Registered Nurses' Association of Ontario

Pregnant or Postpartum women

  • Health impact of tobacco use on the pregnancy and fetus includes: higher risk for abruptio placentae, miscarriage, low birth weight, preterm birth (before 37 weeks), stillbirth, and neonatal death.  Infants and children exposed to second-hand and third-hand smoke have higher risk of developing bronchitis, pneumonia, and otitis media.
  • A tailored, woman-centred approach to tobacco treatment should be used when working with pregnant or postpartum women to support a quit attempt and decrease the likelihood of relapse. 
  • Health-care providers should collaborate with the woman’s partner and household members, when it is safe for the woman,  to develop awareness about the impacts of tobacco use and encourage the reduction or cessation of use
  • Health-care providers should consider the use of following pharmacotherapy as part of a combined intervention
  1. Nicotine Replacement Therapy (NRT):
  • NRT should be provided simultaneously with intensive counselling.
  • The expert panel recommends that intermittent forms of NRT can be offered during the first, second, and third trimesters, after discussing the risks and benefits with the client. Intermittent forms of NRT include nicotine gums, lozenges, inhalers, or sprays/mists.
  • Should additional NRT support be required, the expert panel recommends using the nicotine patch, with the provision that it be removed at bedtime.
  • During breastfeeding, NRT can be safely recommended and used because only a small amount of nicotine enters the breast milk supply
  1. Buproprion
  • In consultation with a nurse practitioner or physician, bupropion is a third-line option to consider during pregnancy if psychosocial interventionsG and nicotine replacement therapy fail
  • At this time, the use of varenicline should be avoided during pregnancy and breastfeeding due to insufficient evidence regarding its safety and efficacy as a tobacco cessation intervention in pregnant women.



Addiction and Mental Health
Integrating Tobacco Interventions into Daily Practice
Point of Care Resources