Background:
While pregnant smokers are receptive to using smoking cessation pharmacotherapies (SCPs), few actually use prescription SCPs during pregnancy. Due to the uncertainty regarding SCP safety during pregnancy, it is hypothesized that caution among healthcare providers (HCPs) contributes to low SCP utilisation. This study examined the extent of HCPs' concerns regarding SCPs, relative to other medications, using data from MotherSafe, the telephone-based Australian teratology information service.

Methods:
71,473 pregnancy-related calls (2001-2016), for which a medication was the primary reason for the call, were categorised as regarding nicotine replacement therapy [NRT], bupropion varenicline or other medicines, which were categorised according to Australia's classification of risk during pregnancy: category A (low risk), B1, B2, B3 , C , D or X (teratogenic). Calls were grouped into those made by HCPs (GPs, midwives, obstetricians or pharmacists) and consumers. Separate logistic regression models examined the odds for HCPs to call about each SCP relative to all other categories of medications.

Results:
HCPs were more likely to call about bupropion (n=12) than other medications in the same (B2) and higher (B3 and C) risk categories (B2: odds ratio [OR] 3.07; 95%CI 1.38-6.83, B3:2.48; 1.11-5.53, C: 2.36; 1.06-5.26). HCPs were more likely to call about varenicline (n=27) than other medications in the same category B3 (2.74; 1.57-4.78), and higher risk categories (C: 2.67; 1.53-4.67, D: 1.89; 1.08-3.32, X: 1.93; 1.02-3.66). There was no difference in HCP's likelihood to call regarding NRT relative to its corresponding category (D) (1.20; 0.94-1.52).

Conclusions:
HCPs had a greater level of concern regarding bupropion and varenicline than other medicines in the same and higher risk categories. As these reservations may be limiting the use of SCP during pregnancy, research is needed to better understand and help correct this imbalance. This includes better quality evidence regarding the safety of SCP during pregnancy.