The Smoking in Pregnancy Challenge Group was established in 2012 in response to a challenge from the then Public Health Minister to produce recommendations on how the smoking in pregnancy ambition contained in the Government’s tobacco strategy could be realised.
The Group is a partnership between professional organisations, the voluntary sector and academia. It presented its report and recommendations to the Public Health Minister in June 2013 and continues to meet annually to review progress. The Smoking in Pregnancy Challenge Group is jointly chaired by Francine Bates, Chief Executive of The Lullaby Trust, and Professor Linda Bauld of UKCTAS and the University of Sterling.
The report says: “When a woman smokes during pregnancy or when she is exposed to secondhand smoke, oxygen to the baby is restricted making the babies heart work faster and exposing the baby to harmful toxins. As a result, exposure to smoke in pregnancy is responsible for an increased rate of stillbirths, miscarriages and birth defects. There is a major health inequality in this as women from more deprived backgrounds are more likely to be exposed to smoke during pregnancy.”
It highlights that there is a need for more support for the use of alternative sources of nicotine in pregnancy, including vaping: “For all smokers’, quit success is more likely if they are supported to consistently access enough nicotine to help manage their cravings when trying to stop smoking. Studies into support for pregnant women routinely find that they are reluctant to use Nicotine Replacement Therapy during pregnancy and for women who are nicotine dependent, this could undermine their quit attempt. One of the reasons for low levels of use is concern among both pregnant women and professionals that use of nicotine could be risky for the development of the baby. However, UK evidence to date does not support these concerns.”
It continues: “E-cigarettes have emerged as a popular choice for smokers trying to quit but there are indications that e-cigarette use is lower among pregnant smokers trying to quit than smokers making a quit attempt in general. Again, this is due to concern and uncertainty about their safety among pregnant women and professionals. There is currently little evidence on the safety or efficacy of using e-cigarettes in pregnancy for smoking cessation. However, given how damaging smoking is to both the mother and baby, completing switching to e-cigarettes may have benefits for women struggling to stop smoking.”
As a consequence, Bauld’s paper recommends:
- The Department of Health should develop a sophisticated communications strategy to ensure both health care professionals and women have a better understanding of the potentially positive role of nicotine containing products, such as NRT and e-cigarettes, in a quit attempt.
- Commissioners need to ensure services are providing pregnant smokers with the right levels of NRT and supporting their choice to use e-cigarettes if that is their preferred way to quit.
- Health Education England should work to improve training and understanding of the role of nicotine (separate from tobacco) is needed for key professionals including obstetricians, midwives, primary care professionals and health visitors.
Francine Bates, Chief Executive, The Lullaby Trust and Co-Chair of the Smoking in Pregnancy Challenge Group said: “This report should be 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 smokefree 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.”
Prof. 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 Dad’s to quit and ensure that women have access to nicotine products that can help make their quit attempt a success.”
ASH 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: “As a profession we are committed to ensuring the women we care for have the safest possible pregnancy. 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.”