Quitting smoking in pregnancy can be hard, even when women really want to quit - that’s why they deserve the best possible support.

Nicotine Replacement Therapy (NRT) is available to pregnant women who need extra help handling cravings and withdrawal, but most do not use it regularly or for long enough for it to work. This N-READY research programme aims to develop and test an intervention, called ‘Baby, Me & NRT’, that will support pregnant women to make better use of NRT to quit smoking. If it works, and increases pregnant woman’s NRT adherence, we will then carry out a further trial to establish the efficacy of the intervention for smoking cessation in pregnancy. 

The research team is made up of behaviour change and smoking cessation experts from the University of Nottingham and the University of East Anglia (UEA), with the latter leading on the intervention development.

The programme

The programme will run for over six years, (July 2017 – April 2023), and is divided into four workstreams:

  1. Discover (complete)
    Integrate evidence from systematic reviews, qualitative research, and behaviour change theory to identify pregnant women’s concerns and beliefs about using NRT and determine the best approach to improve adherence.
  2. Design and develop (ongoing)
    Design and refine a prototype intervention, called ‘Baby, Me & NRT’ to improve pregnant women’s adherence to NRT. Key features: enhanced NRT support from a stop smoking practitioner, daily text messages, and access to specialist resources. The intervention will be optimised through sequential cohorts of pregnant women using a mixedmethods approach (up to 40 participants). Additionally, develop a ‘Necessities & Concerns’ measure to assess pregnant women’s beliefs about NRT and an App (NicUse) for daily recording of NRT use and smoking.
  3. Test impact on NRT adherence (Feb 2020)
    Determine whether the Baby, Me & NRT intervention added to usual NHS cessation support increases pregnant women’s NRT use in the first 28 days following a quit date. A randomised control trial (RCT) design will be used, enrolling 200 pregnant women who want to quit smoking.
  4. Test impact on stopping smoking
    Determine whether the Baby, Me & NRT intervention, used within routine NHS stop smoking services, helps more pregnant women who smoke to quit than current NHS support. A cluster-randomised, stepped-wedge RCT (sample size = 2550 pregnant ‘quitters’) design will be used. 

UEA team

Dr Felix Naughton, Dr Joanne Emery and Dr Lisa McDaid.

The findings from this study will be used to develop policy and practice on smoking cessation in pregnancy. Key publications to date:

Campbell, K., Coleman-Haynes, T., Bowker, K., Cooper, S. E., Connelly, S., & Coleman, T. (2020). Factors influencing the uptake and use of nicotine replacement therapy and e‐cigarettes in pregnant women who smoke: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews, (5).

Hickson, C., Lewis, S., Campbell, K. A., Cooper, S., Berlin, I., Claire, R., ... & Coleman, T. (2019). Comparison of nicotine exposure during pregnancy when smoking and abstinent with nicotine replacement therapy: systematic review and meta‐analysis. Addiction, 114(3), 406-424.

McDaid, L., Thomson, R., Emery, J., Coleman, T., Cooper, S., Phillips, L., ... & Naughton, F. (2020). Understanding pregnant women’s adherence‐related beliefs about Nicotine Replacement Therapy for smoking cessation: A qualitative study. British Journal of Health Psychology.

Thomson, R., McDaid, L., Emery, J., Naughton, F., Cooper, S., Dyas, J., & Coleman, T. (2019). Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals. International Journal of Environmental Research and Public Health, 16(10), 1814.

Thomson, R., McDaid, L., Emery, J., Phillips, L., Naughton, F., Cooper, S., ... & Coleman, T. (2019). Practitioners’ Views on Nicotine Replacement Therapy in Pregnancy during Lapse and for Harm Reduction: A Qualitative Study. International Journal of Environmental Research and Public Health, 16(23), 4791.