Posted 5 Jun, 2026

Our Quit Insights Clinical Series podcast guest is Hao Vo-Tran from the Royal Women’s Hospital, about the importance of smoking and vaping cessation in pregnancy and breastfeeding.

This podcast and article content are intended for health professionals and are for educational and informational purposes only. The content discussed does not constitute medical, legal or professional advice and should not replace your own clinical judgement. 

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Our Quit Insights Clinical Series podcast guest was Hao Vo-Tran, a hospital pharmacist at the Royal Women's Hospital in Melbourne with specialist expertise in medicines use during pregnancy and breastfeeding. Hao is actively involved in developing clinical guidelines and translating evidence into practical advice for healthcare professionals, with a strong focus on improving outcomes for women and babies. Hao is a passionate educator regularly teaching and supporting clinicians and students in this complex area of practice. 

How does smoking affect pregnancy?

This is a really complex question but we do know that smoking is associated with really significant harm to both mum and baby when they're inside, and also when baby is born. We know that smoking can increase lots of complications during pregnancy. It results in adverse birth outcomes, and it can result in increasing the risk of baby mortality. Smoking in pregnancy also increases the rate of low birth weight, preterm birth, and Neonatal Intensive Care Unit (NICU) admissions. One of the scary things about smoking in pregnancy is that it can increase the risk of sudden unexplained death in infancy. It results in respiratory infections and ear infections, and in some really rare cases it can cause hearing loss as well. These are all things that we can see when baby is born, However smoking in pregnancy has also been associated with later behavioural problems, and we can't find this out until after baby is born. 

What are the effects of vaping, nicotine vaping products or NVPs in pregnancy?

Vaping is becoming so widespread, especially in women of reproductive age. 50% of all pregnancies are unplanned, so when a woman finds out that she is pregnant and we find out that she is vaping, unfortunately we don't have a lot of safety information about what happens with regards to vaping in pregnancy. We don't know whether or not it causes the same things as smoking, but there are a few studies out there to suggest that vaping in pregnancy can cause preterm birth, low birth weight, and it also can cause babies being born a lot smaller than we would expect. Because of these unknown effects of vaping in pregnancy, we also don't recommend vaping in pregnancy at all. 

What does the evidence say about cessation during pregnancy in reducing adverse outcomes? 

The evidence is really clear. Smoking cessation improves outcomes for both mum and baby. The number one take-home message from all healthcare professionals should be that quitting smoking is a priority – the best thing that women can do to reduce their risk of adverse effects in pregnancy. When a woman quits smoking in pregnancy, it reduces the risk of low birth weight, preterm birth, and NICU admissions. We know that behavioural interventions in pregnancy to help women quit smoking are effective, like the ones offered at Quit as a multi-session behavioural intervention, and some women can achieve quitting smoking in pregnancy with just behavioural intervention. 

For those who can't and need more help, or because their nicotine dependence is moderate to high, we can offer some pharmacological interventions. The pharmacological interventions such as nicotine replacement therapy or NRT, significantly increase the rate of which women quit. The Royal Women's Hospital Pharmacy Department, in collaboration with Quit, have developed a guideline to help women quit smoking during pregnancy and during breastfeeding. Unfortunately, we don't have very much safety information about vaping cessation in pregnancy and breastfeeding, but we are in the process of developing a guideline after reviewing all the current literature, which is planned to be released later in 2026. 

Is NRT safe to use during pregnancy?

The short answer is yes. Nicotine replacement therapy is much safer and cleaner than continuing to smoke during pregnancy. We know that NRT delivers a much lower nicotine exposure compared to cigarettes. Women who use NRT to help support smoking cessation are no longer exposed to the toxic chemicals that are found in cigarette smoking. NRT in pregnancy is quite well tolerated and there are very few side effects. It can be used at any trimester. Therefore if a woman decides to quit smoking as soon as she finds out that she's pregnant and cannot quit smoking on her own, then we would absolutely recommend the use of NRT if it follows the guidelines.

Is there information about NRT use in vaping?

At the moment there's not as much information about using NRT for vaping cessation, but it is something that we're looking into. 

Are other cessation medications recommended?

Varenicline and bupropion are very effective medicines for smoking cessation in the general population. Unfortunately we don't have as much safety information about their use in pregnancy. Our general recommendation is that if possible, consider an alternative medicine. 

Are there pregnancy-specific considerations when using nicotine replacement therapy or NRT?

I want to reiterate that behavioural interventions should be first line and continue to be used in conjunction with pharmacological treatment. Therefore the pharmacological treatment is NRT. The pregnancy-specific considerations we would recommend are to always use the lowest effective dose for the shortest duration possible. I can't emphasise that enough: use the lowest effective dose. 

With a lot of NRT products available on the market, our recommendation for pregnant women is to start with the faster acting NRT. This delivers a lower amount of nicotine, and it's easy to individualise the treatment and the dosing for pregnant women based on their needs. If a combination of patches or longer-acting and faster-acting NRT is required, then that can be considered in pregnancy. 

With nicotine patches use in pregnancy, our recommendation is that the patch be placed on in the morning and then it should be taken off at night. These patches are generally not recommended for all 24 hours, as because overnight we would prefer pregnant women to be nicotine-free.

Some of the other things that we recommend with NRT patches is to rotate the sites where they're being placed so they don't get too itchy or become too irritated in the same spot. Unfortunately, with some pregnancy complications such as pruritis or if women get cholestasis and their skin becomes very itchy, the patches can get quite difficult, so consider alternative preparations. 

As well as the Quit Centre website, where can health professionals go for further information? 

We would recommend that you go to the Royal Women's Hospital site. There are many different guidelines and recommendations of how to help women and support women in quitting smoking. The RACGP and RANZCOG also have excellent guidance on how to help women in these situations. 

As a post-script to the podcast, Hao also discussed physiological changes during pregnancy that can be affected by smoking, vaping or cessation. 

When a woman becomes pregnant, lots of physiological changes occur in her body. We know their heart and lung function improve because the baby needs a lot of oxygen and a lot of blood, and increasing a pregnant woman's heart function and lung function is a good outcome for baby.

We also know in pregnancy that a woman's kidney function gets so much better. At the same time, the liver usually continues to work well and often becomes more active at metabolising certain medicines. Unfortunately for women who smoke, that can eliminate the nicotine from their body a whole lot faster. When this happens, women can experience withdrawal effects a lot faster as well, which can be things like poor concentration, anxiety, irritability, insomnia, and low mood. Unfortunately, these withdrawal symptoms can overlap with general pregnancy symptoms. A combination of all of these factors can make a pregnant woman feel awful -and we don't want that. 

Are there any physiological changes that can happen when a woman stops smoking?

The answer is yes. We know that when women stop smoking in pregnancy, everything changes as well. We really recommend that women who decide that they want to stop smoking in pregnancy make sure that their healthcare professional reviews them regularly, for their concurrent medicine use, their underlying medical conditions, and the medicines that would be most helpful to the woman if she needs a little help quitting smoking. 

Our thanks to Hao Vo-Tran for these important insights.

Quit Centre resources:

Clinical Tools & Guidelines: