Smoking in pregnancy

 Smoking in pregnancy causes serious risks to both the mother and child. Serious pregnancy-related health problems include increased risk of pre-term delivery, miscarriage, placenta problems around the time of birth, low birth weight and sudden infant death syndrome (SIDS), commonly called cot death.

Other later effects of exposure to tobacco smoke in the womb include risk of respiratory illness in childhood, psychological problems such as attention and hyperactivity problems and possibly a negative effect on educational attainment.

(Source: National Institute for Health and Care Excellence)

The estimated cost to the NHS of smoking during pregnancy is between £20 and £85 million for treating resulting problems in both mothers and their infants.

What do we know?

In 2005 almost a third of mothers reported smoking either immediately before, or during pregnancy and of those, approximately half gave up before the birth of their child. Of the half that continued to smoke, approximately two thirds cut down the amount that they smoked.

A study in Scotland by Shipton et al, however, used a blood test to verify mother’s smoking status and found that true smoking status was underestimated by approximately 25%. This study also showed that those smoking during pregnancy living in the most deprived areas were twice as likely to be recognised by services as smokers than those in the least deprived areas.

According to Health and Social Care Information Centre statistics, 19,968 pregnant women set a quit date in 2013/14, of whom just under half reported successfully quitting. Even if we assume a conservative estimate of a rate smoking in pregnancy of 10%, with over half a million women in England pregnant each year, these numbers would still show that the smoking cessation services are still failing to reach a significant proportion of pregnant smokers.

Facts, Figures and Trends

There were 2,423 mothers resident in Slough that delivered a baby in 2013-2014, of these 10.4% reported being smokers. This is significantly better than the national average of 12%, however it still represents approximately 251 babies at risk the complications detailed above.

Though looking at trends from 2010 to 2014 (Figure 1) there appears to be an increase in smoking at time of delivery, it is important to note that the data from 2010-2013 is based on East Berkshire PCT boundaries and therefore cannot not be directly compared with the latest data.

Figure 1 Prevalence of smoking at delivery in Slough (2010/11 - 2013/14)

Figure 1

(Source: Public Health England Fingertips)

In terms of accessing smoking cessation services, relative to other Berkshire regions a high number of pregnant smokers in Slough used the stop-smoking services in over 2014/15. Of those who set a quit date, however, only 20% succeeded in quitting for at least 4 weeks which was the lowest rate in Berkshire (Figure 2)

Figure 2. Uptake of smoking cessation services across Berkshire (2014/15)

Figure 2

(Source: SmokeFree4Life Berkshire)

National and Local Strategy

National

The governments Tobacco Control Plan (2011) set out a specific target to reduce smoking during pregnancy from 14% in 2009/2010 to 11% by the end of 2015. In the second quarter of 2015, data shows that in England 11.5% of women were known to be smokers at the time of delivery.

NICE Guideline [PH26] “Smoking: stopping in pregnancy and after childbirth” provides guidance to organisations including NHS Stop Smoking Services on the most effective ways to help pregnant women stop smoking.

Both the Start 4 life and Smokefree NHS websites provide guidance and advice for expectant mothers on stopping smoking, including advice on nicotine replacement therapy.

Examples of good practice elsewhere suggests that the most effective interventions to reduce smoking in pregnancy are:

  • Psychosocial interventions which can increase the proportion of women who stop smoking in late pregnancy, and reduce low birth weight and preterm births.
  • Incentive-based interventions show the largest effect, although caution is needed, because they were only effective with intensive delivery and studies of effectiveness were in the US.
  • Financial incentives to promote non-smoking during pregnancy show promise, and may meet the treatment needs of socio-economically disadvantaged women and heavy smokers

Local

The free stop smoking service ‘Smoke free life Berkshire’ is available across the county including in Slough and offers advice and quitting support through a variety of different activities ranging from events in the community, to a travelling clinic offering one-to-one sessions to home visits or video-chat.

What is this telling us?

There is estimated to be a large number of women smoking during pregnancy who are not receiving advice and help to quit through the NHS Stop Smoking Service. More could be done to help women access smoking cessation services in pregnancy.

Of those that have accessed the Stop Smoking Service and set a quit date, a fifth have successfully quit at four weeks

What are the key inequalities?

The Action on Smoking and Health factsheet on smoking notes that younger mothers, women in disadvantaged circumstances and those who have never worked tend to be more likely to smoke throughout their pregnancy. In 2010, mothers under the age of 20 were nearly four times as likely to smoke before or during pregnancy, compared to mothers aged 35 or over (57% compared with 15%).

What are the unmet needs/service gaps?

Quantitative and qualitative data should be collected to help design specific interventions aimed at preventing smoking initiation at a young age as setting a quit date at the booking in period has yielded poor uptake of smoking cessation services to date with the exception of dedicated services such as the Family Nurse Partnership and the Crystal team.
Smoking cessation and prevention services will need to tailor their approach to address concerns around stress management, money management and handling relationships as smoking habits are established very early.

Recommendations for consideration by other key organisations

A key recommendation of the NICE Guideline is for all organisations providing health and support services for this target group to help encourage smoking cessation by:

  • Using any appointment as an opportunity to ask women if they smoke, and if they do explain how NHS Stop Smoking Services can help
  • Offer a referral to services
  • Use local arrangements to make a referral and record this information
  • Provide the NHS Pregnancy Smoking Helpline number (0800 1699 169)
  • Those with training should provide pregnant women who smoke with information on risks of smoking while pregnant.

See also