Nicotine Replacement Therapy (NRT)

(Date: June 2011. Version: 1a)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

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Why should I stop smoking if I’m pregnant?

There is strong evidence that smoking during pregnancy increases the risk of miscarriage, some birth defects, premature birth, low birth weight, and certain pregnancy complications. Pregnant women and women trying to conceive should therefore avoid smoking. Studies have shown that stopping smoking before week 20 of pregnancy can reduce the risk of having a low birth weight baby. 

If you need help to stop smoking during pregnancy please speak to your doctor or midwife. Please read the bumps information leaflet on smoking if you would like to find out more about the risks of smoking during pregnancy.

What is nicotine replacement therapy?

Nicotine is a highly addictive chemical in tobacco. Because of this, stopping smoking often causes withdrawal symptoms that can be difficult to manage. Nicotine replacement products (such as nicotine patches, chewing gum, mouth spray, nasal spray and lozenges) provide a controlled dose of nicotine that can help to control these withdrawal symptoms when stopping smoking. Use of these products can then gradually be reduced until the body is ‘weaned off’ nicotine.

Can I use nicotine replacement therapy (NRT) during pregnancy?

There is not very much information about the effects of nicotine replacement therapy on an unborn baby. It is therefore best if a pregnant woman can stop smoking using willpower or behavioural support therapies, rather than nicotine replacement therapy. However, in some cases nicotine replacement therapy may be considered to be less risky than smoking, particularly if the woman is a very heavy smoker. This is because tobacco smoke contains around 4,000 chemicals, many of which are toxic, and nicotine replacement therapy avoids exposure of both mother and baby to these other potentially harmful substances.

When deciding whether or not to use nicotine replacement therapy during pregnancy it is important to weigh up the risks of continuing to smoke to you or your baby with the risks and possible benefits of using NRT. Some of these will depend on how many weeks pregnant you are. 

Your doctor will be able to advise you about nicotine replacement therapy in pregnancy, and is the best person to help you decide what is right for you and your baby.

Can use of nicotine replacement therapy in pregnancy affect my baby?

Nicotine crosses the placenta into the baby’s bloodstream and the amniotic fluid (the fluid around the baby in the womb).

Only a small number of pregnant women using nicotine replacement therapy have been studied so far and the results of the studies have not all agreed. It is therefore currently unclear whether using a nicotine replacement therapy can affect a baby in the womb, or whether using NRT is definitely safer than smoking in pregnancy.

Smoking during pregnancy is known to increase the risk of miscarriage, cleft lip and/or palate in the baby, premature delivery, and of having a low birth weight baby. We do not know whether these effects are caused specifically by nicotine, or by the combination of chemicals in cigarette smoke.

Can using nicotine replacement therapy in pregnancy cause learning and behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that exposure to certain substances at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.

Several studies have now shown that children whose mothers smoked during pregnancy are more likely to have problems with thinking, learning and behaviour, than children whose mothers did not smoke. It is unclear whether these effects are caused by nicotine, by the other chemicals in cigarette smoke, or by other factors.

There are currently no scientific studies that have specifically investigated whether there may be a link between using nicotine replacement therapy in pregnancy and learning or behavioural problems in the child.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care, most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

Use of nicotine replacement therapy during pregnancy would not normally require extra monitoring of your baby, although if you have smoked heavily in pregnancy your baby’s growth may be monitored more closely. 

Are there any risks to my baby if the father used nicotine replacement therapy?

We would not expect any increased risk to your baby if the father used nicotine replacement therapy before or around the time you became pregnant.

Are E-cigarettes safe to use in pregnancy?

Unlike other forms of nicotine replacement therapy, E-cigarettes contain a number of other chemicals as well as nicotine. No studies have investigated pregnancy outcomes in women who used E-cigarettes during pregnancy. The effects of E-cigarette use on a developing baby are therefore unknown.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from

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General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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