The Case for a Pregnancy‐Specific Nicotine Policy
- 1Department of Paediatrics, Child and Youth Health The University of Auckland Auckland New Zealand
- 2Change for Our Children Christchurch New Zealand
- 3Department of Paediatrics and Child Health University of Otago Dunedin New Zealand
Abstract
Aims: We aimed to evaluate the proposition that nicotine delivery by any means during pregnancy adversely affects the fetus and infant, review national policies on nicotine use in pregnancy across four high‐income countries and propose a coherent pregnancy‐specific nicotine policy framework.
Methods: Clinical guidelines, public health policy documents and evidence‐based recommendations on tobacco and nicotine use in pregnancy were reviewed.
Results: Smoking in pregnancy is strongly associated with adverse perinatal outcomes. Similar but less consistent associations are reported with snus and vaping, supporting avoidance of nicotine in all forms. National policies vary: NZ and the UK adopt harm‐reduction approaches, encouraging substitution with alternative nicotine products such as vaping, whereas the US and Sweden emphasise complete nicotine cessation. We propose a precautionary framework that recognises the mother–infant dyad as the unit of care; prioritises nicotine‐free pregnancy; provides personalised cessation support for all pregnant women; reserves nicotine replacement therapy with clinical caution when behavioural support is insufficient; discourages vaping; and strengthens surveillance through early carbon monoxide monitoring and systematic recording of nicotine exposure.
Conclusion: This framework provides a coherent pregnancy‐specific nicotine policy centred on cessation as the mechanism of protection for the mother‐infant dyad, with the aim of improving pregnancy outcomes.
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BibTeX
@article{mitchell2026case,
title = {{The Case for a Pregnancy‐Specific Nicotine Policy}},
author = {Edwin A. Mitchell and Stephanie Cowan and Barry J. Taylor},
journal = {Acta Paediatrica (Oslo, Norway : 1992)},
year = {2026},
month = jul,
doi = {10.1111/apa.70687},
url = {https://doi.org/10.1111/apa.70687},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - The Case for a Pregnancy‐Specific Nicotine Policy
AU - Edwin A. Mitchell
AU - Stephanie Cowan
AU - Barry J. Taylor
PY - 2026
DA - 2026/07/14
JO - Acta Paediatrica (Oslo, Norway : 1992)
DO - 10.1111/apa.70687
UR - https://doi.org/10.1111/apa.70687
AB - Aims: We aimed to evaluate the proposition that nicotine delivery by any means during pregnancy adversely affects the fetus and infant, review national policies on nicotine use in pregnancy across four high‐income countries and propose a coherent pregnancy‐specific nicotine policy framework. Methods: Clinical guidelines, public health policy documents and evidence‐based recommendations on tobacco and nicotine use in pregnancy were reviewed. Results: Smoking in pregnancy is strongly associated with adverse perinatal outcomes. Similar but less consistent associations are reported with snus and vaping, supporting avoidance of nicotine in all forms. National policies vary: NZ and the UK adopt harm‐reduction approaches, encouraging substitution with alternative nicotine products such as vaping, whereas the US and Sweden emphasise complete nicotine cessation. We propose a precautionary framework that recognises the mother–infant dyad as the unit of care; prioritises nicotine‐free pregnancy; provides personalised cessation support for all pregnant women; reserves nicotine replacement therapy with clinical caution when behavioural support is insufficient; discourages vaping; and strengthens surveillance through early carbon monoxide monitoring and systematic recording of nicotine exposure. Conclusion: This framework provides a coherent pregnancy‐specific nicotine policy centred on cessation as the mechanism of protection for the mother‐infant dyad, with the aim of improving pregnancy outcomes.
SN - 0803-5253
SN - 1651-2227
ER -