Tackling smoking during pregnancy 1

The number of pregnant women in Scotland who tried to give up cigarettes rose last year to nearly 3000, thanks to better education and stop-smoking help.

All mums-to-be will now be offered a breath test to provide personalised information about how much they and their unborn baby are being exposed to dangerous carbon monoxide from tobacco smoke.
The Scottish Government’s announcement of the monitoring initiative is welcome news for ASH Scotland and others involved in the drive to help pregnant women avoid smoking and tobacco use.

DIFFICULT TO QUIT

We know that circumstances mean it is often difficult for pregnant women to quit so it’s important they have the support of those around them. Health workers can also encourage the whole family to provide a tobacco-free “bubble” around the unborn child.

Stubbing out cigarettes will end a tragic toll of children affected by tobacco use during pregnancy. Smoking 10 or more cigarettes a day during pregnancy doubles the risk of stillbirth.

There is also a seven-fold increase in the risk of cot death when the mother smokes over 20 cigarettes a day, particularly if she has smoked during pregnancy.

Sadly, 20 infants die every year in Scotland due to causes directly attributable to smoking in pregnancy. Over 11,000 Scottish babies are affected annually by their mums lighting up while pregnant.

MEDICAL ISSUES

Tobacco use is linked to low birth weight, meaning babies are at greater risk of dying and more likely to suffer from breathing problems needing ventilation in intensive care units immediately after birth. In the longer term, they’re more likely to have some form of disability.

Smoking is also associated with diabetes, asthma and attention deficit disorder in children, as well as even more serious issues including fertility problems in women and men, miscarriage, premature birth, stillbirth and cot death. Then there’s the danger to families of second-hand tobacco smoke from smokers, pregnant or not.

But Scotland is working hard to tackle the potentially devastating consequences of smoking in pregnancy and there has been some notable success. The number of mums-to-be who said they were smokers at their first antenatal booking dropped from 29% in 1995 to 19% in 2011.

Even so, over 30% of pregnant women in the most deprived communities still smoke when they book their first antenatal appointment. That contrasts with around 6% in the least deprived.

There is a similar stark disparity in the number of smoking mums recorded when health visitors drop by for the first time – 29% in the poorest areas compared to 5% amongst the wealthiest. This highlights the need for tailored support services in every community.

CARBON MONOXIDE TESTS

As part of a new Maternity Improvement Programme, all pregnant women will now be offered carbon monoxide (CO) monitoring early in their pregnancy.

The move isn’t about stigmatising women smokers – it’s about providing individual feedback and information, which we know can be an effective spur and support. It can also show up CO that’s come from someone else’s cigarette smoke, as well as other sources such as faulty gas appliances.

If mums-to-be have raised CO levels, midwives will be able to refer them to specialist stop- smoking support services, as well as to additional care during the pregnancy if needed.

The monitoring has already been tried in some areas and we’re delighted to see how positive the results have been.

Over a year, NHS Greater Glasgow & Clyde checked 14,282 pregnant women for CO and 2,521 were then referred to the specialist pregnancy smoking cessation service. Nearly 300 had quit smoking a month later. The health authority has increased its CO testing rate to close to 100%, up from less than 80% two years ago, and there are now calls for a similar CO monitoring scheme across England.

CHALLENGES AHEAD

ASH Scotland was among those who took part in a policy summit on tackling smoking in pregnancy in Scotland. Some of the challenges that lie ahead were clear.

We need to help more pregnant women to quit tobacco and smoking to improve their health and that of their baby. Official guidance on smoking cessation in pregnancy is not always being implemented consistently or comprehensively across Scotland, so all maternity services should now commit resources, develop systems and provide training to ensure that happens.

Reduced exposure to second-hand smoke in homes and cars will help and it’s good to see the current debate on proposed legislation to ban smoking in vehicles with children. And training is essential to equip everyone who works with families to play their part in preventing damage from tobacco smoke before, during and beyond pregnancy.

By working with parents and families we can make the goal of being free from tobacco a reality for every child – a reality that will save lives.

This article first appeared in Friends of The Scotsman

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