Smoking in pregnancy increases the likelihood of miscarriage and stillbirth, and increases the risk of premature birth and low birth weight. Smoking in pregnancy can also have long-term effects on the health of children, such as increased risk of infections, developing asthma and becoming a smoker when older.
What do we know?
Despite smoking prevalence in Shropshire being significantly lower than the national average, prevalence of smoking in pregnancy (16%) is high compared to the national average (13.5%). Significantly more Shropshire women aged under 25 years smoke during pregnancy compared with older age groups. There are also significantly more women smoking in pregnancy in the most deprived fifth of areas in Shropshire compared to the county average. This results in health inequalities being passed on to the next generation, as children with parents who smoke in the home are more likely to be exposed to harm from second-hand smoke, and more likely to become smokers themselves when they grow up.
What are we doing?
In Shropshire a wide range of NHS stop-smoking services is available, commissioned on a ‘payment by results’ model. The tariff payment offered to providers of smoking in pregnancy services is enhanced to recognise the importance of prioritising this group of smokers. As a result, specialised support should be available to all smokers who are pregnant or planning a family. This includes the development of services within local children’s centres.
Smoking services in Shropshire collect patient feedback, and overall levels of satisfaction are very high. Comments received by patients are used to make changes to the services. The services are NICE compliant, and an action plan has been developed in collaboration with Midwifery Services to implement NICE guidance.
What can we do?
NICE guidance recommends that all pregnant women who smoke, those planning a pregnancy and those with a child under 12 months should be referred to an NHS stop smoking service:
- Professionals working with pregnant women should identify those who smoke, including through the use of a CO monitor
- Pregnant women who smoke should be referred to NHS stop smoking services
- Stop smoking service staff should make direct telephone contact with all pregnant women who have been referred
- Assistance should be offered to help partners who smoke
- Evidence-based behavioural support strategies should be used
- Where not contradicted, pharmacological treatment such as nicotine replacement therapy should be offered
- Services should meet the needs of disadvantaged smokers
- All professionals providing on-going support should be trained to National Centre for Smoking Cessation Training standards, and all professionals coming into contact with pregnant women should be trained in brief opportunistic advice