Smoking is the most common modifiable risk factor for complications in pregnancy and increases the risk of poor outcomes for mother and baby. Smoking cessation should be a goal for all women who smoke, especially those who are pregnant or planning a pregnancy. Advice from a trusted health professional is known to be a major trigger for prompting a person who smokes to make a quit attempt, and a brief advice conversation with a patient about their smoking can be fast, simple and effective. Health professionals who care for pregnant women are well-placed to deliver smoking cessation care to women and their partners.
Quit’s 3-step brief advice model, Ask, Advise, Help (AAH) is an approach that promotes cessation and aims to connect pregnant women who smoke to best practice tobacco dependence treatment (such as multi-session behavioural intervention through Quitline) and nicotine replacement therapy (NRT), if clinically appropriate.
Ask all pregnant women about smoking status, and document this in their medical record. This can include carbon monoxide monitoring, if available.
Advise pregnant women to quit in a clear, non-confrontational and personalised way, and advise of the best way to quit.
Help by offering all pregnant women who smoke a referral to behavioural intervention (for example, Quitline) and prescribe (or facilitate access to) nicotine replacement therapy (NRT), if clinically appropriate.
Assessment of a woman’s motivation to quit smoking is not required and brief advice should be offered at every clinically appropriate opportunity.
Multi-session behavioural interventions (for example, Quitline) are recommended as first-line therapy for pregnant women.
Quitline is a confidential, evidence-based telephone counselling service for smoking cessation. Quitline is tailored to meet the needs of priority populations including patients living with mental illness, pregnant women and young people. Quitline also provides counsellors who are Aboriginal or Torres Strait Islanders, and is able to assist people with hearing or speech impairment, or for those needing an interpreter.
Quitline counsellors are counselling professionals who use behaviour change techniques and motivational interviewing. Over multiple calls, Quitline counsellors use core counselling skills to help people plan, make and sustain a quit attempt.
There is evidence that making a proactive referral to Quitline, rather than simply recommending your patient to call, will result in a 13-fold increase in the proportion of patients using behavioural intervention in a quit attempt.
Make a referral to QuitlineSmoking cessation pharmacotherapies include nicotine replacement therapy (formulations include nicotine patch, gum, lozenge, inhalator, mouth spray), varenicline and bupropion.
Varenicline1 and bupropion1 are not currently recommended in pregnancy due to limited efficacy and safety data.
Nicotine replacement therapy (NRT) may be used in pregnant women, noting that:
Non-pharmacological interventions such as multi-session behavioural intervention (for example Quitline) are recommended as first-line therapy.
NRT in conjunction with behavioural intervention may be considered in women unable to achieve abstinence using non-pharmacological interventions alone, or those with moderate to high nicotine dependence. Patients are more likely to stop smoking when pharmacotherapy is combined with behavioural intervention (Quitline).
The risks and benefits of NRT should be discussed with the women prior to initiation.
NRT should be used at the lowest effective dose for the shortest duration possible to minimise fetal exposure to nicotine.
NRT can be introduced at any trimester.
NRT use should be regularly reviewed by the general practitioner (GP) or obstetric care provider (every seven days or as soon as practicable).
1The Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals. East Melbourne, Vic: RACGP, 2021
Nicotine Replacement Therapy (NRT)
NRT is effective for increasing smoking cessation during pregnancy.
There are different formulations of NRT:
Transdermal – nicotine patch
Faster-acting – nicotine gum, lozenge, inhalator and mouth spray.
Combination NRT therapy is using a nicotine patch together with a faster-acting formulation.
Pregnant women who have relapsed in the past or who experience cravings using one formulation of NRT alone, may use combination therapy under medical supervision.
Nicotine mouth spray contains a small amount of alcohol and is not considered first-line therapy in pregnancy.
If a nicotine patch is used, it should be removed at bedtime to minimise adverse effects and fetal exposure to nicotine.
Some formulations are currently subsidised by the Pharmaceutical Benefits Scheme (PBS). All formulations of NRT can be accessed over the counter through pharmacies and supermarkets.
Learn more about Supporting smoking cessation in pregnancy and breastfeeding guideline (PDF), developed by Quit in collaboration with The Royal Women’s Hospital Pharmacy Department.
Vapes
From 1 January 2024, reforms to the regulation of vapes are being implemented in Australia. There are currently no TGA-approved vapes registered in the Australian Register of Therapeutic Goods (ARTG). This means that vapes have not been assessed by the TGA for safety, quality and efficacy, and their long-term health impacts remain unknown.
Vapes are not recommended by the RACGP or the Royal Women's Hospital's and Quit's clinical guidelines in pregnancy, due to limited efficacy and safety data.
Clinically significant drug interactions occur with tobacco smoke.
This Drug interactions with smoking table (PDF) lists medications and drugs that require dosage adjustments when smoking is stopped.
Patients should be regularly monitored with regard to their smoking status and doses of relevant drugs adjusted accordingly.
Last updated: 7 October 2024