The NEJM ran an editorial to accompany this paper. This was almost comical in its lack of understanding. It said that the findings of this research were consistent with previous research:
The finding that nicotine-replacement therapy did not improve long-term quit rates in pregnancy is consistent with two other, smaller, placebo-controlled studies of nicotine gum or patches in pregnant smokers. In these studies, adherence to therapy was also low with respect to dose (number of pieces of gum per day) and duration of treatment; the average duration of use of nicotine-replacement therapy was less than 20% of the recommended duration for the patch and less than 50% of that recommended for gum.
And it went on to lament like a voice crying in the wilderness:
Adherence to therapy is a well-recognized determinant of efficacy. With low adherence rates in placebo-controlled trials of nicotine-replacement therapy in pregnant smokers, it is difficult for clinicians to counsel their patients regarding whether such treatment would be efficacious or safe if used as directed.
Of course, the human tendency to weakness of will is the problem: if it weren’t, people wouldn’t need nicotine patches in the first place.
Despite the absence of evidence that nicotine patches do any good in pregnancy, they have been widely, almost routinely, recommended. This is because the desire to do something rather than nothing is among the strongest known, if not to man, then at least to the medical profession. When in doubt, prescribe.