Intended for healthcare professionals


Financial rewards for pregnant smokers who quit

BMJ 2015; 350 doi: (Published 28 January 2015) Cite this as: BMJ 2015;350:h297
  1. Deirdre J Murphy, professor of obstetrics
  1. 1Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Republic of Ireland
  1. Deirdre.j.murphy{at}

Incentives help but not enough, and not for long

Smoking in pregnancy is associated with a wide range of adverse perinatal outcomes including preterm birth, intrauterine growth restriction, and perinatal death.1 2 3 The associations are almost certainly causal and the risks are modifiable by behavioural change.4 5 6 Although smoking cessation before 15 weeks of gestation yields the greatest benefits, quitting at any point can be beneficial.4 6 The potential benefits of total smoking cessation extend beyond the index pregnancy to risk reduction for sudden infant death syndrome, childhood respiratory illness, and the long term health of the mother.1 7 A Cochrane review of smoking cessation in pregnancy found that financial incentives seemed the most effective intervention, increasing abstinence more than threefold, although data were preliminary.8 The linked paper (doi:10.1136/bmj.h134) by Tappin and colleagues suggests that financial incentives may help women to quit smoking from early through to late pregnancy.9

The risks of smoking in pregnancy are widely understood by women, who are exposed to public health education, antenatal counselling, and warnings on cigarette packaging. Pregnancy seems to motivate women to stop smoking, but there is a persistent cohort …

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