We thank Drs Janssen and Oudijk for their comment on our article on the use of smoking cessation interventions during gestation among pregnant smokers. However, their comments are based on animal studies and have limited clinical implications; furthermore, they do not provide comparative data with the effect of smoking itself. Furthermore, Janssen and Oudijk falsely interpret a non–statistically significant increased risk as “no positive effect” in the only human data that they gave as supporting documentation. In Coleman et al’s meta-analysis, nicotine replacement therapy (NRT) use during gestation increased smoking cessation (which confirms our finding ); Coleman et al also showed that NRT use during pregnancy decreased the risk of adverse pregnancy outcomes, although the estimates were non–statistically significant. Coleman et al further revealed that NRT regimens were associated with higher rates of “survival without developmental impairment” in children, which is a benefit. In another study, Vaz et al described that greater adherence was seen with NRT patches, which is what we are looking for in clinical practice.

With regards to smoking and second-hand smoking risks, human scientific peer-reviewed literature has shown that maternal smoking during pregnancy leads to adverse pregnancy outcomes such as major malformations, low birthweight, and chronic comorbidities in children such as asthma, which is a baseline risk. Hence, our study has attempted to determine the best option available to stop smoking during and after pregnancy to decrease the likelihood of 2 specific outcomes: low birthweight and prematurity. To do that, we have selected a study group of pregnant smokers within a predefined prospective pregnancy cohort; all our study subjects were smokers at the beginning of pregnancy. Hence, our findings reflect the clinical pathway by which a pregnant smoker would decide whether to stop or continue smoking once pregnancy is diagnosed. Our findings give the risk of adverse pregnancy outcomes above and beyond the risk that is associated with smoking.

We greatly disagree with Drs Janssen and Oudijk who stated that NRT should not be a valid option to stop smoking during pregnancy on the basis that it might increase the risk of chronic obstructive pulmonary disease in animals. Of note, chronic obstructive pulmonary disease is a condition that is diagnosed at 40 years of age on average and where smoking/second-hand smoking are the main risk factors. This is in direct contradiction with what Janssen and Oudijk are putting forward based on animal studies. Finally, psychologic interventions to stop smoking during pregnancy have shown very modest success rates, which again is in contradiction with Janssen and Oudijk.