People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
This guideline should be read alongside NICE's guidelines on patient experience in adult NHS services and babies, children and young people's experience of healthcare, which have guidance on giving information to people and discussing their views and preferences.
At the time of publication (February 2025), no nicotine-containing e-cigarettes were licensed as a medicine for stopping smoking by the Medicines and Healthcare products Regulatory Agency (MHRA) and commercially available in the UK market. All nicotine-containing e-cigarettes in the UK that are not licensed as a medicine by the MHRA are regulated by the Tobacco and Related Products Regulations (2016), and cannot be marketed by the manufacturer for use for stopping smoking.
These recommendations aim to help women, and trans men and non-binary people, stop smoking during pregnancy and in the first year after childbirth.
Other recommendations relevant in pregnancy are in the section on support to stop smoking in secondary care services.
These recommendations are for healthcare professionals providing maternity care to pregnant women, and pregnant trans men and non-binary people.
Provide routine carbon monoxide testing at the first antenatal appointment and at the 36-week appointment to assess the pregnant woman or pregnant person's exposure to tobacco smoke. Provide carbon monoxide testing at all other antenatal appointments if they:
smoke or
are quitting or
used to smoke or
tested with 4 parts per million (ppm) or above at the first antenatal appointment. [2023]
Provide an opt-out referral to receive stop-smoking support during pregnancy for those who:
say they smoke or have stopped smoking in the past 2 weeks or
have a carbon monoxide reading of 4 ppm or above or
have previously been provided with an opt-out referral but have not yet engaged with stop-smoking support.
See also the section on identifying smoking among carers, family and other household members. [2021]
Explain:
that it is normal practice to refer anyone who is pregnant and who smokes or has recently quit
that the carbon monoxide test will allow them to see a physical measure of their smoking and exposure to other people's smoking
what the carbon monoxide reading means, taking into consideration the time since they last smoked and the number of cigarettes smoked (and when) on the day of the test. [2021]
If the pregnant woman or pregnant person does not smoke but has a carbon monoxide level of 3 ppm or more, help them to identify the source of carbon monoxide and reduce it. (Other sources include household or other secondhand smoke, heating appliances or traffic emissions.) [2013]
If the pregnant woman or pregnant person has a high carbon monoxide reading (more than 10 ppm) but says they do not smoke:
advise about possible carbon monoxide poisoning
ask them to contact the Gas Emergency Line (0800 111 999) for gas safety advice
phrase any further questions about smoking sensitively to encourage a frank discussion. [2010]
Record carbon monoxide level and any feedback given in individual antenatal records. If these antenatal records are not available locally, use local protocols to record this information. [2010]
For a short explanation of why the committee made the 2021 and 2023 recommendations and how they might affect practice, see the rationale and impact section on stop-smoking support in pregnancy: identification and referral .
Full details of the evidence and the committee's discussion are in evidence review H: opt-out stop-smoking support.
These recommendations are for people providing stop-smoking support or advice to pregnant women, and pregnant trans men and non-binary people.
Contact anyone who has been referred for help. Discuss smoking and pregnancy and the issues they face, using an impartial, person-centred approach. Invite them to use the service. If necessary (and resources permit), make at least 3 contacts using different methods. Advise the maternity booking midwife of the outcome. [2010]
Try to see those who cannot be contacted by other methods. This could happen during a routine antenatal care visit (for example, when they attend for a scan). [2010]
Provide information about the risks of smoking to an unborn child and the benefits of stopping for both the pregnant woman or pregnant person, and the baby. [2010]
Address any factors that could prevent pregnant women or pregnant people from using stop-smoking support. This could include:
a lack of confidence in their ability to quit
lack of knowledge about the services on offer
difficulty accessing these services
lack of suitable childcare
fear of failure and concerns about being stigmatised. [2010]
If pregnant women or pregnant people are reluctant to attend the stop-smoking service, think about providing structured self-help materials or giving details of telephone quitlines or NHS online stop-smoking support. Also think about offering to visit them at home, or at another venue, if it is difficult for them to attend specialist services. [2010]
Address any concerns pregnant women or pregnant people, and their partners or family, may have about stopping smoking and offer personalised information, advice and support on how to stop. [2010]
Send information on smoking and pregnancy to those who opt out during the initial telephone call. This should include details on how to get help to quit at a later date. [2010]
These recommendations are for people providing stop-smoking support or advice to pregnant women, and pregnant trans men and non-binary people.
Provide the pregnant woman or pregnant person with intensive and ongoing support (brief interventions alone are unlikely to be sufficient) throughout pregnancy and beyond. This includes regularly monitoring smoking status using carbon monoxide tests. Use carbon monoxide measurements to encourage them to quit and as a way to provide positive feedback once a quit attempt has been made. [2010]
Biochemically validate that the pregnant woman or pregnant person has quit on the date they set and 4 weeks after. If possible, use urine or saliva cotinine tests, as these are more accurate than carbon monoxide tests. (They can detect exposure over the past few days rather than hours.) [2010]
When carrying out tests, check whether the pregnant woman or pregnant person is using nicotine replacement therapy (NRT) as this may raise cotinine levels. Take into account that no measure can be 100% accurate. Some people may smoke so infrequently – or inhale so little – that their intake cannot reliably be distinguished from that from passive smoking. [2010]
For anyone who has stopped smoking in the 2 weeks before their maternity booking appointment, continue to provide support in line with the recommendations in this section and stop-smoking support practice protocols. [2010]
Establish links with contraceptive services, fertility clinics and antenatal and postnatal services so that everyone working in those organisations knows about local stop-smoking support. Ensure they understand what these services offer and how to refer to them. [2010]
For guidance on the use of prescribed medicines during pregnancy, also see the section on medicine dosages for people who have stopped smoking.
These recommendations are for people providing stop-smoking support or advice to pregnant women, and pregnant trans men and non-binary people.
Cytisinicline is sometimes referred to as cytisine. For clarity and consistency with the BNF and the medicine's marketing authorisation in the UK, we use the international non-proprietary name cytisinicline throughout this guideline.
Consider NRT alongside behavioural support to help pregnant women and pregnant people to stop smoking in pregnancy (see the BNF's information on NRT). [2021]
Consider NRT at the earliest opportunity in pregnancy and continue to provide it after pregnancy if it is needed to prevent a relapse to smoking, including if the pregnancy does not continue (see the BNF's information on NRT). [2021]
Give pregnant women and pregnant people clear and consistent information about NRT. Explain:
that it may help them stop smoking and reduce their cravings
how to use NRT correctly, including how to get a high enough dose of nicotine to control cravings, prevent compensatory smoking and stop successfully. [2021]
Advise those using nicotine patches during pregnancy to remove them before going to bed. [2010]
Emphasise to pregnant women and pregnant people that:
most smoking-related health problems are caused by other components in tobacco smoke, not by the nicotine
any risks from using NRT are much lower than those of smoking
nicotine levels in NRT are much lower than in tobacco, and the way these products deliver nicotine makes them considerably less addictive than smoking. [2021]
Do not offer cytisinicline, varenicline or bupropion during pregnancy or breastfeeding. [2010, amended 2025]
For a short explanation of why the committee made the 2021 recommendations and how they might affect practice, see the rationale and impact section on nicotine replacement therapy and other pharmacological support .
Full details of the evidence and the committee's discussion are in evidence review J: nicotine replacement therapy and e-cigarettes in pregnancy: update.
These recommendations are for providers of stop-smoking support for pregnant women, and pregnant trans men and non-binary people.
In addition to NRT and behavioural support, offer voucher incentives to support pregnant women and pregnant people to stop smoking, as follows:
refer pregnant women and pregnant people to an incentive scheme at the first maternity booking appointment or at the next available opportunity
provide vouchers only for abstinence validated using a biochemical method, such as a carbon monoxide test with a reading of less than 4 ppm
stagger incentives until at least the end of pregnancy (incentives totalling around £400 have been shown to be effective)
do not exclude those who have relapsed or whose pregnancy does not continue from continuing to take part in the scheme and trying again
ensure vouchers cannot be used to buy products that could be harmful during pregnancy (for example, alcohol and cigarettes). [2021]
Consider providing voucher incentives jointly to the pregnant woman or pregnant person, and to a friend or family member that they have chosen to support them during their quit attempt. [2021]
Ensure staff are trained to promote and deliver incentive schemes to pregnant women and pregnant people to stop smoking. [2021]
For a short explanation of why the committee made the 2021 recommendations and how they might affect practice, see the rationale and impact section on incentives to stop smoking .
Full details of the evidence and the committee's discussion are in evidence review I: incentives during pregnancy.
These recommendations are to help providers of stop-smoking support reach all pregnant women, and pregnant trans men and non-binary people, including those whose circumstances may make it more difficult to use services (for example, because of cultural or sociodemographic factors, age or language).
Involve pregnant women and pregnant people who find it difficult to use or access existing stop-smoking support in the planning and development of services. [2010]
Collaborate with the family nurse partnership and other outreach schemes to identify additional opportunities for providing intensive and ongoing stop-smoking support during pregnancy. (Note: family nurses make frequent home visits.) [2010]
Work in partnership with agencies that support pregnant women and pregnant people with complex social and emotional needs. This includes substance misuse services, youth and teenage pregnancy support and mental health services. [2010]
These recommendations are for providers of stop-smoking support. See also the section on identifying smoking among carers, family and other household members.
Offer pregnant women's partners, and the partners of pregnant trans and non-binary people, who smoke help to stop. Use an intervention that comprises 3 or more elements and multiple contacts. Discuss with them which options to use – and in which order, taking into account:
their preferences
contraindications and the potential for adverse effects from stop-smoking pharmacotherapies
the likelihood that they will follow the course of treatment
their previous experience of stop-smoking aids
do not favour one course of treatment over another; together, choose the one that seems most likely to succeed taking into account the above. [2010]