***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aims To assess whether associations between maternal smoking during pregnancy and offspring smoking initiation  are due to intrauterine mechanisms . Design Comparison of associations of  maternal and partner smoking behaviour during pregnancy with  offspring smoking initiation using partner smoking as a negative control ( n = 6484 ) and a Mendelian r and omization analysis ( n = 1020 ) , using a genetic variant in the mothers as a proxy for smoking cessation during pregnancy . Setting A longitudinal birth cohort in South West Engl and . Participants Participants of the Avon Longitudinal Study of Parents and Children ( ALSPAC ) . Measurements  Smoking status during pregnancy  was self-reported by mother and partner in question naires administered at pregnancy . Latent classes of offspring smoking initiation ( non-smokers , experimenters , late-onset regular smokers and early-onset regular smokers ) were previously developed from question naires administered at 14–16 years . A genetic variant , rs1051730 , was genotyped in the mothers . Findings Both mother and partner smoking were similarly positively associated with offspring smoking initiation classes , even after adjustment for confounders . Odds ratios ( OR ) [ 95 % confidence interval ( CI ) ] for class membership compared with non-smokers were : experimenters : mother OR = 1.33 ( 95 % CI = 1.06 , 1.67 ) , partner OR = 1.28 ( 95 % CI = 1.06 , 1.55 ) , late-onset regular smokers : mother OR = 1.80 ( 95 % CI = 1.43 , 2.26 ) , partner OR = 1.86 ( 95 % CI = 1.52 , 2.28 ) and early-onset regular smokers : mother OR = 2.89 ( 95 % CI = 2.12 , 3.94 ) , partner OR = 2.50 ( 95 % CI = 1.85 , 3.37 ) . There was no clear evidence for a dose – response effect of either mother or partner smoking heaviness on class membership . Maternal rs1051730 genotype was not clearly associated with offspring smoking initiation class in pre-pregnancy smokers ( P = 0.35 ) . Conclusion The association between smoking during pregnancy and offspring smoking initiation does not appear to operate through intrauterine mechanisms Background : Nicotine replacement therapy ( NRT ) helps smokers quit smoking , but trials indicate that there is no evidence that it is effective during pregnancy . As metabolism increases during pregnancy , NRT may deliver insufficient nicotine to alleviate withdrawal symptoms . There is mixed evidence as to what levels of cotinine are reached from nicotine exposure during pregnancy while using NRT compared with smoking . Methods : We analyzed data on 33 pregnant participants from the NRT arm of a r and omized control trial who had stopped smoking and were still using 15mg/16hr nicotine patches 1 month after quitting .  Salivary cotinine levels when smoking at baseline were compared with levels on NRT at 1 month using the Wilcoxon test . Results : Cotinine levels were a median of 98.5ng/ml while smoking and 62.8ng/ml while using NRT and remaining abstinent ( p = .045 ) . Participants with the highest cotinine measurements when smoking also tended to have the steepest reduction in cotinine levels while using NRT . This was most noticeable among participants with baseline cotinine levels more than 150ng/ml ( n = 9 ) who had a greater reduction in median cotinine levels ( median difference −134.8ng /ml [ 95 % CI = −144.5 to −125.9 ] ) than those with a baseline cotinine level under 150ng/ml ( n = 24 ; median difference −27.9ng/ml [ 95 % CI = −49.35 to −1.75 ] ) . Conclusions : In a pragmatic trial that replicated clinical practice , cotinine levels generated using NRT during pregnancy were lower than levels achieved from smoking . Although the sample size of this study was small , our findings are significant and are consistent with the hypothesis that NRT patches deliver an inadequate dose of nicotine to aid smoking cessation during pregnancy INTRODUCTION Nicotine replacement therapy ( NRT ) medications have been shown to be effective in increasing smoking cessation rates . There is , however , a lack of good evidence describing how individuals in primary care use these medications and which factors are likely to affect this . The study objectives are to describe adherence and consumption , examine key factors that may determine use , and examine the relationship between consumption of NRT  and abstinence from smoking . METHODS Secondary analysis of data from a r and omized controlled trial conducted in smoking cessation services in primary care . Adult smokers ( n = 633 ) starting a quit attempt within smoking cessation clinics were followed for 6 months , with NRT use closely monitored for an initial treatment period of 4 weeks . The main outcomes were 4-week adherence to prescribed NRT , mean daily consumption of NRT over the 4-week period , and abstinence from smoking at 4 weeks . RESULTS Levels of adherence to prescribed NRT  were high : more than 94 % in participants who completed the treatment period . After controlling for possible confounders , prescribing higher doses of patch and oral NRT was associated with higher mean daily consumption of NRT .  Using an inhalator to deliver oral NRT was associated with both higher adherence and higher consumption . The amount of NRT consumed predicted future abstinence when reverse causation was accounted for . CONCLUSIONS Most individuals within a clinical trial in primary care who persisted with a quit attempt adhered closely to their prescription . Prescribing higher doses of NRT led to higher consumption and higher consumption to higher abstinence BACKGROUND Nicotine-replacement therapy is effective for smoking cessation outside pregnancy and its use is widely recommended during pregnancy . We investigated the efficacy and safety of nicotine patches during pregnancy . METHODS We recruited participants from seven hospitals in Engl and who were 16 to 50 years of age with pregnancies of 12 to 24 weeks ' gestation and who smoked five or more cigarettes per day . Participants received behavioral cessation support and were r and omly assigned to 8 weeks of treatment with active nicotine patches ( 15 mg per 16 hours ) or matched placebo patches . The primary outcome was abstinence from the date of smoking cessation until delivery , as vali date d by measurement of exhaled carbon monoxide or salivary cotinine . Safety was assessed by monitoring for adverse pregnancy and birth outcomes . RESULTS Of 1050 participants , 521 were r and omly assigned to nicotine-replacement therapy and 529 to placebo .  There was no significant difference in the rate of abstinence from the quit date until delivery between the nicotine-replacement and placebo groups ( 9.4 % and 7.6 % , respectively ; unadjusted odds ratio with nicotine-replacement therapy , 1.26 ; 95 % confidence interval , 0.82 to 1.96 ) , although the rate was higher at 1 month in the nicotine-replacement group than in the placebo group ( 21.3 % vs. 11.7 % ) . Compliance was low ; only 7.2 % of women assigned to nicotine-replacement therapy and 2.8 % assigned to placebo used patches for more than 1 month . Rates of adverse pregnancy and birth outcomes were similar in the two groups . CONCLUSIONS Adding a nicotine patch ( 15 mg per 16 hours ) to behavioral cessation support for women who smoked during pregnancy did not significantly increase the rate of abstinence from smoking until delivery or the risk of adverse pregnancy or birth outcomes . However , low compliance rates substantially limited the assessment of safety . ( Funded by the National Institute for Health Research Health Technology Assessment Programme ; Current Controlled Trials number , IS RCT N07249128 . ) OBJECTIVE : To estimate the safety and efficacy of treatment with 2-mg nicotine gum for smoking cessation during pregnancy . METHODS : Pregnant women who smoked daily received individualized behavioral counseling and r and om assignment to a 6-week treatment with 2-mg nicotine gum or placebo followed by a 6-week taper period . Women who did not quit smoking were instructed to reduce the number of cigarettes smoked by substituting with gum . Measures of tobacco exposure were obtained throughout the study . RESULTS : Participants in the nicotine ( nequals;100 ) and placebo ( nequals;94 ) groups were comparable in age , race/ethnicity , and smoking history . Biochemically vali date d smoking-cessation rates were not significantly higher with nicotine gum compared with placebo ( after 6 weeks of treatment : 13 % compared with 9.6 % , P=.45 ; at 32–34 weeks of gestation : 18 % compared with 14.9 % , P=.56 ) . Using a completer analysis , nicotine gum significantly reduced the number of cigarettes smoked per day  ( nicotine gum : −5.7 [ st and ard deviation (SD)=6.0 ] ; placebo : −3.5 [ SD=5.7 ] , P=.035 ) , and cotinine concentration  ( nicotine gum : −249 ng/mL [ SD=397 ] ; placebo : −112 ng/mL [ SD=333 ] ; P=.04 ) . Birth weights were significantly greater with nicotine gum compared with placebo ( 3,287 g [ SD=566 ] and 2,950 g [ SD=653 ] , respectively , P<.001 ) . Gestational age was also greater with nicotine-replacement therapy than with placebo ( 38.9 weeks [ SD=1.7 ] and 38.0 weeks [ SD=3.3 ] , respectively ; P=.014 ) . CONCLUSION : Although nicotine gum did not increase quit rates , use of nicotine gum increased birth weight and gestational age , two key parameters in predicting neonatal wellbeing . CLINICAL TRIAL REGISTRATION : Clinical trials.gov , www . clinical trials.gov , NCT00115687 LEVEL OF EVIDENCE : In a prospect i ve , population -based cohort study , the authors investigated the effect of in-utero exposure to maternal smoking and consumption of alcohol , coffee , and tea on the risk of strabismus .  They review ed medical records for children in the Danish National Birth Cohort identified through national registers as possibly having strabismus . Relative risk estimates were adjusted for year of birth , social class , maternal smoking , maternal age at birth , and maternal coffee and tea consumption . The authors identified 1,321 cases of strabismus in a cohort of 96,842 Danish children born between 1996 and 2003 . Maternal smoking was associated with a significantly elevated risk of strabismus in the child , increasing with number of cigarettes smoked per day ( < 5 cigarettes/day : relative risk ( RR ) = 0.95 , 95 % confidence interval ( CI ) : 0.80 , 1.14 ; 5-<10 cigarettes/day : RR = 1.38 , 95 % CI : 1.12 , 1.70 ; > or = 10 cigarettes/day : RR = 1.90 , 95 % CI : 1.57 , 2.30 ) . Nicotine replacement therapy was not associated with strabismus risk ( RR = 1.22 , 95 % CI : 0.92 , 1.61 ) . Light maternal alcohol consumption was inversely associated with strabismus risk , whereas maternal coffee and tea drinking were not associated with strabismus risk . In conclusion , smoking during pregnancy is associated with an increased risk of strabismus in the offspring . Conversely , light alcohol consumption is associated with decreased risk Objective To determine the efficacy of 16 hour nicotine patches among pregnant smokers , with the dose individually adjusted according to saliva cotinine levels ( potential range 10 - 30 mg/day ) . Design R and omised , double blind , placebo controlled , parallel group , multicentre trial ( Study of Nicotine Patch in Pregnancy , SNIPP ) between October 2007 and January 2013 . Setting 23 maternity wards in France . Participants 476 pregnant smokers aged more than 18 years and between 12 and 20 weeks ’ gestation , who smoked at least five cigarettes a day . After exclusions , 402 women were r and omised : 203 to nicotine patches and 199 to placebo patches . Data were available on 192 live births in each group . Interventions Nicotine and identical placebo patches were administered from quit day up to the time of delivery . Doses were adjusted to saliva cotinine levels when smoking to yield a substitution rate of 100 % . Participants were assessed monthly and received behavioural smoking cessation support . Main outcome measures The primary outcomes were complete abstinence ( self report confirmed by carbon monoxide level in expired air ≤8 ppm ) from quit date to delivery , and birth weight . The secondary outcomes were point prevalence of abstinence , time to lapse ( a few puffs ) or relapse , and delivery and birth characteristics . All data were analysed on an intention to treat basis . 
    Output:
    
Pregnant women who use nicotine replacement therapy instead of smoking reduce their nicotine exposure