NEJM: Smoker’s nicotine patches fail to decrease the rate of smoking during pregnancy. Smoking during pregnancy increases the risk of miscarriage, preterm delivery, birth defects and SIDS but what does the patch do? Early pregnancy patch users have a 60 per cent higher chance of birth defects than non-smokers and should be warned against using nicotine replacement therapies. If it really is “First do no harm” then how can anything be dispensed by docs that harms? Best option: make an informed decision and no smoking or patching during pregnancy.