The official NHS position on vaping during pregnancy is nuanced but clear. Stopping smoking completely is the strongest recommendation. Licensed nicotine replacement therapy (NRT) such as patches and gum is the preferred quit aid because it is regulated and available on NHS prescription. However, NHS guidance explicitly states that if a vape helps you stop smoking, it is much safer for you and your baby than continuing to smoke. This position is supported by Tommy’s, the Royal College of Midwives, the Smoking in Pregnancy Challenge Group and NICE guideline NG209 (Tobacco: preventing uptake, promoting quitting and treating dependence).

The reasoning is based on harm reduction. Smoking in pregnancy is one of the most serious avoidable risks to a developing baby: it causes placental complications, preterm birth, miscarriage, low birthweight, increased SIDS risk and birth defects. The damage comes primarily from carbon monoxide (which restricts oxygen to the baby) and the 4000+ other chemicals in tobacco smoke, NOT primarily from nicotine. Vape produces neither carbon monoxide nor tar nor most of the tobacco-specific chemicals. NHS guidance: vaping is significantly less harmful than continuing to smoke, even though it is not 100% safe.

The landmark 2022 randomised controlled trial by Professor Peter Hajek (Queen Mary University of London), published in Nature Medicine, recruited 1140 pregnant women from 23 NHS hospitals across England plus 1 NHS Stop Smoking Service in Scotland. Among women who used only their allocated treatment, vapes were nearly twice as effective as nicotine patches for quitting smoking during pregnancy. Both approaches were safe. The only meaningful difference in birth outcomes was that fewer women in the e-cigarette group had babies with low birthweight. The researchers concluded this was likely because vapes more effectively reduced cigarette use. NHS Stop Smoking Services now use vapes as part of standard pregnancy support, though they are not yet on NHS prescription.

Why vape is preferred over continuing to smoke in pregnancy

Three reasons combine. First, no carbon monoxide: cigarette smoke produces CO that binds haemoglobin and reduces oxygen delivery to the baby; vape produces no CO. Pregnant women who smoke have measurably higher CO levels at NHS midwife appointments, which is why CO breath testing is part of all antenatal care now. Second, no tar or tobacco-specific carcinogens: the 4000+ chemicals in cigarette smoke include known causes of fetal harm; vape e-liquid contains 4-5 main ingredients (PG, VG, nicotine, flavouring, water), all of which have less direct fetal toxicity than tobacco smoke chemicals. Third, more effective for quitting: the Hajek 2022 trial confirmed that vape outperforms patches for pregnancy smoking cessation when used as allocated.

What flavours and strengths to choose during pregnancy

UK NHS guidance specifically advises pregnant women to avoid liquorice-flavoured vape liquid. Liquorice root has been associated with adverse effects in pregnancy in larger amounts, and although vape flavour concentrations are small, the precautionary principle applies. Choose fruit, mint or menthol flavours instead. For nicotine strength, match what you needed when smoking: a 10-cigarettes-per-day smoker typically needs 10-20mg/ml nicotine to avoid relapse. Lower strengths than you needed for smoking often cause relapse back to cigarettes, which is worse than the vape itself. Disposable vapes are acceptable if they keep you off cigarettes, but refillable kits with adjustable strengths and verified TPD-compliant flavours are preferred. Lost Mary, Elf Bar and other major UK brands all have TPD-compliant ranges suitable for pregnancy use.

Where to get NHS pregnancy quit support

Three main routes. First, your midwife: every UK NHS maternity team now has access to dedicated stop smoking advisors or smoking cessation midwives. Self-refer or ask your midwife at your booking appointment. Second, the National Smokefree Helpline (0300 123 1044, open 9am-8pm Monday to Friday and 11am-4pm weekends): trained advisors who can refer to local services. Third, NHS Stop Smoking Services (England, Scotland, Wales, Northern Ireland all have equivalents): free behavioural support, free prescription NRT, increasingly access to vape starter packs as part of standard pathways. Since April 2023, pregnant women who smoke have been offered financial incentives in addition to behavioural support, recognising that pregnancy is the highest-impact time to support quitting.

For UK pregnant smokers and vapers, the four-step framework below combines NHS guidance with practical advice from UK NCSCT-trained stop smoking advisors.

Pregnant women who relapse to smoking should not consider this a failure: most quitters need multiple attempts, and keeping a vape on hand significantly lowers the chance of going back to cigarettes. NHS Stop Smoking Services treat relapse as expected and support multiple quit attempts. If you live with someone who smokes, ask them to vape outdoors or away from you; secondhand smoke affects babies even in utero through reduced birthweight. For UK pregnant vapers using our Omagh or Strabane stores, our team are trained to advise on TPD-compliant products and can point you to NHS Stop Smoking Services in your area.