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Our key recommendations

This page provides a brief overview of the Smoking in Pregnancy Challenge Group's key recommendations for ending smoking during pregnancy.

Our key policy asks

  1. A new Tobacco Control Plan for England with a commitment to deliver a smokefree start for every child by 2030. Including:
    1. Raising the age of sale for tobacco to 21 to reduce smoking prevalence in the age cohort most likely to smoke during pregnancy
    2. A target for reducing SATOD to 4% by 2030, putting England on track to deliver a smokefree start for every child before 2040
    3. A ‘polluter pays’ levy imposed on tobacco manufacturers to raise funding for the measures needed to end smoking before, during and after pregnancy
  2. Commitments made through the NHS Long Term Plan to provide smoking cessation support to pregnant women who smoke must be fully implemented and sustained

Why it matters

Smoking during pregnancy undermines Government goals to improve birth outcomes and child health, and adds to the cost of living:

  • Smoking or exposure to second-hand smoke during pregnancy increases the risk of stillbirth, miscarriage and sudden infant death. Children born to parents who smoke are more likely to develop health problems including respiratory conditions, learning difficulties, and diabetes, and are more likely to grow up to be smokers.
  • Smoking during pregnancy adds to the cost of living and pushes families into poverty. The average smoker spends £2,500 per year on tobacco, with 31% of households in poverty once spend on smoking is taken into account.
  • The health and economic impacts of smoking lock in disadvantage across the generations.

Increasing quitting among pregnant women will reduce health inequalities and ease the burden on the NHS:

  • Younger women from the most deprived backgrounds/areas are the most likely to smoke and be exposed to secondhand smoke during pregnancy. This group has significantly higher rates of infant mortality than the general population.
  • Pregnant smokers require more care and place additional costs the NHS than non-smokers. It is estimated that maternal smoking cost the NHS over £20 million in 2015/16.
  • Every person that quits smoking today is a person who won’t need a hospital bed due to smoking-related disease tomorrow.

Without action thousands of families will suffer devastating consequences which could have been prevented:

  • The Government has missed the ambition set in the 2017 Tobacco Control Plan to reduce SATOD rates to 6% by 2022– currently 9.1% of women (~50,000) smoke during pregnancy. The previous Tobacco Control Plan has expired leaving England without a target for reducing smoking during pregnancy.
  • Reducing rates of maternal smoking would contribute to the national ambition to halve stillbirth and neonatal mortality by 2025.

Impact of smoking and exposure to secondhand smoke during pregnancy

Maternal smokingSecondhand smoke exposure
Low birthweight2 times more likelyAverage 30-40g lighter
Heart defects25% more likelyIncreased risk
Stillbirth47% more likelyPossible increase
Preterm birth27% more likelyPossible increase
Miscarriage32% more likelyIncreased risk
Sudden infant death3 times more likely45% more likely

Sources: Zhao L et al. Parental smoking and the risk of congenital heart defects in offspring: An updated meta-analysis of observational studies. 2020; RCP. Hiding in plain sight: treating tobacco dependency in the NHS. 2018; Pineless BL et al. Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. 2014; RCP & RCPCH. Passive Smoking and Children. 2010.