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Smoking in pregnancy — DFSRH MCQ

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EasySmokingSmoking in pregnancyDFSRH

A 31-year-old woman at 11 weeks’ gestation attends a sexual health service. She smokes 18 cigarettes daily and has been unable to stop using behavioural measures alone. She experiences persistent background cravings with additional cravings after meals. She wishes to make another quit attempt and accepts referral for ongoing behavioural support. She asks for the pharmacological strategy most likely to help while minimising fetal exposure to tobacco smoke. Which is the most appropriate adjunct to behavioural support?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Offer a long-acting nicotine patch with short-acting nicotine gum, removing the patch before bed

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · A = shown as D

NRT should be considered alongside behavioural support during pregnancy because its risks are substantially lower than continued exposure to tobacco smoke. This patient has both persistent background cravings and predictable breakthrough cravings; combined long-acting and short-acting NRT addresses both components and is more likely to support cessation than either formulation alone. NICE advises removal of nicotine patches before bedtime during pregnancy. A is plausible because short-acting NRT is permissible in pregnancy, but it provides less effective control of her sustained background cravings when used alone. B provides continuous craving control, but single-formulation NRT is generally less effective than combined NRT, and pregnant users should not wear nicotine patches overnight. D is an effective cessation strategy for some non-pregnant adults, but varenicline should not be offered during pregnancy or breastfeeding. E may also be used for smoking cessation outside pregnancy, although it is generally less effective than combination NRT or varenicline; NICE specifically advises against offering bupropion during pregnancy or breastfeeding. The nicotine exposure associated with correctly used NRT should not be equated with the substantially greater harm caused by continued smoking, which includes exposure to combustion products in addition to nicotine.

Reference: Tobacco: preventing uptake, promoting quitting and treating dependence — Treating tobacco dependence during pregnancy and in the first year after childbirth (2021; amended 2025) — https://www.nice.org.uk/guidance/ng209/chapter/Treating-tobacco-dependence-during-pregnancy-and-in-the-first-year-after-childbirth Tobacco: preventing uptake, promoting quitting and treating dependence — Treating tobacco dependence (2021; amended 2025) — https://www.nice.org.uk/guidance/ng209/chapter/treating-tobacco-dependence