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ASH Scotland

Taking action on smoking and health

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  1. Home
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  3. Providing information on tobacco, health and inequality
  4. Key topics
  5. Tobacco use in pregnancy

Tobacco use in pregnancy

ASH Scotland information briefing on tobacco use in pregnancy
(updated September 2012)

Key points:

  • smoking is the single largest preventable causeof 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
  • smoking cessation is an effective intervention which has immediate and long term health benefits for pregnant women and families.

Epigenetics

  • November 2012 Economist article on epigenetics, examining the theory that genetic damage from smoking may be passed from grandmother to grandchild Epigenetics and health: Grandma's curse

Figures for Scotland

In Scotland:

  • NEW quit attempts 27 May 2014
    in 2013, there were 2,918 quit attempts made by pregnant women, a decrease of 155 of the 2012 figure of 3,073.   NHS Smoking Cessation Service Statistics (Scotland) 1st January to 31st December 2013.  Available from: Information Services Division (ISD) Scotland publications page [accessed 27 May 2014]
  • the number of women who were smokers at the time of their booking appointment fell from 25.4% in 2000/01 to 18.4% in 2012/13. The level of 'Not Known' has decreased from 13.5% in 2000/01 to 4.6% in 2012/13. It should be noted that the percentage of ‘unknowns’ may include a proportion of smokers and it is also known that there is considerable under-reporting of smoking by pregnant women themselves.
    Births in Scottish Hospitals - year ending 31st March 2013, summary, published 26th August 2014, Information Services Division Scotland [Accessed 27 August 2014]
  • 29.8 of women who were current smokers at booking were in the most-deprived quintile (SIMD 1) and 22.2 in SIMD 2, compared to 6% in the least deprived quintile (SIMD 5).  See table 10, Births in Scottish Hospitals, Information Services Scotland [accessed 27 August 2014]
    NB Also see table 11 for figures at first visit (recorded during the health visitor’s first visit to a woman and her new baby following the birth, usually around 10 days post-partum).
  • there is evidence that self-reported smoking is under-reported and that the true smoking figures for pregnant women may be underestimated by up to 25%.
    Source: Shipton D, Tappin D, Vadiveloo T, Crossley J, Aitken D, Chalmers J. Reliability of self reported smoking status by pregnant women for estimating smoking prevalence: a retrospective, cross sectional study. BMJ 2009;339:b4347.  www.bmj.com/content/339/bmj.b4347.full [Accessed 06.09.12]
  • 73% of BC2 (birth cohort 2 from 1st March 2010 and 28th February 2011) women never smoked during pregnancy, compared with 75% in BC1 (birth cohort 1 in 2005), but a further 9% of BC2 stated that they gave up once they discovered they were pregnant (a response option not offered in BC1).
    Source: Growing Up in Scotland: Birth Cohort 2. Results from the First Year. Scottish Government, 20 February 2013.  Available from:
    www.scotland.gov.uk/Publications/2013/02/3280/2 [Accessed 20 Feb 2013]

UK

The UK Infant Feeding Survey 2010 (published November 2012) reports that:

  • around a quarter of mothers (26%) in the UK smoked in the 12 months before or during their pregnancy, which was down from a third (33%) in 2005. Lower levels of smoking were seen in all countries in the UK
  • across the UK, the proportion of mothers smoking before or during pregnancy fell from 33% to 26% between 2005 and 2010. Lower levels of smoking were seen in all countries in 2010 compared to 2005. The most significant decreases in smoking levels before or during pregnancy were in Scotland, where smoking levels fell from 35% to 27%, and in England, where they fell from 32% to 26%.
  • mothers in Wales were the most likely to have smoked before or during pregnancy (33%) and mothers in England the least likely (26%)
  • twelve per cent of mothers continued to smoke throughout their pregnancy, down from 17% in 2005
  • of mothers who smoked before or during their pregnancy, over half (54%) gave up at some point before the birth
  • the highest levels of smoking before or during pregnancy were found among mothers in routine and manual occupations (40%) and among those aged under 20 (57%). Mothers aged under 20 were also the least likely to have given up smoking at some point before or during pregnancy (38%), but by socio-economic group, mothers who had never worked were the least likely to have done so (29%)
  • almost nine in ten mothers (88%) who were smoking before or during pregnancy received some type of information on smoking. Midwives were the most common source of information, mentioned by 85% of mothers who had received information. Almost a third of mothers (32%) lived in a household where at least one person smoked during their pregnancy, including just under one in five (19%) where only other people smoked (not the mother herself)
  • at Stages 2 and 3 (when babies were around four to six months old and eight to ten months old respectively), three per cent of infants lived in a household where at least one person ever smoked in the home.

Chapter 11, NHS Information Centre, Infant Feeding Survey
https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010 [Accessed 27 April 2018]


For further ASH Scotland information see:

  • ASH Scotland information briefing on breast-feeding, tobacco use and second-hand smoke (March 2011)
  • 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 - September 2012
    Coleman T, Chamberlain C, Davey MA, Cooper SE, Leonardi-Bee J. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD010078
    Nicotine replacement therapy is the only pharmacotherapy for smoking cessation that has been tested in RCTs conducted in pregnancy.  There is insufficient evidence to determine whether or not NRT is effective or safe when used to promote smoking cessation in pregnancy or to determine whether or not using NRT has positive or negative impacts on birth outcomes. Further research evidence of efficacy and safety is needed, ideally from placebo-controlled RCTs that investigate higher doses of NRT than were tested in the included studies.
  • 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]
  • 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]
Key topics Economics Inequalities Stopping smoking Second-hand smoke Tobacco control legislation in Scotland Illicit tobacco Tobacco industry interference Tobacco use in pregnancy Global tobacco control Tobacco endgames
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