Smoking in Pregnancy

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Smoking in Pregnancy

• What can we do?

Hilary Wareing Co Director Tobacco Control
Collaborating Centre
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Two consistent background characteristics
differentiate SIDS deaths from infants who die
suddenly from identified causes

• age distribution
• high level of exposure to tobacco smoke
• (even when socio-economic status is taken into
  account.)

Ref Fleming P, Blair PS, Sudden Infant Death
Syndrome and parental smoking, Early Hum Dev
(2007, doi 10.1016/j.earlhumdev.2007.07.011
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Professor George Haydock, FSIDs scientific
adviser says The figures show that maternal
smoking is now the most important avoidable risk
factor for Sudden Infant Death Syndrome
(SIDS).If no women smoked in pregnancy, about
60 per cent of cot deaths could be avoided. This
means that in the UK the number of deaths could
fall from around 300 a year to 120 a year.Cot
death is still the biggest killer of babies over
one month old in the UK today, claiming more
lives than traffic accidents, leukaemia and
meningitis put together.
Ref Medical News Today 22 Oct 2007
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Effective recruiting of women into cessation
programmes priority

• Brief intervention training for all midwives,
  health visitors, children centre staff, midwifery
  support works etc
• Active recruitment by midwives, health visitors,
  midwifery support workers, children centre staff
  
• Compact smokerlyzers for all midwives, health
  visitors and other key health professionals
• Best practice flow chart
• Smoking questionnaire
• Recruit using the Call Centre

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Data Collection

• Recorded by professional for all women
• Mandatory field
• Take out dont know option
• Use questionnaire rather than single question

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Timing of brief interventions

• Early - call centre - booking visit
• Dont give up

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Cessation Support

• Very skilled support
• Peer support see breast feeding evidence-
  utilise midwifery support workers
• Telephone and home support during pregnancy
• Drop in support at Children Centres
• Intensive post natal support
• Involve partners / families
• Best practice flow chart

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Training

• Level 2 / 3 for specialists
• Brief intervention for all
• Peer support training

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Nicotine Replacement Therapy

• Assessment using an NRT protocol
• Assessment of how NRT is currently used
• Assessment of impact on cessation during
  pregnancy

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Materials

• Targeted leaflets
• Culturally sensitive material

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Cost benefit analysis

• PCTs
• Acute Trusts

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What are we doing in Birmingham?
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ACCESS TO GOOD FOOD
SAFER URBAN COMMUNITIES
MAXIMISING AVAILABLE INCOME

IMPROVING MATERNAL AND CHILD NUTRITION
REDUCING SMOKING IN PREGNANCY
INCREASING EDUCATIONAL ATTAINMENT
REDUCING LOW BIRTH WEIGHT
INCREASING EARLY BOOKING
REDUCING TEENAGE PREGNANCY
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What are we doing in Birmingham?
Smoking in Pregnancy Service - Suggested Referral
Pathway
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What are we doing in Birmingham?
Smoking in Pregnancy Service - Suggested Referral
Pathway
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What next?

• Monitor and evaluate
• Improve effectiveness of service
• Improve service to post natal women
• Reduce exposure to secondhand smoke