, and understanding of the consequences of smoking during pregnancy. Health Providers (HPs) related barriers are lack of knowledge and awareness about nicotine replacement therapy (NRT) prescription, Credibility of HPs and at an organization level, weak policies and organizational frameworks are some of the barriers. Facilitators to NRT use in pregnancy are relationships with partners, family, friends, and HPs, knowledge, and awareness about NRT, an organizational framework like stop smoking-cessation services (SSSs), Carbon monoxide (CO) monitoring, community support for smoking cessation, and clear policies. Smoking-cessation treatment should consist of three phases: preparation, intervention, and maintenance. Preparation aims to increase the pregnant smoker's motivation to quit and to build confidence that he or she can be successful. Intervention can take any number of forms (or a combination of them) to help pregnant smokers to achieve abstinence. Maintenance, including support, coping strategies, and substitute behaviors, is necessary for permanent abstinence.