England: Encouraging but insufficient decline in smoking among pregnant women

New data from the National Health Service (NHS)[1] (which is the equivalent of health insurance) show that the smoking rate among pregnant women in the third trimester fell to 9.5% in 2021 in England, its lowest rate since 2015. This is encouraging but still insufficient to meet the government's target of reaching 6% or less by 2022.

Smoking prevalence among pregnant women declined six times faster between 2019/20 and 2020/21 than the average of the previous four years. However, to achieve the government's target of 6% or fewer pregnant women smoking by 2022, significant efforts are needed.[2].

Deep disparities between regions

The highest rates of smoking during pregnancy are found in the poorest regions and communities, particularly in the north of the country. In the north of England, the latest data shows that 12.11 pregnant women smoke in the third trimester. This proportion is only 6.51 in London and the southeast of the country.

However, these regions also saw the greatest declines, contributing to improvements in the health of the most deprived communities. The NHS cautions that caution is needed when interpreting figures collected during the COVID-19 pandemic. However, it appears indisputable that the most significant declines in recent years have been observed in locations in the north of England where there are comprehensive strategies to combat smoking among deprived populations, as well as targeted and intensive support for pregnant women.

The effectiveness of targeted cessation assistance programs

In Greater Manchester, the third-trimester smoking rate fell from 12.6% in 2017/18 to 9.8% in 2020/21. In 2018, the Greater Manchester Health and Social Care Partnerships' "smoke-free pregnancy" program[3] was implemented and is recognized as best practice nationally. Between April 2020 and March 2021, the program supported more than 1,700 people in their smoking cessation journey, particularly pregnant women and their partners, and recorded a success rate of 65 %.

NHS maternity staff in Greater Manchester have received comprehensive training on smoking and its risks, carbon monoxide (CO) measurements to check for tobacco smoke exposure in pregnant women and then refer these people to a maternity-led smoking cessation service.

The risks of active and passive smoking during pregnancy

Active and passive smoking during pregnancy increases CO levels in the body and can restrict the baby's essential oxygen supply. This greatly increases the risk of complications. The major consequences of this prenatal tobacco exposure on the fetus are well documented.[4]. Certain malformations are particularly mentioned (congenital heart disease, bone, facial and digestive tract anomalies); fetal death in utero (+50%) ; low birth weight (x 2); increased risk of prematurity (approximately +10%); early miscarriages.

Some consequences of this prenatal exposure are also observable after birth: increased risks of sudden infant death (x 2 to 4), asthma, respiratory pathologies and infections, overweight and obesity (x 1.5 to 2).[5]

Tobacco consumption among pregnant women and adolescents in France is one of the highest in Europe. A 2016 national survey estimated that approximately 30% of pregnant women smoked before pregnancy and that half of them still smoked in the third trimester of pregnancy.[6].

Keywords: England, Active smoking, passive smoking, pregnancy, pregnant women

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[1] NHS, Statistics on Women's Smoking Status at Time of Delivery, July 6, 2021, accessed July 8, 2021

[2] ASH UK, During the pandemic smoking in pregnancy fell below 10% for the first time since records began BUT Government still not on track to reach target of 6% or less by 2022, July 6, 2021, accessed July 8, 2021

[3] Greater Manchester, Health and Social Care Partnership, New figures reveal smoking in pregnancy rates at all-time low in Greater Manchester, July 6, 2021, accessed July 8, 2021

[4] CNCT, Specific risks for women, accessed July 8, 2021

[5] Tobacco Free Generation, Health consequences of tobacco exposure at all ages of childhood, April 16, 2021, July 8, 2021

[6] Demiguel V, Bonnet C, Andler R, et al. Evolution of tobacco consumption during pregnancy in France in 2016. Weekly Epidemiological Bulletin, 2018;(35-36):694-703. http://invs.santepubliquefrance.fr/ or http://bit.ly/3qxLz7A