Many people feel worried, frightened, or guilty when they discover they are pregnant after smoking, drinking alcohol, or using substances. These feelings are understandable, and it's important to acknowledge the courage it takes for someone to share these concerns.
Early, unintentional exposure does not always cause harm, and people are not to blame for what they did before knowing they were pregnant.
What matters now is helping them feel safe, supported, and informed. Encourage them to make any changes they feel able to and to contact their midwifery service or GP as early as possible.
Early engagement allows maternity professionals to offer compassionate, non‑judgemental care, routine checks, and clear advice to support their health and their baby's wellbeing
Smoking
Smoking before and during pregnancy can negatively affect fertility and pregnancy outcomes.
Stopping smoking before conception is one of the best steps a parent can do to improve fertility and ensure a healthier pregnancy, reducing risks for both parent and baby.
Both partners should work together to quit smoking to improve their chances of conceiving.
Babies exposed to tobacco smoke are more likely to be underdeveloped and have poor health.
After birth, smoking by anyone in the household is linked to a higher risk of sudden infant death. Even second-hand smoke during pregnancy can harm the baby.
Smoking before conception can harm fertility and negatively affect the health of a future pregnancy, posing risks for all genders of reproductive age.
Addressing smoking before conception is key to improving reproductive health and reducing pregnancy complications.
Smoking rates are higher among teenagers and people in disadvantaged areas, contributing to health inequalities. Supporting smoke-free pregnancies and homes is essential for reducing risks.
Creating a smoke-free environment at home is essential for maternal and fetal health, as well as reducing second-hand smoke exposure:
- advice people to always smoke outside and ask visitors to smoke outside
- don't smoke in the car or let anyone else do so (illegal if under 18 is present)
Since 2015, it has been illegal to smoke in a car carrying anyone under 18.
Women and people trying to conceive should join smoking cessation programmes to improve their preconception health. Partners and supporters play an important role in this too.
Nicotine Replacement Therapy (NRT)
NRT is often recommended as a safer option to help women and people quit smoking before and during pregnancy, although its use before conception should also be considered carefully.
Pregnant women and people who are trying to quit should be supported with NRT to manage nicotine withdrawal and stay smoke-free.
Vaping and e-cigarettes as a harm‑reduction tool
While e-cigarettes are often perceived as a safer alternative to smoking, they are not risk-free and still contain nicotine and other chemicals that can affect health.
During preconception and pregnancy, the safest option is to avoid both smoking and vaping.
Messages for professionals to share:
- all support for smoking cessation, including discussions about vaping, should be managed through local referral pathways such as stopping smoking ensuring individuals receive evidence-based, locally approved support.
- advise anyone smoking to speak to their GP or local stop smoking service for help to quit smoking
More information
Derbyshire residents can get free 12-week stop smoking support from Live Life Better Derbyshire or telephone: 0800 085 2299 or telephone: 01629 538 200.
Derby residents can get free stop smoking support from Livewell or telephone: 01332 641254.
People can contact the National Smokefree Helpline, telephone: 0300 123 1044.
Protecting a baby from tobacco smoke is one of the best things individuals can do to give their child a healthy start in life. It can be difficult to stop smoking, but it's never too late to quit. Stop smoking in pregnancy.
Substance use
Using non‑prescription or recreational drugs can have serious, long‑lasting effects on a person's health and wellbeing.
During pregnancy, these substances can harm the developing baby and increase the chance of complications.
Substance use before pregnancy can also affect fertility, making it harder to conceive, and can impact the health of both parents and their future child.
Even small amounts of illegal drugs can change how the placenta works and can affect a baby's growth. This can happen even for people who consider themselves 'low‑risk' or occasional users.
Impact of partner's substance use
A partner's drug use can also affect preconception health and pregnancy, regardless of gender.
Substance use can lower fertility, increase the risk of pregnancy complications, and affect a child's future health. Ongoing use can also create an environment that feels unsafe or unstable, even if the partner is not the biological parent.
Supporting both partners helps create a healthy and secure foundation for pregnancy and early parenting.
Messages for professionals to share:
- advise women and pregnant people to contact their GP or midwife as soon as they find out they're pregnant
- offer signposting to support for anyone planning to conceive who uses drugs. Encourage people to reach out for help to stop using. Addiction counselling, peer support, and medical treatment can help restore hormonal balance, improve fertility, and reduce risks for both parent and baby
- highlight the benefits of stopping drug use before pregnancy. Quitting before conception helps create a safer, calmer home environment and reduces the harms linked to substance use
- If a partner is involved in the pregnancy, include both partners in discussions about preconception health and substance use. This promotes shared responsibility and encourages open communication about drug use, fertility, and family planning. Providing support and treatment for both partners can improve pregnancy and future child health outcomes.
- include partners in conversations where appropriate. If a partner is involved in the pregnancy, invite them to be part of discussions about substance use and preconception health. Shared understanding and open communication can improve outcomes for the pregnancy and the future child. Support for both partners when wanted and appropriate, can strengthen relationships and promote healthier choices
Resources
Derbyshire Healthcare NHS Foundation Trust - advice, support, and treatment to adults in Derbyshire who need help with their drug or alcohol use.
Derbyshire Recovery Partnership (DRP) provides advice, support and treatment for adults in Derbyshire who wish to address issues and problems arising from the use of drugs.
Change Grow Live offers free and confidential service for young people aged 18 and under living in Derbyshire (excluding Derby City) who are using drugs or alcohol and want some support.
Alcohol
Drinking alcohol before getting pregnant can affect fertility, pregnancy outcomes, and a child’s long‑term health. There is no safe amount of alcohol during pregnancy, and the safest choice is to avoid alcohol when planning a pregnancy or when there is any chance you could be pregnant.
Alcohol can also affect decision‑making. Drinking may lead to unsafe sexual behaviours, which increases the chance of an unintended pregnancy. When someone is not using reliable contraception, there is a higher risk of early fetal exposure to alcohol before they realise they are pregnant.
Alcohol in the very early stages of pregnancy — even before a person knows — can increase the risk of Fetal Alcohol Spectrum Disorders (FASDs). These conditions can lead to lifelong physical, learning, and behavioural difficulties.
More information is available from the NHS about fetal alcohol spectrum disorder.
Alcohol use before or during pregnancy also increases the risk of miscarriage, and it can reduce fertility in both women and men.
Impact of partner's alcohol use
Partners' drinking habits can influence fertility, pregnancy outcomes, and the family environment. Heavy or frequent drinking by a partner can create stress, instability, and increase risks for both the parent and child.
A partner's drinking habits can also affect fertility, the health of the pregnancy, and the emotional environment of the family. Heavy or frequent drinking by a partner can cause stress, create instability, and increase risks for both the parent and the child.
Messages for professionals to share:
- advise women and pregnant people to contact their GP or midwife as soon as they find out they're pregnant
- support people planning a pregnancy to reduce or stop drinking. Let them know that help is available. Counselling, support groups, and medical advice can make stopping alcohol easier and safer
- include partners in conversations where appropriate. Talking about alcohol use as a couple promotes shared responsibility, openness, and a more supportive environment for pregnancy and parenting
- use clear, reassuring messages, for example: "If you're thinking about having a baby, avoiding alcohol now helps keep you healthy and gives your baby the best start. There is no safe amount of alcohol during pregnancy."
Resources
Derbyshire Addictions Advice Service (DAAS) is staffed by dedicated and experienced professionals and are led by a management team and board of Trustees with years of experience in related areas.
Derbyshire Healthcare NHS Foundation Trust offers advice, support and treatment to adults in Derbyshire who need help with their drug or alcohol use.
Change Grow Live offers free and confidential service for young people aged 18 and under living in Derbyshire (excluding Derby) who are using drugs or alcohol and want some support.
#DRYMESTER - Helping Parents-To-Be Go Alcohol Free to keep risks to babies to a minimum, the safest approach is to go alcohol free throughout pregnancy.