Written by Adrian McConnell, Chief Executive, CO Research Trust


Since 2017, the CO Research Trust (CORT) has been working alongside Improving Performance in Practice (iPiP) and a network of committed partners to address a serious but often overlooked issue: the risk of carbon monoxide (CO) exposure during pregnancy.

This work began with the 2017 All-Party Parliamentary Carbon Monoxide Group (APPCOG) Carbon Monoxide Poisoning: Saving Lives, Advancing Treatment – A Call for Action Across the Healthcare Sector report, which set out four priorities for change:

1. To understand the true scale of environmental CO poisoning

2. To identify barriers and enablers to detecting CO poisoning

3. To improve protection for pregnant women through healthcare and other interventions

4. To strengthen public and professional education on CO safety
 

Eight years later, we have made significant progress in every one of these areas. But to turn that progress into real-world protection, investment in implementation and delivery is now essential.


How Big is the Problem?

The recent literature review, undertaken by iPiP highlights just how dangerous CO exposure can be in pregnancy.

It links exposure not only to foetal and neonatal death, but also to congenital malformations and long-term neurological problems.

Evidence also points to a potential connection with cardiac disease and dementia, as well as affecting those with underlying conditions and other health inequalities.

Perhaps most importantly, the review confirmed that chronic low-level exposure, which is often undetected, can cause significant harm to both unborn babies and vulnerable adults.

The IPPCO Study, one of the first to measure CO exposure in the homes of pregnant women, produced some important findings:

  • 57.8% of homes had detectable CO levels
  • 31.7% recorded levels above 4ppm, and 14.3% exceeded 10ppm
  • Several households surpassed WHO recommended limits
  • 44% of homes did not have a working CO alarm
     

Beyond the data, the study provided important insights into perceptions of risk amongst pregnant women. Many women assumed CO exposure “wouldn’t happen to them,” and healthcare professionals identified the urgent need for a system-wide response.

An academic paper from this research has now been published in the BMC Pregnancy and Childbirth Journal, with more to follow; offering an evidence base that can no longer be ignored.

Turning Research into Resources

However, good research is just the beginning. To make a real difference, these findings need to be translated into tools that professionals can use.

CORT funded the UK Health Security Agency (UKHSA) to develop and pilot a CO exposure algorithm for midwives — a practical decision-support tool to help maternity teams identify, respond to, and prevent harm during antenatal appointments . This updated guidance has now published and is live for all healthcare professionals to access, to see it in action visit - https://www.gov.uk/government/publications/carbon-monoxide-co-antenatal-checks-algorithm-for-midwives 

At the same time, iPiP partnered with NHS England’s e-Learning for Healthcare (elfh) team to create a suite of four online training modules. These sessions, designed for health and social care professionals, aim to increase awareness and confidence in recognising and responding to CO exposure. The piloting of the modules has now concluded and they are being readied for a national launch.

Furthermore, iPiP has been working with Fire and Rescue Services and maternity teams in Warwickshire and the West Midlands to evaluate a referral pathway for pregnant women at risk of exposure. The results have informed the development of a national implementation toolkit so this approach can be adopted more widely.

These are not abstract concepts or pilot ideas: they are practical, evidence-based tools ready to be rolled out.

Building the System Around Prevention

In March 2025, CORT’s CO in Pregnancy Symposium brought together researchers, clinicians, and public health leaders. The message was clear: to have lasting impact, this work must now be embedded across the system.

To make that happen, a Strategic Stakeholder Group on Environmental CO and Pregnancy, is being established, bringing together representatives from the Department of Health and Social Care, NHS England, Royal Colleges, Fire and Rescue Services, local authorities, and leading charities.

I am delighted that Clea Harmer, Chief Executive of SANDS, has agreed to chair this group. CORT plans to work with this national group of experts to ensure national alignment, sustained collaboration, and clear accountability.

What Comes Next?

To date, this work has been made possible thanks to £576,906 of funding from CORT and the UK’s four gas distribution networks, along with in-kind support from AICO, Kane, and Inter-Medical.

That investment in research has brought us to this point — where we have a solid evidence base, tested interventions, and a growing network of committed partners.

The next step is to deliver.

There now needs to be a national implementation phase, which will:

  • Embed CO awareness into everyday practice across health and social care
  • Roll out the UKHSA algorithm and ensure its integration into maternity services
  • Launch the e-learning modules nationally, supported by regional workshops and communications campaigns
  • Formally evaluate how this work improves detection, prevention, and outcomes for women and families
  • Extend the programme to all four nations, ensuring consistency and equity across the UK
  • Influence national policy, positioning CO exposure as a critical part of public health and housing safety


This work will also build on the broader agenda around fuel poverty, air quality, and healthy homes — recognising that CO safety does not sit in isolation but within a much wider conversation about health equity.

Why Does This Matter?

Too often, good research fails to influence practice because there’s no investment in delivery. We know the risks of carbon monoxide exposure. We know what works to prevent it. We’ve built the partnerships and the tools to make a real difference.

But without implementation, this knowledge stays trapped in reports and papers, instead of protecting the people who need it most.

By supporting this next phase, we can achieve measurable impact:

  • Greater awareness of CO risks among health and social care professionals
  • Better detection and faster action in maternity and social care
  • Safer homes for pregnant women, babies, and vulnerable adults
  • A sustainable national framework for prevention


What can we do?

We’ve come a long way: from a call for action in 2017 to tangible progress in 2025. Now, we need to turn that progress into lasting change.

This is the moment to make sure no pregnant woman, or unborn baby suffers preventable harm from carbon monoxide exposure.

The next step is for everyone with an interest in carbon monoxide prevention, to come together, to help deliver national implementation, to influence policy, and to ensure this vital work reaches every corner of the UK.

If we come together now, we can turn research into action, and knowledge into lives saved and healthier futures.