The use of nicotine gum or patches to help a smoker quit whilst pregnant
or breastfeeding is a curly question. The drug company information on
both the gum and patches warns that all forms of nicotine are dangerous
to pregnant and b/f women, and thus women who smoke should be encouraged
to stop using education and behavioural techniques. The manufacturers of
several brands of patches  point out that cigarette smoking is associated
with low birth weight, increased risk of spontaneous abortion and increased
perinatal mortality, but that the risks associated with nicotine patches
is unknown (but is thought to be similar). Nicotine also passes into breast
milk at a plasma:milk ration of 2.9, and is said to be contraindicated in
breastfeeding women.
What I wonder is, if a mum is already smoking 20 plus cigarettes a day,
she is already getting nicotine, plus masses of other nasties, into her
foetus or breastmilk already. It seems to me that if using a patch or gum
of nicotine will help her quit smoking, then it seems like the lesser of
two evils. I'm not a pharmacist or an expert in this field, but I'm lead
to believe that the blood levels of nicotine from using the gum is one
to two thirds that of smoking a cigarette, and that patches achieve levels
about one half the smoking level. I'd be interested to hear what others
think about this. (If anyone is still on line apart from me and Janet!)

Fiona Coombes
NMAA Breastfeeding Counsellor
Family Physician  IBCLC
Perth, Western Australia