Smoking and pregnant women
Smoking during pregnancy
5.1 Smoking during pregnancy harms the unborn child and leads to lower birthweight. New evidence also shows that women who smoke during pregnancy pass harmful carcinogens on to their baby39.
5.2 24 per cent of women smoke during pregnancy, and only 33 per cent of women smokers give up during pregnancy40. The main reason is that smoking is addictive and is very hard to give up. We need to make people more aware of the serious risks of smoking during pregnancy and to offer them help when they try to give up.
5.3 Many parents continue to smoke at home while bringing up children. Children of smoking parents are more likely to suffer illness or even cot death. They are also much more likely to take up smoking themselves9. Almost half of single women smoke during pregnancy40.
' children of smoking parents are more likely to suffer illness or even cot death'
5.4 The problems of smoking during pregnancy are closely related to health inequalities between those in need and the most advantaged. Women with partners in manual groups are more likely to smoke during pregnancy than those with partners in non-manual groups: 26 per cent of women with partners in manual groups smoke during pregnancy, compared with 12 per cent with partners doing non-manual work40.
5.5 Helping pregnant women to give up smoking not only leads to health gains for mothers and their children, it can also mean immediate cost savings for the NHS. This is because smoking in pregnancy leads to low birthweight babies who may need very costly intensive care treatment. Savings to the NHS can amount to between three and six times the cost of providing help to pregnant women to give up smoking19.
5.6 There is good evidence that helping pregnant women to give up smoking is cost-effective. Of course, many health professionals, particularly midwives and primary care teams, already provide advice to stop smoking to women smokers when they become pregnant.
What we are going to do
5.7 Pregnant women who smoke will be a key focus of action at local level as our new NHS smoking cessation services are developed. In Health Action Zones, where many of those women most in need live, up to £60 million in new money will flow from April 1999, to deliver expert help where it is most needed.
Clwyd Smoking in Pregnancy
The Clywd Smoking in Pregnancy project is targeted at all pregnant women in North East
Wales. Its aim is to increase the quit rate in pregnant women and to help ensure they do
not start smoking again in the months after their baby is born. The project includes training
for professionals, such as doctors, midwives and nurses; structured help for women; and
evaluation to see how well the project has worked. The ultimate aim is to ensure help in
quitting is available to all pregnant smokers, as part of their pre-natal care.
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5.8 At the moment, nicotine replacement therapy (NRT) is not advocated in the UK for pregnant women. However, the American Agency for Health Care Policy and Research has suggested that NRT should be offered in pregnancy to the heaviest smokers who are unable to stop without it. We believe research should be done here to evaluate this. That is why we have made this one of the key smoking research priorities for the future, and we will be looking for well-structured proposals to come forward. This may well be a suitable area for joint funding with the pharmaceutical industry.
5.9 We will also support local NHS action with our new national public education campaign. Shifting young women's attitudes and behaviour on smoking will be a particularly important theme. As we develop the campaign we will build in tailored messages to highlight the importance of giving up smoking when pregnant.
During Pregnancy
5.10 Pregnancy is an ideal time for women and their partners who smoke to consider quitting; they are eager for information, have access to health services, and are often keen to make changes to their lifestyle. Most women are motivated to do what they can to make sure their baby is healthy. Often this can include wanting to stop smoking. The sooner the mother stops, the better for her own health, and that of her baby.
Pregnancy QuitlineTM
The Pregnancy Quitline pilot was launched in 1997 and is run by the charity Quit®, with joint NHS and commercial funding. Counsellors give callers information about the service, establish an on-going relationship, and agree a smoking cessation programme tailored directly to the needs of each individual. Contact between the counsellors and client may be more or less frequent depending on the level of support needed in each case. In its first year, Pregnancy Quitline has answered 3000 calls, (in addition to those made by counsellors to clients). 40 percent of clients are aged between 16 and 24, with half being referred by their GP or midwife. Evaluation is under way, but initial results are encouraging.
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5.11 Midwives, GPs, obstetricians and other health professionals have regular, one-to-one contact with pregnant women. These contacts are ideal opportunities to offer support and practical advice on giving up smoking.
5.12 Evidence also shows that pre-natal counselling involving at least ten minutes person-to-person contact and written materials specifically designed for pregnant women, can double quit rates41.
5.13 Women need specific and continuing support following the birth of their child. Health professionals can help by encouraging new mothers in their efforts to continue not smoking. For example, advice on breast feeding could include awareness that if the mother smokes, some nicotine will pass into the baby's bloodstream. Advice on how to reduce the risks of cot death could also include support with smoking cessation.
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