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Step up efforts to curb smoking in pregnancy, government urged

More targeted action is needed, amid fears rates are stalling says healthcare coalition

Caroline White

Friday, 06 July 2018

The government needs to step up its efforts to curb smoking in pregnancy if it is to reach its ambition of reducing rates to less than six per cent by 2022, a coalition of health and maternity organisations has warned.

In the wake of new government figures on smoking in pregnancy published earlier this week, the Smoking in Pregnancy Challenge Group, a coalition of health, voluntary sector, and maternity organisations, is calling for bold government action to tackle the issue amid fears that the fall in prevalence may be stalling.

The figures show that just under 11 per cent of pregnant women were known to be smokers at the time of delivery in 2017-18. This is similar to the level recorded in 2016-17, although it is down from the 16 per cent recorded in 2006-07.

Its report* includes a new analysis estimating the positive impact of achieving the government’s stated ambition. By 2022 this would mean that around 30,000 fewer women would be smoking in pregnancy, leading to 45 – 73 fewer stillbirths; 11 – 25 fewer neonatal deaths; seven – 11 fewer sudden infant deaths; 482 – 796 fewer preterm births; and 1455 – 2407 fewer low birthweight babies.

But none of this will be possible unless rates of smoking in pregnancy come down, says the report, which makes several recommendations to increase the pace of change.

National action is needed to ensure that all areas have evidence-based services and processes in place to identify, refer, and support pregnant women who smoke to quit and address the large variation in performance around the country, says the report.

Support to women from disadvantaged backgrounds where smoking in pregnancy rates are highest, needs to be given a boost. This should include greater use of incentive schemes, supporting women between pregnancies and providing support to fathers and other household members, it recommends.

Use of alternative sources of nicotine should be expanded to help pregnant women stub out their habit, it says. Health professionals and women often hold misconceptions about using nicotine replacement therapy and e-cigarettes as part of quit attempts.

Gaps in training for midwives, obstetricians, and health visitors need to be plugged. Stopping smoking is part of ensuring a safe pregnancy and should be a basic part of training, says the report.

Francine Bates, chief executive of The Lullaby Trust and co-chair of the Smoking in Pregnancy Challenge Group said the report should act as a wake-up call.

“On the current trajectory, the government will miss its ambition to reduce rates of smoking among pregnant women, with tragic consequences. We have made real progress in the past in helping women to have smoke-free pregnancies and we must be ambitious about what can be achieved in the future to protect thousands of families from entirely preventable and heart-breaking outcomes,” she insisted.

Professor Linda Bauld, University of Stirling and Deputy Director, UK Centre for Tobacco and Alcohol Studies and co-chair of the Smoking in Pregnancy Challenge Group added: "There is great evidence about what can help reduce smoking in pregnancy, but we are simply not using this evidence to provide support to all women.

“At the very least every woman should receive care that meets the guidance set out by NICE. But we should go further and integrate this with wider use of incentive schemes, greater support to help dads to quit and ensure that women have access to nicotine products that can help make their quit attempt a success.”

Action on Smoking and Health chief executive Deborah Arnott said: “We are deeply concerned that lack of progress in supporting pregnant women to quit indicates that the system is not working for pregnant smokers. There have been big cuts to the support available to all smokers to help them quit both within the NHS and from local authorities. It is right that there should be more targeted support to help women in pregnancy, but that support must also be there before and after they have had a baby.”

Gill Walton, chief executive of the Royal College of Midwives said that the profession was committed to ensuring that women had the safest possible pregnancies.

“Stopping smoking is part of achieving this. However, the provision in place around the country is not consistent. Some midwives have access to excellent training, the equipment they need and have high quality stop smoking services available for the women they support. Investment is needed to ensure that this is universal.”

Dr Max Davie, officer for Health Promotion for the Royal College of Paediatrics and Child Health, said: “Smoking during pregnancy can significantly harm a baby and with over 4,000 toxic chemicals going straight into their fragile body with each cigarette smoked, it’s hardly surprising the risks are so serious – stillbirth, cot death, problems breathing and feeding and being more prone to infection.

“The government’s smoking in pregnancy reduction target might seem ambitious but with concerted effort, it can be achieved and as a result hundreds of babies will go on to survive and thrive. As children’s doctors, we fully support the recommendations outlined in today’s report and urge government to act quickly, particularly with support aimed at those families considered most at risk.”


*Review of the Challenge 2018. A report prepared by the Smoking in pregnancy challenge group, July 2018.

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