Tobacco use in pregnancy

Figures for Scotland

• 'The overall percentage of women who report smoking at the time of their first antenatal booking has decreased consistently from 29.0% in 1995 to a new low of 18.1% in 2009. However, it should be noted that the percentage of 'unknowns' has risen from 5% in 1995 to 14.3% in 2009 and that this may include a proportion of smokers. There is known to be considerable under-reporting of smoking by pregnant women themselves.'
  ISD Scotland, Births, Statistical Publication Notice, 31 August 2010 [online]. Available from: www.isdscotlandarchive.scot.nhs.uk/isd/6364.html
  [accessed 13 July 2011]
• 19.5% of mothers in Scotland smoked at the health visitor’s first visit
  ISD Scotland, Births in Scottish Hospitals 2008/9
  Available from: www.isdscotland.org/Health-Topics/Maternity-and-Births/Births/
  [accessed 13 July 2011]
• 29.4% of pregnant women in the most deprived SIMD quintile smoke at booking, compared to 5.8% in the least deprived SIMD quintile.
  Available from: www.isdscotland.org/Health-Topics/Maternity-and-Births/Births/
  [accessed 13 July 2011]

Key points:

• smoking is the single largest preventable cause of foetal and infant morbidity in the UK
• smoking in pregnancy affects the health of mother and baby so the focus should not just be on the baby
• women should be supported to quit rather than put under pressure to do so
• smoking increases the risk of pregnancy-related illness and complications
• maternal exposure to second-hand smoke also has adverse health effects for the mother and the foetus
• exposure to second-hand smoke is a serious health threat to infants

For further ASH Scotland information see:

• ASH Scotland information briefing on tobacco use in pregnancy (March 2011) (pdf, 67kb)
• ASH Scotland information briefing on breast-feeding, tobacco use and second-hand smoke (March 2011)(pdf 52kb)
• ASH Scotland information briefing on child exposure to second-hand smoke in the home (updated February 2011) (pdf 60 kb)
• tobacco-related research articles relevant to pregnancy and infants identified from PubMed by the ASH Scotland Information Service updated weekly)
• key topic - second-hand smoke
• key topic - inequalities

The evidence base:

• NEW - March 2012
  Daniel F Mackay, Scott M Nelson, Sally J Haw, Jill Pell. Impact of Scotland's Smoke-Free Legislation on Pregnancy Complications: Retrospective Cohort Study. PLoS Med 9(3): e1001175. doi:10.1371/journal.pmed.1001175. These findings suggest that the introduction of national, comprehensive smoke-free legislation in Scotland was associated with significant reductions in preterm delivery and babies being born small for gestational age. These findings are plausible and add to the growing evidence of the wide-ranging health benefits of smoke-free legislation, and support the adoption of such legislation in other countries that have yet to implement smoking bans.
Tappin, D., MacAskill, S., Bauld, L, Eadie, D., Shipton, D. and Galbraith, L., 2010. Smoking prevalence and smoking cessation services for pregnant women in Scotland. Substance Abuse Treatment, Prevention and Policy, 5, 1.
[Accessed 29 September 2011]
• Hackshaw, A, Rodeck, C, Boniface, S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls,  Human Reproduction, Update (2011) doi: 10.1093/humupd/dmr022 First published online: July 11, 2011.
  [Accessed 13 July 2011]
• British Medical Association (2004). Smoking and reproductive life: the impact of smoking on sexual, reproductive and child health. BMA, London. www.bma.org.uk/health_promotion_ethics/tobacco/smokingreproductivelife.jsp
  [accessed 13 July 2011]
• Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2009, Issue 3.
  [accessed 13 July 2011]
• Passive smoking and children: A report by the Tobacco Advisory Group of the Royal College of Physicians (March 2010) – conclusions and recommendations. http://old.rcplondon.ac.uk/professional-Issues/Public-Health/Documents/Preface-to-passive-smoking-and-children-March-2010.pdf
  [accessed 13 July 2011]