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) focuses on identifying people who smoke and connecting them to evidence-based tobacco dependence treatment: multi-session behavioural intervention through Quitline and nicotine replacement therapy (NRT), if clinically appropriate.
Ask all pregnant women (and their partners) about smoking status and document this in their medical record. This can include carbon monoxide monitoring, if available.
Advise all pregnant women who smoke 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 an opt-out referral to behavioural intervention through Quitline (13 7848), and by prescribing (or helping patients to access) approved pharmacotherapy, such as nicotine replacement therapy (NRT).
Assessment of a woman’s motivation to quit smoking is not required and brief advice should be offered at every clinically appropriate opportunity.
Quitline is a confidential, evidence-based telephone counselling service. Quitline is tailored to meet the needs of priority populations including patients living with a mental illness, pregnant people and young people. The Aboriginal Quitline is provided by counsellors who are Aboriginal and/or Torres Strait Islander. Quitline has provision to assist individuals with hearing or speech impairment or for people 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 Quitline
Smoking cessation pharmacotherapies include nicotine replacement therapy (formulations include nicotine patch, gum, lozenge, inhalator, mouth spray), varenicline and bupropion. These medications have been approved by the Therapeutic Goods Administration (TGA) for efficacy, safety and quality.
Varenicline and bupropion are not recommended in pregnancy.
Nicotine replacement therapy (NRT) may be used in pregnant women, noting that:
Non-pharmacological interventions such as multi-session behavioural intervention (for example, as delivered by 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. Patients are more likely to stop smoking when pharmacotherapy is combined with behavioural intervention (Quitline).
NRT can be introduced early in pregnancy to maximise health benefits from smoking cessation. NRT use should be regularly reviewed by a medical practitioner (general practitioner (GP) or obstetric care provider) as often as practicable.
NRT should be used at the most effective dose for the shortest duration possible to minimise foetal exposure to nicotine.
NRT is effective and can increase smoking cessation rates by 43%.
There are different formulations of NRT:
Transdermal – nicotine patch
Faster-acting – nicotine gum, lozenge, inhalator and mouth spray
Combination 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 nicotine patch is used, it should be removed at bedtime to minimise foetal exposure to nicotine.
Nicotine patch, lozenge and gum are currently subsidised by the Pharmaceutical Benefits Scheme (PBS). All formulation of NRT can be accessed over the counter through pharmacies and supermarkets.
Learn more about NRT in pregnancy.Access practical videos outlining how to use each formulation of NRT
Nicotine vaping products (NVPs)
Nicotine vaping products contain liquid nicotine designed to be inhaled using a vaping device. From 1 October 2021, patients require a prescription for NVPs (this includes products purchased both in Australia and imported from overseas).
There are currently no TGA-approved NVPs registered in the Australian Register of Therapeutic Goods (ARTG). This means that NVPs have not been assessed by the TGA for safety, quality and efficacy.
NVPs are not recommended by the RACGP clinical guidelines in pregnant or breastfeeding women. The effects of NVPs on foetal development and obstetric outcomes are not known.
Clinically significant drug interactions occur with tobacco smoke.
This Drug interactions with smoking table 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: 8 September 2022