Tobacco and Alcohol Research

Smoking in Pregnancy Research Group

The Smoking in Pregnancy research group is based within the Centre for Public Health and Epidemiology in the School of Medicine at the University of Nottingham.

With collaborators around the UK and internationally, our research group is a leading centre for research on Smoking in Pregnancy. 

Watch the video for an overview of our research and the work we are doing to help reduce smoking rates in pregnancy and prevent women from returning to smoking after they have had their babies.

The issue

Smoking in pregnancy is the biggest cause of harm to babies, very young infants and to mothers. In the UK up to 12% of women smoke throughout pregnancy and this is completely reversible. Pregnancy motivates around 50% of smokers to stop but many women either can’t stop during pregnancy or, if they do, they re-start smoking again afterwards.

Our aims

  1. Reduce smoking rates in pregnancy and to prevent women from returning to smoking after they have had their babies.

  2. Develop and test effective methods for helping pregnant women to quit smoking and prevent relapse after childbirth. 

  3. Influence health policy and NICE recommendations to ensure that evidence-based methods for encouraging cessation and preventing relapse are used in routine clinical practice.


We design and conduct trials to test out new ways of helping women to stop smoking when they are pregnant. We are skilled in applied health services research, health psychology, behavioural sciences, statistics, qualitative research, systematic review, epidemiology, economics and analysis of large, routine databases.

Have you ever smoked while you have been pregnant or very soon afterwards? If so we would be keen to hear from you. We need to hear your views to help us design research which is relevant and useful for women who smoke when pregnant.


Current and recent projects include:

  • An NIHR research programme aimed at increasing pregnant women’s use of NHS Stop Smoking Services.  In this, we have tested new ways to engage women with NHS cessation support and when and how this is best offered; we have also tested in a  pilot randomised controlled trial, a new text message-based, self-help, smoking cessation intervention for pregnant women.

  • Studies to identify behaviour change techniques (BCTs) which are appropriate for but not currently used in pregnant smokers’ behavioural support for.  This aims to integrate ‘new’ BCTs into standard NHS behavioural support for pregnant smokers.

  • Developing and evaluating an economic model to value cessation interventions in pregnancy in economic terms and determining the healthcare costs amongst infants and children which are attributable to smoking in pregnancy.

  • Exploratory work investigating the role of e-cigarettes in pregnant and postpartum women and of nicotine replacement therapy (NRT) used by pregnant smokers.

  • We also test cessation interventions for non-pregnant smokers; we recruited > 300 non-pregnant smokers to a large RCT testing the effectiveness for quitting of using nicotine replacement therapy (NRT) in the month before abstinence begins (the NIHR-HTA ‘Preloading Study’).

Previous research:

  • Smoking, Nicotine And Pregnancy (SNAP) Trial – with 1050 participants, this is the world’s largest trial of NRT for smoking cessation in pregnancy. It investigated the effectiveness, safety and cost-effectiveness of NRT provided to pregnant women. Findings were published in the New England Journal of Medicine and Lancet Respiratory Medicine.




  • We have completed randomised controlled trials (RCTs)1-3, systematic reviews4-6 and database studies7 8 investigating nicotine replacement therapy (NRT) use in pregnancy; these suggest NRT is safe in pregnancy but at standard doses, has borderline efficacy. We helped update of an authoritative review of psychosocial interventions for smoking cessation in pregnancy9 led by an Australian team.

  • We found that identifying smokers at fetal ultrasound appointments using exhaled carbon monoxide and referring them for NHS smoking cessation support doubles the proportion of women who successfully stop smoking.10 11

  • We are investigating ways of making text-based intervention for smoking cessation in pregnancy available to pregnant smokers over the internet.12 13

  • We are refining an economic model for valuing smoking cessation in pregnancy and will make this available for other researchers to use.14-16

  • We are developing behavioural support methods tailored which are tailored for pregnant smokers and which will be incorporated into mandatory national online training modules provided by the National Centre for Smoking Cessation and Training (NCSCT) for NHS smoking cessation advisors. 


Our research has been published in leading peer-reviewed journals. See our individual staff profiles to find out more.

Selected publications

1. Coleman T, Cooper S, Thornton JG, et al. A randomized trial of nicotine-replacement therapy patches in pregnancy. New England Journal of Medicine 2012;366(9):808-18.

2. Cooper S, Lewis S, Thornton J, et al. The SNAP trial: a randomised placebo-controlled trial of nicotine replacement therapy in pregnancy - clinical effectiveness and safety until 2 years after delivery, with economic evaluation. Health Technol Assess 2014;18(54).

3. Cooper S, Taggar J, Lewis S, et al. Effect of nicotine patches in pregnancy on infant and maternal outcomes at 2 years: follow-up from the randomised, double-blind, placebo-controlled SNAP trial. The Lancet Respiratory Medicine 2014;2(9):728-37.

4. Coleman T, Chamberlain C, Davey M-A, et al. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2015(12):CD010078.

5. Coleman T, Chamberlain C, Cooper S, et al. Efficacy and safety of nicotine replacement therapy for smoking cessation in pregnancy: systematic review and meta-analysis. Addiction 2011;106(1):52-61.

6. Coleman T, Chamberlain C, Davey MA, et al. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2012;9:CD010078.

7. Dhalwani NN, Szatkowski L, Coleman T, et al. Nicotine Replacement Therapy in Pregnancy and Major Congenital Anomalies in Offspring. Pediatrics 2015;135(5):859-67.

8. Dhalwani NN, Szatkowski L, Coleman T, et al. Prescribing of nicotine replacement therapy in and around pregnancy: a population-based study using primary care data. The British journal of general practice : the journal of the Royal College of General Practitioners 2014;64(626):e554-60.

9. Chamberlain C, O'Mara-Eves A, Oliver S, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2013;10:CD001055.

10. Sloan M, Campbell KA, Bowker K, et al. Pregnant Women’s Experiences and Views on an “Opt-Out” Referral Pathway to Specialist Smoking Cessation Support: A Qualitative Evaluation. Nicotine & Tobacco Research 2016.

11. Campbell KA, Cooper S, Fahy SJ, et al. 'Opt-out' referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support. Tobacco Control 2016.

12. Cooper S, Foster K, Naughton F, et al. Pilot study to evaluate a tailored text message intervention for pregnant smokers (MiQuit): study protocol for a randomised controlled trial. Trials 2015;16(1):29.

13. Naughton F, Cooper S, Bowker K, et al. Adaptation and uptake evaluation of an SMS text message smoking cessation programme (MiQuit) for use in antenatal care. BMJ Open 2015;5(10):e008871.

14. Jones M, Lewis S, Parrott S, et al. Re-starting smoking in the postpartum period after receiving a smoking cessation intervention: a systematic review. Addiction 2016;111:981-90. DOI: 10.1111/add.13309.

15. Jones MJ. The development of the Economic impacts of Smoking In Pregnancy (ESIP) model for measuring the impacts of smoking and smoking cessation during pregnancy. [PhD]. University of Nottingham, 2015.

16. Jones M, Lewis S, Parrott S, et al. Systematic critical review of previous economic evaluations of smoking cessation during pregnancy. BMJ Open 2015;5(11):e008998.




Contact us

If you are a prospective PhD student or would like to help us with our research, please get in touch. 

Nicki Stockdale
Research Administrator












Tobacco and Alcohol research

The University of Nottingham

email:Chris Hill