Nicotine patch use in pregnancy: plasma and urine measurements of nicotine and cotinine

OBJECTIVE: The null hvpothesis i.s that the levels of nicotine and coiininc are unchanged by ihe use of nicotine patch compared lo IrveK seen in smoking. STUDY DESIGN: fwetm smoking pregnant women were recruited lor smoking ressalion. Following preliminary blood levels lot nicotine (N) and cotinine (C), noustress tests, and ultrasounds tor letal well-being, tinpatients were first patched with a 22 mg iransdennal nicotine patch in the hospital. Gestutional ages r.tuged from 2,"i to 32 weeks. Following patch application. 24-hour urine ,iud a.m. and p.m. blood levels for cotinine and nicotine were drawn foi 4 days. Baseline smoking lvefs öl N and C. were compared to levels obtained on day -4 of the nicotine patch. RESULTS: In all cases, plasma N and cotinine C. levels were higher ti to 8 hours after the nicotine patch was placed (peak) vs. 2-4 hours after the nicotine patch was placed (trough) (p < .01. sign lest). Mean plasma lexels of N and C are given in ng ml. below Smoking patch(Trough) Patch (Peak) Cotinine 148.7 88.7 124.8 SEM 16.5 6.1 7.8 Variance 5137 740 1221 Nicotine 7.W 4.06 1:1.1 SFM l.46 0.13 1.12 Variance 17,0 1.65 11.4- p < .02 compared, to smoking baseline (rank sum test)= p < .005 tlifferenees in variance CONCLUSIONS: Plasma N and C ltu-K and patteins change wlu-n pregnan; women couvei t h oin cigaieite smoking to nicotine patch therap. Tin- low trough leveN o C and the high peak levels of N associated with nicotine patch therapy mav be associated uiih decreased success in using nicotine patch tierapy iti preguaney. Nicotine patch use in piegnano does, however produce much more predictable plasma levels oi N and C than cigarette smoking.