National guidance and policy

National guidance and policy

This page provides an overview of national guidance and policy relating to smoking in pregnancy.

Guidance and policy

NICE guidance providing the evidence-based model for smoking cessation support within maternity settings:

The Saving Babies’ Lives Care Bundle Version 2 (2019) – ‘Element 1: Reducing smoking in pregnancy’ recommends carbon monoxide (CO) testing of all pregnant women at antenatal booking appointment; CO testing a 36 weeks; referral to a stop smoking service/specialist based on an opt out system; and training on CO monitor use and Very Brief Advice (VBA) for all relevant maternity staff. An evaluation of the Care Bundle found that stillbirths fell by a fifth at maternity units where the guidance was implemented, saving more than 160 babies’ lives. You can read the NHS press release here. Version 1 of the Saving Babies’ Lives Care Bundle can be accessed here.

The NHS Long Term Plan, published January 2019,  includes a commitment to deliver an opt-out smokefree pregnancy pathway including focused sessions and treatments for expectant mothers and their partners. Areas with the greatest level of need will be prioritised with a commitment to support 600,000 people to quit over the next five years. The press release which includes a quote from Dr Clea Harmer, co-chair of the Challenge Group, can be found here.

The 2017 Tobacco control plan for England includes an ambition to reduce rates of smoking in pregnancy to 6% or less by 2022.  The Plan further commits Government to a number of specific actions including commitments to embed CO Screening in Maternity Services Data Set and to take further action via the Maternity Transformation Programme.

Response to inquiry on e-cigarettes

In December 2017 the Smoking in Pregnancy Challenge Group submitted its response to the House of Commons Committee on Science and Technology Inquiry into e-cigarettes. You can read the submission here and learn more about the inquiry here.

CLeaR self-assessment tool for smoking in pregnancy

The CLeaR model for helping local areas to map their current tobacco control activity against evidence-based best practice has been around since 2012, and been used by around two-thirds of localities across England. In 2017, Public Health England developed deep dive CLeaR tools to allow for a more in-depth review of specific topics within tobacco control; one of these is around addressing smoking in pregnancy. This tool builds upon evidence from NICE guidance and allows localities or LMSs to benchmark themselves by working through a series of questions. These questions are grouped around 4 broad themes:

  • Systems (including leadership and commissioning)
  • Training
  • Communications (both internal and external)
  • Treatment (referral pathways and behavioural support)

The CLeaR tool is free to download and use from here. Completing the tool should require input from a range of partners involved in tackling maternal smoking, such as maternity staff, SSS commissioners and providers, CCGs, communications staff, etc. Once completed, it will provide an at-a-glance summary of areas of strength and those requiring further development, which should then inform future action planning.

For further discussion on the CLeaR tool, or for support with your local assessment, please email