It’s not news that smoking during pregnancy can lead to numerous birth defects, including premature birth, low-birth-weight infants, stillbirth, and sudden infant death syndrome (SIDS). So mothers often turn to nicotine replacement therapy (NRT), such as nicotine patches or gum, to help in their smoking cessation efforts. But many doctors disagree over whether nicotine patches are worth it, because nicotine itself can cause potentially equal harm to unborn infants.

Though up to 30 percent of doctors introduce the prospect of nicotine replacement therapy to pregnant smokers, others don’t believe a nicotine patch or gum does any good. “Let’s first start with, does it work?” Ted Slotkin, professor of pharmacology at Duke University School of Medicine, told NPR. “The answer is not very well or not at all.” A 2012 New England Journal of Medicine study found that nicotine replacement therapy, though effective for smoking cessation among regular smokers, was actually not helpful for pregnant women. However, most doctors do agree on one thing: nicotine replacement products are at least slightly better than outright smoking, because the baby will be spared all the thousands of other chemicals present in cigarette smoke —  carbon monoxide, for example, can damage fetal cells. “It’s much better that [the pregnant mother take] nicotine instead of all the other smoke products, because they’re going to cause lung cancer and other things,” Slotkin told NPR.

Researchers, led by Maria Morales-Suarez-Varela of the University of Valencia in Spain, likewise found similar results when researching the nicotine patch in pregnant women. "Nicotine is fetotoxic, but one could argue that if nicotine replacement (patches, gum, or inhalers) is the only effective smoking cessation tool, for some pregnant women it is a better alternative than smoking because hundreds of potentially harmful substances are replaced by a single one," the authors concluded, according to the Daily Mail. "On the other hand, nicotine substitutes have a different absorption route and may reach higher peak values."

Effects Of Nicotine On Development

But even if a pregnant woman manages to stop smoking cigarettes, and does nicotine replacement therapy instead, to what extent does the nicotine have a negative effect on her unborn child? Slotkin believes “an awful lot” of health problems can be caused by nicotine. Some animal studies have pointed out a link between nicotine patches and birth defects. Nicotine interrupts endogenous acetylcholine receptors in the brain and lungs, which can cause developmental disruptions and abnormalities. “Logically, nicotine replacement should be safer than smoking, but several animal studies indicate that the total dose of nicotine that the fetus is exposed to may be what really matters for brain development,” the authors of a 2007 study write in their conclusion. However, other research has come up with different results: another study found that the use of NRT during pregnancy did not actually increase the risk of stillbirth.

How To Curb Nicotine During Pregnancy

Whether you’re a long-time smoker and are struggling to kick the habit, or you smoked for the first few weeks of your pregnancy without knowing you were pregnant, it’s a worrisome situation to be in. Outright quitting cold-turkey — though it’s certainly the best option — can be daunting for some smokers. Slotkin believes that if you can’t stay away from nicotine at all, the best option might be to choose nicotine gum over nicotine patches. This is because nicotine patches provide a constant flow of nicotine through the skin, while nicotine gum or lozenges interrupt that flow, ultimately reducing the total amount of the stimulant that the baby is exposed to.

A 2008 study, conducted by Dr. Cheryl Oncken of the University of Connecticut Health Center, found that nicotine gum could be a healthier alternative than nicotine patches. “[T]his study suggests that two milligrams of nicotine gum does not increase smoking cessation rates, but may reduce overall tobacco exposure during pregnancy,” the authors write in the conclusion. “Nicotine gum was associated with greater birth weight and gestational age than placebo gum, yielding parameters similar to those of a nonsmoker.”

Ultimately, the truth is that there is no exact answer on whether nicotine replacement therapy is an absolute risk. “There’s no clear path to follow,” Dr. Oncken told NPR. “So the decision has to be between the patient and her health care provider.”