What are the guidelines for providing support to pregnant women who wish to quit smoking?

Provide routine carbon monoxide testing at the first antenatal appointment and at 36 weeks to assess tobacco smoke exposure, and test at other appointments if the woman smokes, is quitting, or has a CO reading of 4 ppm or above ¹.

Offer an opt-out referral to stop-smoking support during pregnancy for women who report smoking, have a CO reading of 4 ppm or above, or have previously been referred but have not engaged ¹.

Provide intensive and ongoing support throughout pregnancy and beyond, including regular monitoring with CO tests and biochemically validating cessation with urine or saliva cotinine tests ¹.

Address any concerns about stopping smoking, and offer personalized advice, including stress management techniques such as breathing and relaxation exercises ¹.

Advise women to use exercise, such as brisk walking, to help with cravings, although evidence on long-term benefits is limited ¹.

Encourage family support, as it can increase the likelihood of quitting ¹.

Support abrupt quitting if possible, and provide structured self-help materials or telephone support if women are reluctant to attend services ¹.

Offer pharmacological support, such as nicotine replacement therapy (NRT), considering individual preferences and previous experiences, and explain that most health risks are due to other components in tobacco smoke, not nicotine ¹.

Prescribe NRT from the earliest opportunity and continue after pregnancy if needed to prevent relapse, ensuring women understand how to use it correctly ¹.

Do not offer cytisinicline, varenicline, or bupropion during pregnancy or breastfeeding ¹.

Consider voucher incentives to support cessation, and involve partners and family members who smoke in support strategies ¹.