Smoking in Pregnancy

The Tobacco Control Plan for England (2011), which was published in 2011, set out a strategy to reduce smoking prevalence and announced a number of targets to be achieved by 2015. A specific target was included for reducing smoking during pregnancy from 14% in 2009/10 to less than 11% by the end of 2015.

NICE Guidelines (2010)recommend various actions that can be taken to encourage pregnant women to stop smoking.

The Smoking Status at Time of Delivery (SATOD) collection is published on a quarterly basis to monitor the prevalence of smoking in pregnancy. This is shown at a Clinical Commissioning Group and Area Team level. This data is then also used to estimate annual prevalence rates at a Local Authority level for inclusion in the Public Health Outcomes Framework.

The 2014/15 Q2 data for England shows that 11.5% of pregnant women were known to be smokers at the time of delivery. This had fallen from 11.7% for the same quarter in 2013/14 and from 12.0% for the previous year (2013-14).

All health professionals such as GPs, practice nurses and midwives, who come into contact with pregnant women who smoke, should provide support and encouragement to help them quit smoking. Some of the other recommended actions include:-

• Identifying pregnant women who smoke and referring them to NHS Stop Smoking Services, including measuring levels of carbon monoxide in all pregnant women and referring those who smoke to services

• Stop Smoking Services to contact all women by phone and attempting to see those whose contact was not possible at key maternity appointments. Offering appointments at other venues, including home visits is recommended

• Provide initial on-going support including the provision of interventions throughout pregnancy and after delivery. It recommends the use of Carbon monoxide testing and the provision of support to women who recently quit, including the use of Nicotine Replacement Therapy when needed

• Ensure services meet the needs of disadvantaged pregnant women who smoke, including collaboration with agencies who support women with complex needs, such as substance misuse services, teenage pregnancy support and mental health services

• Ensure partners and others who smoke who are related or in the same household as pregnant women, are offered stop smoking support and advice on passive smoking

• Training should be provided to relevant professionals, namely midwives, on delivering stop smoking interventions to pregnant women. All other relevant professionals should be trained on how to deliver brief interventions to initiate a referral to stop smoking services The Berkshire Tobacco Control Alliance team are made up of Public Health and Public Protection Officers from the six Berkshire Unitary Authorities- Bracknell, Reading Royal Borough of Windsor and Maidenhead (RBWM), Slough, West Berkshire and Wokingham as well as members from Berkshire Stop Smoking Service-presently Solutions for Health, Service Royal Berkshire Fire and Rescue, Thames Valley Police and HM Revenue and Customs

 

The Berkshire Tobacco Control Action Plan sets out a clear vision for tobacco harm reduction. This consists of targets and aspirations aimed at:

• Stopping the inflow of young people recruited as smoker

• Motivating and assisting every smoker to stop their dependence on tobacco

• Protecting families and communities from tobacco related harm

The plan is currently in development, a link will provided as soon as it is completed.

 

Smoking during pregnancy can cause serious pregnancy-related health problems. These include: complications during labour and an increased risk of miscarriage, premature birth, still birth, low birth-weight and sudden unexpected death in infancy ( Royal College of Physicians,1992). 

Babies born to mothers who smoke are more likely to develop serious respiratory illnesses (such as bronchitis and pneumonia) and other conditions such as asthma and glue ear. 

( Royal College of Physicians1992). There is also evidence linking smoking in pregnancy with psychological problems in young children, such as attention and hyperactivity problems and negative and disruptive behaviours ( Button et al, 2007).

The Public Health Outcomes Framework includes an indicator to measure the prevalence of smoking at delivery. This is an estimate at a local authority level, based on the data collected in the Statistics on Women's Smoking Status at Time of Delivery collection. In 2013/14, 1613 mothers resident in Wokingham delivered a baby, of these 5.9% were smokers. This is significantly better than the England average of 12%. However, it is important to note the PHOF data for 2013/14 is based on different inclusion criteria, than from 2010-2013, so cannot be compared to previous data. This year it is based on the number of women resident in Wokingham compared with aggregated data for the old Berkshire West PCT boundary.

Figure 1 - Prevalence of smoking at delivery in Wokingham Borough compared with England

 Source: Public Health Outcomes Framework , 2014

Smoking during pregnancy is strongly associated with a number of factors including age and socio-economic circumstances. Young mothers aged 20 years or under are five times more likely than those aged 35 and over to smoke during pregnancy. Mothers in routine and manual occupations are more than four times as likely to smoke throughout pregnancy, compared to those in managerial and professional occupations. Pregnant women who live in rented accommodation and are single or have a partner who smokes, and those who are less educated are also more likely to smoke ( NICE 2010).

Many of the women most likely to smoke during pregnancy live in circumstances which make it difficult for them to quit the habit. 

This suggests that staff involved in delivering local programmes that support young mothers and especially those from disadvantaged backgrounds, need to raise the topic of smoking in a sensitive manner and encourage efforts to stop smoking by signposting to the local NHS Stop Smoking service. Commissioners of these programmes need to ensure that staff has the confidence and competence to raise the topic of smoking in an appropriate manner and have the information required to make the referral.

The fact that a significant number of women continue to smoke during pregnancy suggests that specific interventions are required for this group. These may include referral pathways and interventions that better address the stigma often felt by pregnant women who smoke and that may often act as a barrier against accessing generic stop smoking programmes.

There is also a lack of stop smoking services available outside of normal working hours.

Recommendations for consideration by other key organisations such as: CCG’s, General Practices, Local Authority department e.g housing and other providers.

Ensure all agencies working with pregnant women or women likely to become pregnant can support and signpost those to SmokefreeLife Berkshire stop smoking services.

• Adult Smoking

References

HM Government; Healthy Lives; Healthy People: A Tobacco Control Plan for England (March 2011)

 

Health & Social Care Information Centre; Statistics on Women's Smoking Status at Time of Delivery - England, 2014/15 Quarter 2 (published December 2014)

Public Health England; Public Health Outcomes Framework data tool (updated February 2015)