Smoking in Pregnancy

Men and women who smoke are less likely to conceive. Smoking reduces sperm count and motility in men and hormonal imbalance in women, reducing pregnancy rates in smoking couples.


125,000 spontaneous miscarriages occur each year in the United Kingdom, with one fifth of these occurring in women who smoke. This makes smoking during pregnancy the single most preventable cause of foetal death alongside causing low birth weight and increased perinatal mortality.

Nicotine can freely cross the placenta along with toxic constituents of tobacco smoke, for example carbon monoxide. Second-hand smoke can also result in reduced birthweight.

One estimate is that 24% of infant killed by sudden death syndrome are a result of mothers smoking during pregnancy.

There are also links between smoking during pregnancy and intellectual and behavioural deficits through childhood and into adulthood. Although the risks from smoking to the child appear to be dose dependent, light smokers still put their child at significant risk.

It should therefore constantly be reiterated by healthcare professionals to women who continue to smoke during pregnancy; smoking is the best thing for both the mother and the baby through pregnancy and beyond. Cessation should occur prior to conceiving for the best possible outcome for the child.



In 2011, 11% of UK mothers were recorded as smoking at the time of delivery in 2015, with a range in all areas from 2% to 26%.

Most women who become pregnant and fail to quit smoking during the first trimester will not succeed in quitting through to term.

The prevalence of smoking through pregnancy is higher in those from lower socio-economic backgrounds, lower educational levels, those who started younger and those who have partners who smoker.

Partners who are openly pro-cessation to the pregnant mother are more likely to be successful in encouraging complete cessation.

There is perception amongst low income, teenage smokers that by smoking, and reducing the birth weight of the foetus, they will reduce the pain of delivery.

Of the pregnant women who do manage to quit, 63% relapse within 6 months of birth.


In the UK, the most effective intervention for reducing smoking in pregnant women has been increasing the price of cigarettes through taxation. However, this has a downside; individuals from low socioeconomic backgrounds can be driven into poverty as they are unable to quit.

The most effective intervention in pregnant women centres around ‘behavioural support.’ These are effective at promoting smoking cessation in pregnant women, however they are underused.

Nicotine replacement therapies (NRTs) can also be used in assisting smoking cessation, however there is discussion as to whether these are completely safe or a harm reduction strategy.

As previously stated, nicotine can cross the placenta and may affect the developing foetus. However, studies have shown no adverse effects to the child from wearing a nicotine patch for up to four days. The NHS currently advises that licenced NRTs are safe for pregnant women to use during pregnancy.

Electronic cigarettes are the newest smoking cessation aid which healthcare professionals must give advice about. Unfortunately, confusion and misconceptions about electronic cigarettes may prompt women who are pregnant to utilise an electronic cigarette without knowing all potential risks.

It must be stressed that electronic cigarettes during pregnancy do not remove all risks and does still expose the unborn baby to nicotine and other inhalants from the electronic cigarette liquid. Some ingredients in the electronic cigarette liquid are toxic and liquid production is not regulated. 

Bibliography & Further Reading
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Baeza-Loya S, Viswanath H, Carter A, Molfese DL, Velasquez KM, Baldwin PR, Thompson-Lake DG, Sharp C, Fowler JC, De La Garza R. Perceptions about e-cigarette safety may lead to e-smoking during pregnancy. Bulletin of the Menninger Clinic. 2014;78(3):243.
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