Alcohol, smoking and caffeine in pregnancy

If you drank alcohol or smoked before you knew you were pregnant, bring it up with your care team. They can help you plan what to do now. CDC advises stopping alcohol during pregnancy and seeking help if that is difficult; stopping smoking can help even later in pregnancy.

Alcohol: no known safe amount or timing

CDC says there is no known safe amount of alcohol during pregnancy and no safe time to drink it. Wine, beer and spirits can all be harmful. Alcohol exposure can affect development, and is associated with miscarriage, preterm birth and stillbirth, among other harms.

NHS advice is to avoid alcohol if you are pregnant or planning a pregnancy. If you have already drunk alcohol, the amount or timing alone cannot tell you what happened in your pregnancy. CDC explains that not every baby is affected, but it is impossible to know which babies will be affected.

Ask for help if avoiding alcohol is difficult. Your GP or an alcohol support service in the UK, or your doctor or local treatment service elsewhere, can help you make a plan. Tell them you are pregnant, and explain what you drink and what happens when you try to reduce it.

If reducing alcohol brings on symptoms such as shaking, sweating, nausea or anxiety, get medical help before attempting to stop suddenly. Alcohol withdrawal can be dangerous. Ask your care team for a supported plan.

Smoking: support is part of the plan

Cigarette smoke restricts the oxygen supply to the baby. Stopping smoking reduces risks including stillbirth, early birth and low birthweight. The NHS says the earlier you stop the better, but stopping even in the last weeks of pregnancy can still help. If an attempt has been difficult, you can ask for help again.

Secondhand smoke matters too. Smoke from someone you live with can affect you and the baby before and after birth. Include your home and the people around you in a quitting conversation, if that is useful. You can ask for a smoke-free space now.

In the UK, a midwife, pharmacist or GP can help you access a stop-smoking adviser. NHS guidance allows nicotine replacement therapy during pregnancy when it helps someone stop smoking and they cannot stop without it. Speak to a professional before choosing a product.

Vaping: the regional messages differ

The NHS says that if an e-cigarette helps someone stop smoking, it is much safer than continuing to smoke. This compares vaping with smoking cigarettes; the NHS also acknowledges gaps in what is known about e-cigarettes. Discuss your current use with a stop-smoking adviser rather than treating the comparison as a reason to start vaping.

CDC says e-cigarettes and other nicotine-containing products are not safe in pregnancy, and that nicotine can harm the developing brain and lungs. It advises people unable to stop smoking to talk to their healthcare provider about treatment. UK and US wording differs, so ask your local care team for a quitting plan.

Caffeine: count more than coffee

The NHS advises no more than 200mg of caffeine a day. ACOG describes moderate consumption as less than 200 milligrams per day. The UK limit and US description are close, but differ in their wording. Neither is a recommendation to have caffeine.

Caffeine also appears in tea, cola, energy drinks, chocolate and some supplements or tablets. Think about the whole day when checking intake. The NHS notes that filter coffee and coffee-shop drinks can contain more caffeine than instant coffee, so counting cups alone can give an incomplete picture.

Where to get help

Book a conversation with your midwife, GP or stop-smoking adviser in the UK, or your doctor or midwife elsewhere, if stopping tobacco or alcohol feels difficult. You can say plainly, “I want help with this.” Your care team can help you work out a quitting plan.

Contact your GP or alcohol treatment service today if reducing alcohol causes withdrawal symptoms. Call 999 now in the UK, 911 in the US, or your local emergency number for severe withdrawal symptoms such as confusion, hallucinations or a seizure after stopping drinking.