{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:06:23Z","timestamp":1784041583811,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aimed to evaluate the proposition that nicotine delivery by any means during pregnancy adversely affects the fetus and infant, review national policies on nicotine use in pregnancy across four high\u2010income countries and propose a coherent pregnancy\u2010specific nicotine policy framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical guidelines, public health policy documents and evidence\u2010based recommendations on tobacco and nicotine use in pregnancy were reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Smoking in pregnancy is strongly associated with adverse perinatal outcomes. Similar but less consistent associations are reported with snus and vaping, supporting avoidance of nicotine in all forms. National policies vary: NZ and the UK adopt harm\u2010reduction approaches, encouraging substitution with alternative nicotine products such as vaping, whereas the US and Sweden emphasise complete nicotine cessation. We propose a precautionary framework that recognises the mother\u2013infant dyad as the unit of care; prioritises nicotine\u2010free pregnancy; provides personalised cessation support for all pregnant women; reserves nicotine replacement therapy with clinical caution when behavioural support is insufficient; discourages vaping; and strengthens surveillance through early carbon monoxide monitoring and systematic recording of nicotine exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This framework provides a coherent pregnancy\u2010specific nicotine policy centred on cessation as the mechanism of protection for the mother\u2010infant dyad, with the aim of improving pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apa.70687","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:36:44Z","timestamp":1784039804000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Case for a Pregnancy\u2010Specific Nicotine Policy"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6187-7648","authenticated-orcid":false,"given":"Edwin A.","family":"Mitchell","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Child and Youth Health The University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Cowan","sequence":"additional","affiliation":[{"name":"Change for Our Children  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry J.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"issue":"3","key":"e_1_2_16_2_1","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1136\/jech.46.3.218","article-title":"Who Continues to Smoke While Pregnant?","volume":"46","author":"Cnattingius S.","year":"1992","journal-title":"Journal of Epidemiology and Community Health"},{"key":"e_1_2_16_3_1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1515\/REVEH.2006.21.2.81","article-title":"Smoking and the Sudden Infant Death Syndrome","volume":"21","author":"Mitchell E. A.","year":"2006","journal-title":"Reviews on Environmental Health"},{"key":"e_1_2_16_4_1","unstructured":"WHO \u201cReport on the Global Tobacco Epidemic 2025 Warning About the Dangers of Tobacco \u201daccessed June 26 2026 www.who.int\/publications\/i\/item\/B09466."},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/ntab017"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00197\u20102018"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.70352"},{"issue":"1","key":"e_1_2_16_8_1","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jpeds.2011.06.052","article-title":"Bed Sharing and the Risk of Sudden Infant Death Syndrome: Can We Resolve the Debate?","volume":"160","author":"Vennemann M. M.","year":"2012","journal-title":"Journal of Pediatrics"},{"issue":"5","key":"e_1_2_16_9_1","doi-asserted-by":"crossref","first-page":"e002299","DOI":"10.1136\/bmjopen-2012-002299","article-title":"Bed Sharing When Parents Do Not Smoke: Is There a Risk of SIDS? An Individual Level Analysis of Five Major Case\u2013Control Studies","volume":"3","author":"Carpenter R.","year":"2013","journal-title":"BMJ Open"},{"issue":"1456","key":"e_1_2_16_10_1","first-page":"52","article-title":"The Combination of Bed Sharing and Maternal Smoking Leads to a Greatly Increased Risk of Sudden Unexpected Death in Infancy: The New Zealand SUDI Nationwide Case Control Study","volume":"130","author":"Mitchell E. A.","year":"2017","journal-title":"New Zealand Medical Journal"},{"key":"e_1_2_16_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0809890"},{"key":"e_1_2_16_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph23040416"},{"issue":"10","key":"e_1_2_16_13_1","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1093\/ntr\/ntae074","article-title":"Pharmacokinetics and Pharmacodynamics of Inhaled Nicotine Salt and Free\u2010Base Using an E\u2010Cigarette: A Randomized Crossover Study","volume":"26","author":"Christen S. E.","year":"2024","journal-title":"Nicotine & Tobacco Research"},{"issue":"8","key":"e_1_2_16_14_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.26702","article-title":"E\u2010Cigarette Nicotine Delivery Among Young Adults by Nicotine Form, Concentration, and Flavor: A Crossover Randomized Clinical Trial","volume":"7","author":"Cho Y. J.","year":"2024","journal-title":"JAMA Network Open"},{"issue":"2","key":"e_1_2_16_15_1","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1124\/jpet.301.2.594","article-title":"Accelerated Metabolism of Nicotine and Cotinine in Pregnant Smokers","volume":"301","author":"Dempsey D.","year":"2002","journal-title":"Journal of Pharmacology and Experimental Therapeutics"},{"issue":"6","key":"e_1_2_16_16_1","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1159\/000457063","article-title":"Extent of Nicotine and Cotinine Transfer to the Human Fetus, Placenta and Amniotic Fluid of Smoking Mothers","volume":"8","author":"Luck W.","year":"2017","journal-title":"Developmental Pharmacology and Therapeutics"},{"issue":"3","key":"e_1_2_16_17_1","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/S0002-9378(12)90818-2","article-title":"Simultaneous Fetal and Maternal Cotinine Levels in Pregnant Women Smokers","volume":"168","author":"Donnenfeld A. E.","year":"1993","journal-title":"American Journal of Obstetrics and Gynecology"},{"issue":"1","key":"e_1_2_16_18_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1002\/bdrb.20068","article-title":"Environmental Tobacco Smoke and Sudden Infant Death Syndrome: A Review","volume":"77","author":"Adgent M. A.","year":"2006","journal-title":"Birth Defects Research. Part B, Developmental and Reproductive Toxicology"},{"key":"e_1_2_16_19_1","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2025.1525510","article-title":"Nicotine Replacement Therapy as a Smoking Cessation Tool for Adolescents: An Update","volume":"16","author":"Beis I.","year":"2025","journal-title":"Frontiers in Psychiatry"},{"issue":"3","key":"e_1_2_16_20_1","article-title":"Pharmacological Interventions for Promoting Smoking Cessation During Pregnancy","volume":"3","author":"Claire R.","year":"2020","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"2","key":"e_1_2_16_21_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1111\/add.15185","article-title":"Fetal Safety of Nicotine Replacement Therapy in Pregnancy: Systematic Review and Meta\u2010Analysis","volume":"116","author":"Taylor L.","year":"2021","journal-title":"Addiction"},{"key":"e_1_2_16_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003822"},{"key":"e_1_2_16_23_1","unstructured":"National Institute for Clinical Excellence \u201cTobacco: Preventing Uptake Promoting Quitting and Treating Dependence \u201daccessed June 27 2026 https:\/\/www.nice.org.uk\/guidance\/ng209\/chapter\/Update\u2010information."},{"key":"e_1_2_16_24_1","volume-title":"WHO Clinical Treatment Guideline for Tobacco Cessation in Adults. Licence: CC BY\u2010NC\u2010SA 3.0 IGO","author":"World Health Organisation","year":"2024"},{"key":"e_1_2_16_25_1","volume-title":"Tobak Och Nikotin Under Graviditet Och Vid Amning. Kunskapsst\u00f6d f\u00f6r V\u00e5rdgivare (Barnmorskemottagning)","author":"Socialstyrelsen"},{"key":"e_1_2_16_26_1","unstructured":"1177 V\u00e5rdguiden \u201cNikotin Och Graviditet. Sweden \u201d(2023) accessed June 27 2026 https:\/\/www.1177.se\/barn\u2010\u2010gravid\/graviditet\/livsstil\u2010och\u2010halsa\u2010under\u2010graviditeten\/nikotin\u2010och\u2010graviditet\/."},{"issue":"1","key":"e_1_2_16_27_1","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1186\/s12884-024-06633-6","article-title":"Vaping During Pregnancy: A Systematic Review of Health Outcomes","volume":"24","author":"Ussher M.","year":"2024","journal-title":"BMC Pregnancy and Childbirth"},{"issue":"5","key":"e_1_2_16_28_1","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1038\/s41591-022-01808-0","article-title":"Electronic Cigarettes Versus Nicotine Patches for Smoking Cessation in Pregnancy: A Randomized Controlled Trial","volume":"28","author":"Hajek P.","year":"2022","journal-title":"Nature Medicine"},{"key":"e_1_2_16_29_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jhazmat.2024.137028","article-title":"Associations Between Vaping During Pregnancy and Perinatal Outcomes: A Systematic Review and Meta\u2010Analysis","volume":"486","author":"Deprato A.","year":"2025","journal-title":"Journal of Hazardous Materials"},{"issue":"1","key":"e_1_2_16_30_1","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1186\/s12884-024-06863-8","article-title":"Daily Snuff Use During Pregnancy, Gestational Length and Birth Weight; Register\u2010Based Study","volume":"24","author":"Lie R. T.","year":"2024","journal-title":"BMC Pregnancy and Childbirth"},{"issue":"2","key":"e_1_2_16_31_1","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1038\/s41390-022-02463-4","article-title":"Association of Maternal Snuff Use and Smoking With Sudden Infant Death Syndrome: A National Register Study","volume":"94","author":"Gunnerbeck A.","year":"2023","journal-title":"Pediatric Research"},{"issue":"4","key":"e_1_2_16_32_1","first-page":"11","article-title":"Maternal Use of Snus as Smokeless Tobacco in Pregnancy and Infant Lung Function","volume":"10","author":"Bains K. E. S.","year":"2024","journal-title":"ERJ Open Research"},{"key":"e_1_2_16_33_1","unstructured":"Health NZ \u201cSmoking Alcohol and Drugs When You Are Pregnant \u201daccessed June 26 2026 https:\/\/www.healthnz.govt.nz\/health\u2010topics\/pregnancy\u2010maternity\/having\u2010a\u2010healthy\u2010pregnancy\/alcohol\u2010drugs\u2010smoking\u2010during\u2010pregnancy."},{"key":"e_1_2_16_34_1","unstructured":"New Zealand College of Midwives \u201cSmoking Vaping and Drugs \u201daccessed June 26 2026 https:\/\/www.midwife.org.nz\/women\/pregnancy\/smoking\u2010and\u2010drugs\/."},{"key":"e_1_2_16_35_1","unstructured":"Royal College of Midwives \u201cPosition Statement: Support to Quit Smoking in Pregnancy \u201daccessed June 26 2026 https:\/\/uat.rcm.org.uk\/media\/3394\/support\u2010to\u2010quit\u2010smoking\u2010in\u2010pregnancy.pdf."},{"key":"e_1_2_16_36_1","doi-asserted-by":"crossref","unstructured":"Royal College of Physicians \u201cHiding in Plain Sight: Treating Tobacco Dependency in the NHS \u201d(2018) https:\/\/www.rcplondon.ac.uk\/projects\/outputs\/hiding\u2010plain\u2010sight\u2010treating\u2010tobacco\u2010dependency\u2010nhs.","DOI":"10.12968\/indn.2018.11.28"},{"key":"e_1_2_16_37_1","volume-title":"Smokers Urged to Swap Ciga\u2010Rettes for Vapes in World First Scheme","author":"Department of Health & Social Care","year":"2023"},{"key":"e_1_2_16_38_1","unstructured":"NHS Digital \u201cStatistics on Women's Smoking Status at Time of Delivery: England Quarter 4 2023\/24.\u201d"},{"key":"e_1_2_16_39_1","volume-title":"Sixteenth Annual Report: Reporting Mortality and Morbidity 2021","author":"Perinatal and Maternal Mortality Review Committee","year":"2024"},{"key":"e_1_2_16_40_1","volume-title":"The Swedish Medical Birth Register \u2013 Smoking Habits During Pregnancy","author":"Socialstyrelsen"},{"issue":"1","key":"e_1_2_16_41_1","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.wombi.2023.10.008","article-title":"Is Carbon Monoxide Testing in Pregnancy an Acceptable and Effective Smoking Cessation Initiative? An Integrative Systematic Review of Evidence","volume":"37","author":"Gaudron E.","year":"2024","journal-title":"Women and Birth"}],"container-title":["Acta Paediatrica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apa.70687","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apa.70687","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apa.70687","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:36:49Z","timestamp":1784039809000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apa.70687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":40,"alternative-id":["10.1111\/apa.70687"],"URL":"https:\/\/doi.org\/10.1111\/apa.70687","archive":["Portico"],"relation":{},"ISSN":["0803-5253","1651-2227"],"issn-type":[{"value":"0803-5253","type":"print"},{"value":"1651-2227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"assertion":[{"value":"2026-04-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"apa.70687"}}