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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Nutrition, exercise, smoking and substance use

Obstetrics and gynaecology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Withdrawal and intoxication can threaten two lives

Reduced consciousness, respiratory depression, chest pain after stimulants, severe alcohol withdrawal, seizures, overdose, suicidal intent or acute fetal concerns require emergency care; abrupt unsupported withdrawal from alcohol, opioids or dependence-forming medicines may also be dangerous.

Action: Assess airway, breathing, circulation, glucose, observations and gestation; call emergency and maternity teams; give indicated antidote or resuscitation treatment; and involve specialist alcohol or drug services urgently without delaying lifesaving maternal care.

Synopsis

Give practical, non-judgemental antenatal advice on food, activity and weight while identifying tobacco, alcohol or drug exposure early and connecting the pregnant person with effective, coordinated support.

  • Discuss diet, activity, smoking, alcohol and recreational drugs compassionately at booking and revisit them when circumstances change; stigma and punitive language reduce disclosure and attendance.
  • Promote a varied diet with vegetables and fruit, higher-fibre starchy foods, protein and pasteurised dairy or fortified alternatives; pregnancy does not require eating for two.
  • Limit total caffeine to no more than 200 mg daily and follow current NHS food-safety advice on unpasteurised products, undercooked meat or eggs, liver, high-mercury fish and infection-prone chilled foods.
  • There is no known safe alcohol level in pregnancy and the safest approach is not to drink; reassure after a small inadvertent exposure while advising no further alcohol.
  • Aim for at least 150 minutes of moderate-intensity activity each week and muscle-strengthening activity twice weekly, starting gradually if previously inactive and adapting to symptoms or complications.
  • Test carbon monoxide at booking and 36 weeks, and at other appointments for current, recent or former smokers or when the booking reading is at least 4 ppm.
  • Make an opt-out stop-smoking referral for current smoking, stopping within the previous two weeks or carbon monoxide of 4 ppm or more; consider NRT with behavioural support because its risk is substantially lower than smoking.
  • Refer regular alcohol or drug use promptly to a named specialist maternity and substance service; do not advise abrupt self-detoxification from alcohol, opioids or other dependence-forming substances.

    • Key red flags

    Syncope, chest pain, severe breathlessness, vaginal bleeding, fluid loss, painful contractions or reduced fetal movement during or after exercise requires urgent clinical assessment rather than advice simply to rest.

    Confusion, hallucinations, tremor with autonomic instability, seizures or repeated vomiting after reduced alcohol intake suggests dangerous withdrawal and needs emergency specialist treatment.

    Pinpoint pupils, slow breathing, cyanosis or reduced consciousness after opioid use is an overdose emergency; give naloxone when indicated and call emergency services.

    Cocaine or other stimulant use with chest pain, severe hypertension, neurological symptoms, abdominal pain or bleeding can signal maternal cardiovascular disease or placental abruption.

    Food insecurity, eating disorder, rapid weight loss, persistent vomiting, malabsorption or inability to retain fluids requires targeted medical, dietetic and social support rather than generic diet advice.

    Threats, coercion, exploitation, unsafe housing or a child at risk identified during substance assessment activates the local safeguarding pathway alongside confidential treatment.

    Investigation priorities

    01
    Diet and food-security assessmentFirst step

    Identify nutrient gaps, unsafe foods, financial barriers and clinical conditions that require more than population advice.

    Management branches

    Routine discussionTurn broad advice into attainable actions

    The first booking visit or a later review opens a lifestyle and wellbeing discussion.

    1. Ask about diet, activity, nicotine, alcohol and drugs using private, non-judgemental language and identify material barriers to change.
    2. Agree one or more specific actions such as food-safety changes, caffeine reduction, gradual weekly activity or contact with a support service.
    3. Document the plan, provide credible resources and revisit progress and new risks without treating difficulty or relapse as failure.

    Key medicines

    Nicotine replacement therapySelect a licensed formulation and sufficient dose with specialist behavioural support; use regularly as instructed and remove a transdermal patch before bedtime during pregnancy.Review ongoing smoking and technique to avoid undertreatment or unintended dual exposure; product choice and dose should reflect dependence and current BNF advice.
    Nyxoid intranasal naloxoneGive 1.8 mg as one spray into one nostril immediately for suspected opioid overdose; call 999 and give a second 1.8 mg spray after 2 to 3 minutes if there is no response.Each device contains one dose; use a new device in the alternate nostril for further doses, monitor for recurrent depression and expect possible acute withdrawal in opioid dependence.
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    Sources and review status9 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

    • NICE NG247 maternal nutrition recommendations
    • NHS foods to avoid in pregnancy
    • UK Chief Medical Officers pregnancy activity guidance 2026
    • NICE NG209 treating tobacco dependence in pregnancy
    • NICE NG201 antenatal lifestyle recommendations
    • NICE CG110 pregnancy and complex social factors
    • UK clinical alcohol guideline for pregnancy
    • NHS illegal drugs in pregnancy
    • Nyxoid naloxone 1.8 mg SmPC

    Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom