Articles

Key takeaways

• Smoking during pregnancy can harm your baby's growth and health.
• Secondhand smoke also poses risks to you and your baby.
• Your midwife can test your carbon monoxide levels and offer support.
• Making a plan and using support can help you quit smoking.

The effects of smoking and vaping on your pregnancy

Smoking during pregnancy can harm your baby. It reduces the amount of oxygen and nutrients that pass from you to your baby through the placenta. Every cigarette you avoid helps your baby's health and development.

Smoking increases your risk of several complications. These include miscarriage and a pregnancy growing outside the womb (ectopic pregnancy). Sadly, it also increases the risk of losing a baby during pregnancy (stillbirth) or soon after birth.

It also raises the risk of problems with the placenta, such as it coming away from the wall of the womb (placentae abruption). This can cause serious bleeding and is a significant risk for your baby.

How smoking affects your pregnancy

Smoking also increases the risk of your baby being born too early (premature birth), which is when your baby is born before 37 weeks of pregnancy. Smoking can reduce your baby's growth in the womb, making it more likely that your baby will have a low weight at birth (low birth weight). Smoking can also affect how your baby develops in the womb. These complications are thought to be due partly to reduced blood and oxygen supply to the baby through the placenta.

If you stop smoking in the very early weeks of pregnancy, your baby is no more likely to have a low birth weight than babies of non-smokers.

We know this can be worrying to read, but being aware of the risks is the first step to protecting your baby. Stopping smoking at any point helps reduce these risks.

Risks to your baby's development

Smoking during pregnancy can sometimes lead to problems with your baby’s development. One of the risks include a problem with the development of their face, like a gap in their lip or the roof of their mouth (cleft lip and palate). It can also affect how parts of your baby's body develop, such as their skull, tummy wall, and heart. Their feet can also be affected.

Stopping smoking at any time during your pregnancy will help reduce these risks for your baby.

Smoking during pregnancy can also affect your baby's health after they are born. They may have a greater risk of:

• Sudden infant death syndrome (SIDS)
• Asthma
• Chest and ear infections
• Pneumonia

They also have a higher risk of behavioural problems, such as having difficulty paying attention (attention deficit hyperactivity disorder, or ADHD). It may also affect their learning and development as they grow up. Stopping smoking reduces all these risks.

Vaping and nicotine replacement therapy

E-cigarettes are also known as vapes. They contain nicotine, flavouring, and other chemicals. There is not much research yet on the safety of e-cigarettes in pregnancy. However, many healthcare professionals believe vaping may expose the baby to fewer toxic chemicals than smoking. E-cigarettes do not produce tar or carbon monoxide, which are two main toxins in cigarette smoke. The vapour from an e-cigarette contains some potentially harmful chemicals, but at much lower levels than cigarette smoke. It is safest to avoid both secondhand tobacco smoke and secondhand vapour from e-cigarettes.

Products that help you stop smoking by giving you nicotine without the other harmful chemicals in cigarettes are known as nicotine replacement therapy (NRT). NRTs are safe to use in pregnancy. These include patches, chewing gum, and lozenges. Mouth sprays are also available. NRTs deliver clean forms of nicotine and are effective aids for stopping smoking.

NRT is safer than smoking because it does not contain poisons like tar or carbon monoxide. It provides nicotine to help manage withdrawal cravings. NRT is available free on prescription while you are pregnant and for one year after your baby is born.

Understanding the risks of secondhand smoke

Secondhand smoke, also known as passive smoking, is when you inhale smoke or fumes from someone else who is smoking or vaping. It contains chemicals that can harm you and your baby. Breathing in other people's tobacco smoke means toxins, like nicotine and carbon monoxide, enter your blood. These toxins then pass to your baby.

It is important to know that similar to smoking or vaping yourself, secondhand smoke can affect you and your baby before and after birth and result in similar significant risks.

If people around you smoke, it can also make it harder for you to quit.

Creating a smoke-free environment

It does not matter how much people try to keep their smoke away from you. If someone smokes in your home, you and your baby could still be exposed. Opening windows and doors or smoking in another room will not make it safe.

Smoke can linger in the air for two to three hours after a cigarette is finished.

Talk to any smokers in your home about how their smoking affects you and your baby. Your midwife can also discuss this with both of you. If a smoker cannot or will not quit, make sure they do not smoke in the house or car.

It is illegal to smoke in a car when someone under 18 is inside.

• Try to avoid places where people will be smoking indoors.
• Ask drivers not to smoke in the car or avoid travelling with them.
• Tell visitors to smoke outside, with the door and any nearby windows closed.
• Keep an umbrella and raincoat by the door to make it easier for people to smoke outside.
• Suggest any smokers you live with to contact NHS stop smoking services.

How your care team can help you quit

Your midwife will offer you a breath test at your first antenatal appointment. This test measures your level of exposure to carbon monoxide (CO). Carbon monoxide is a poisonous gas that you cannot see or smell.

You blow into a hand-held machine, called a CO monitor.

The CO monitor measures the level of carbon monoxide in your body in parts per million (ppm). The more carbon monoxide you have breathed in, the higher your reading will be. If your reading is 4 ppm or higher, your midwife should refer you to NHS Stop Smoking Services.

Your carbon monoxide level should be low if you do not smoke. However, other things can cause a higher reading.

You might be breathing in harmful amounts of secondhand smoke. You could also be exposed to other household smoke, such as from a wood-burning stove. A faulty gas appliance at home could also put you at risk of carbon monoxide poisoning.

Support services available

If you smoke or have recently stopped smoking, you should be referred to a specialist midwife or stop smoking adviser. These services offer one-to-one appointments. They can also suggest ways to help you cope with cravings and withdrawal symptoms.

The midwives and other healthcare professionals looking after you will be supportive.

Local stop smoking services are free of charge. They have trained advisers who can give you one-to-one help and support. You can also get help from your GP.

The NHS Pregnancy Smoking Helpline is available on 0300 123 1044. You can also find information on the NHS website and the NHS Quit Smoking website.

NHS Stop Smoking services can offer individual or group sessions. They may have a pregnancy stop smoking specialist. They can also advise on dealing with stress and weight gain.

These services can support the use of nicotine replacement therapy (NRT) to help manage cravings.

Making a plan to quit or cut back

Getting support can increase your chances of quitting for good. Do not be afraid to talk to your midwife or doctor about your smoking. They are there to help you have a safe and healthy pregnancy.

Practical steps to quit

1. Set a quit date – Choose a date when you plan to stop smoking and work towards it.
2. Use nicotine replacement therapy (NRT) – Using NRT can be an easier way to stop than quitting suddenly without any help.
3. Get support – Your local community pharmacy, practice nurse, or smoking cessation service can help. They can prescribe NRT, which is free during your pregnancy and for one year after your baby is born.
4. Identify triggers – Pinpoint situations or feelings that make you want to smoke, such as after a meal or when tired. Understanding these triggers can help you plan how to avoid them.
5. Manage cravings – A craving usually lasts about 20 minutes. Try to distract yourself during this time with an activity like washing the floor or singing to your baby.
6. Involve others – You might want to tell everyone about your quit date to get their support. Or you might prefer to keep it quiet so no one tries to tempt you.
7. Reward yourself – Put away the money you would have spent on cigarettes. After six weeks of being smoke-free, spend it on a treat for yourself.
8. Find new ways to relax – If you smoke for a few minutes of peace, think about how else you could spend that time.
9. Keep healthy snacks – Keep strong-tasting sweets (like mints) and healthy snacks nearby. This can help you avoid resorting to unhealthy options.

If you have one cigarette, it does not mean you have failed. Think about why it happened and plan how to avoid that situation again. Do not give up on giving up.

Partner and friend support

Your partner and friends can play a big part in helping you quit. If they smoke, encourage them to get support with you.

You can ask them to help distract you when you have a craving or are coping with withdrawal symptoms. Ask them to help you plan how to manage and change routines associated with smoking. Remind them to be patient with you when you are finding it tough.