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. An encouraging development but still insufficient to meet the government's target of reaching 6% or less by 2022.

Smoking prevalence among pregnant women fell six times faster between 2019/20 and 2020/21 than the average of the previous four years. However, in order to meet 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 in poorer areas and communities, particularly in the north of the country. In the north of England, the latest figures show that 12.11% of pregnant women smoke in the third trimester. This is down to just 6.51% in London and the south-east.

However, these areas have also seen the biggest declines, contributing to improvements in the health of the most deprived communities. The NHS cautions that some caution is needed when interpreting figures collected during the COVID-19 pandemic. However, it is clear that the biggest declines in recent years have been in places in the north of England where there are comprehensive strategies to tackle 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 Programme[3] was implemented and is recognised as best practice nationally. Between April 2020 and March 2021, the programme supported over 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 exposure to tobacco smoke in pregnant women and then refer these people to a maternity-led stop smoking 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 supply of essential oxygen. 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 estimates that approximately 30% pregnant women smoke before pregnancy and that half of them still smoke in the 3rd trimester of pregnancy.[6].

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

AE

[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] Generation Without Tobacco, 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