W
elcome to this
edition of
Improving Health
Together which
focuses on the issue of
smoking in pregnancy.
Smoking in pregnancy
Issue 6.1 Updated February 2012
13.8% of women are
known to have smoked
through their pregnancy
in North Yorkshire and
York during 2010-2011.
For York the figure is
16.7% and for North
Yorkshire it is 12.1%.
The national prevalence
is 13.5%1.
Stopping smoking during
pregnancy is the single
most important step a
mother can take to
benefit her health and her
baby’s health.
Supporting women to
quit before becoming
pregnant, staying
stopped after the baby is
born and supporting
partners to quit are all
part of the smoking in
pregnancy agenda.
This factsheet will focus
on what interventions/
good practice may be
introduced into everyday
working practice,
alongside the evidence
base and where further
relevant information and
resources may be
sourced.
Key facts
 Smoking during pregnancy can cause serious pregnancy-related health
problems. These include: complications during labour and an increased
risk of miscarriage; premature birth; still birth; low birth-weight and sudden
unexpected death in infancy (Royal College of Physicians 19922).
 Smoking during pregnancy increases the risk of infant mortality by an
estimated 40%. (Department of Health 20073).
 Mothers under the age of 20 were almost six times as likely as those aged
35 or over to have smoked throughout pregnancy (35% and 6%
respectively). (NHS The Information Centre 20114)
 Mothers in routine and manual occupations were five times more likely
than those in managerial and professional occupations to have smoked
throughout pregnancy (20% and 4% respectively)4.
Percentage of NYY women smoking at time of delivery—2010/2011
Harrogate and District NHS
Foundation Trust
Scarborough and North East
Yorkshire Healthcare NHS Trust
8.2%
19.5%
South Tees Hospitals NHS
Foundation Trust
11.2%
York Teaching Hospital NHS
Foundation Trust
16.7%
Brief advice
Specialist service for
pregnant women
Offering brief advice to stop smoking is the single
most cost effective and clinically proven
preventative action a healthcare professional can
take.
 ASK and record smoking status
 ADVISE patients of the health benefits of
quitting
 ACT on patient’s response and refer to NHS
support
NHS North Yorkshire and York has a specialist
service just for pregnant women and their partners.
Specially trained advisors offer confidential,
personalised, one to one support at a time and
place to suit the pregnant woman.
By actively encouraging and supporting pregnant
women to stop smoking, health workers can reduce
the risk of the mother having a small baby, infant
death, ectopic pregnancy and premature birth.
Research shows that the earlier a pregnant woman
stops smoking, the greater the benefits she and her
baby will enjoy.
Information about brief advice leaflets and training is on
page 4.
Evidence base
NICE public health guidance 26: How to stop smoking in
pregnancy and following childbirth, provides evidence
based recommendations on interventions. The guidance
is summarised below:
North Yorkshire Stop Smoking Service
 0300 303 1603
www.northyorkshireandyork.nhs.uk/StayingHealthy/
StopSmoking/
1
&
2
Identifying pregnant women who smoke and
referring them to NHS stop smoking services.
3
&
4
NHS Stop smoking services - contacting referrals
and ongoing support
5
Use of Nicotine Replacement Therapy (NRT) and
other pharmacological support
Local Smoking in Pregnancy Advisors
Selby and York
Siobhan Farnsworth 0300 303 1603
Scarborough,
Whitby and
Ryedale
Sue Cullen
01723 342877
Harrogate and
Rural District
Jo Rollerson
01423 553009
Craven
Frances Astin
01756 701737
Hambleton and
Richmondshire
Christiane Adams
01609 764814
Specialist advisors meet with individuals to offer
advice and support to help them quit. They also
offer training to health and social care professionals.
The specialist service is skilled in supporting
heavily addicted smokers to stop smoking.
However, pregnant women and their partners
can also get support from:
6
7
GP Practices
Improving Health Together
Meeting the needs of disadvantaged pregnant
women who smoke
 NHS Stop smoking services should be impartial,
client-centred and be sensitive to the difficult
circumstances clients may be facing.
Pharmacies
Mon-Fri 9 am-8 pm
Sat-Sun 11 am-5 pm
 The service should contact all women who have
been referred and send information to those who
opt out.
 The guidance sets out effective interventions for
stop smoking support.
 There is mixed evidence on the effectiveness of
NRT in helping pregnant women to stop smoking.
The benefits and risks should be discussed with
the individual.
Other sources of stop smoking
support
NHS Smoking in
Pregnancy Helpline
 Midwives are expected to identify women who
smoke, offer them information and refer them to
NHS stop smoking services.
 All those responsible for providing health and
support services for pregnant women are also
expected to ask women about their smoking
status and offer to refer them to NHS Stop
Smoking services. If they have specialist training,
they should also offer information.
Partners and others in the household who smoke
 Should also be offered support.
8
 0800 1699 169
Training
 All healthcare professionals working with
pregnant women should have appropriate
smoking cessation training.
http://smokefree.nhs.uk/
smoking-and-pregnancy/
2
Issue 6.1 — Updated February 2012
Recommended action for reducing smoking before,
during and after pregnancy
Adapted from: Reducing smoking pre-conception, during pregnancy and postpartum. Integrating high impact
actions into routine healthcare practice. NHS Yorkshire and Humber, 2007.5
High impact action 1: Promoting smoking
cessation to women of child bearing age
High impact action 5: Supporting continuing
smokers
Promoting smoking cessation to women before they
become pregnant is considered one of the most
effective ways of reducing rates of smoking during
pregnancy.
The adverse effects of smoking on birth weight occur
primarily during the second and third trimester.
 Quitting before pregnancy offers the best
protection for the baby. It also increases a
woman’s motivation to quit for her own heath,
which reduces her likelihood of relapse later on.
 Messages that promote a smokefree home are a
non-confrontational way of bringing up the topic of
smoking and maintaining a positive client
relationship.
 Practitioners’ advice needs to focus on stopping
altogether rather than cutting down. However
experts suggest that health protection strategies
(such as cutting down and smoke free homes)
should be considered during the last trimester for
those who feel unable to stop.
 Ensure that continuing smokers are referred to the
Stop Smoking Service.
High impact action 6: Involving partners and
families
High impact action 2: Identifying pregnant women
who smoke
Smoking by the partner or other close family and
friends is a critical factor in continuing smoking by
pregnant women and in starting again after the baby
is born.
It is important to identify pregnant women who are
smokers and record their smoking status so they can
be offered support. However, it is likely that many
pregnant women do not admit to smoking because of
societal disapproval.
 The smoking in pregnancy service offers stop
smoking support to partners of pregnant women.
 Incorporating a smoking-related biomarker, e.g.
cotinine or carbon monoxide test, helps identifying
smokers.
 Multiple choice questions improve disclosure
rates.
 Promoting a smokefree home gives family
members leverage to encourage smokers to quit
and stay stopped.
High impact action 7: Maintaining cessation after
the baby is born
High impact action 3: Reaching pregnant smokers
as soon as possible and throughout pregnancy
Almost 80% of women who quit smoking because of
their pregnancy start smoking again within a year.
A survey in 1999 found that only 38% of pregnant
smokers report receiving advice on stopping smoking.
 It is important to highlight the benefits of quitting for
the mother’s health as well as quitting for the sake
of the baby.
 Every pregnant smoker (including those who have
recently quit) needs to be identified and offered
assistance in quitting and support in staying
stopped.
 Sensitivity and tact are needed when addressing
smoking issues. Pregnant women who continue
to smoke suffer guilt, anxiety and additional stress.
 A smokefree home appears to help women to stay
quit for longer.
High impact action 8: Promoting smokefree
families
Children exposed to secondhand smoke are at
increased risk for sudden death syndrome, acute
respiratory infections, ear problems and more severe
asthma.
High impact action 4: Increasing effectiveness of
current interventions
Brief cessation counselling in pregnancy is likely to be
more cost-effective than all the rest of prenatal care.
 Smokers who don’t smoke in their home at all are
four times more likely to make a quit attempt
compared to smokers who haven’t imposed any
smoking restrictions at home.
 Pregnant smokers tend to be young, have more
psychological, emotional and family problems,
have less support and financial resources, less
residential stability, live in smoke filled home
environments and with partners who smoke.
Improving Health Together
3
Issue 6.1 — Updated February 2012
Resources
References/Policy Context
1 Statistical Release, Smoking status at delivery,
Quarter 4 2010/2011. Department of Health,
2011 www.dh.gov.uk/prod_consum_dh/groups/
dh_digitalassets/documents/digitalasset/
dh_127465.xls
Information for professionals
Smokefree
Posters, leaflets and cue cards.
Select ‘Smoking and Pregnancy’ from the
resources drop down menu
http://smokefree.nhs.uk/resources/
Tel: 0800 085 5076
Brief advice leaflet
http://smokefree.nhs.uk/resources/wpcontent/resources/files/pdf/CED047%
20Smokefree%20booklet%201st.pdf
NHS Smokefree factsheet
http://smokefree.nhs.uk/resources/wp-content/
resources/files/documents/
smoking_and_pregnancy.doc
2 Smoking and the Young. London, Royal College
of Physicians, 1992.
3 Review of the health inequalities infant mortality
PSA target. London, Department of Health,
2007.
4 Infant Feeding Survey 2010: Early results. NHS
The Information Centre, 2011. www.ic.nhs.uk/
webfiles/publications/003_Health_Lifestyles/
IFS_2010_early_results/
Infant_Feeding_Survey_2010_headline_report2.
pdf
5 Reducing smoking pre-conception, during
pregnancy and postpartum. Integrating high
impact actions into routine healthcare practice.
NHS Yorkshire and Humber, 2007.
www.yorksandhumber.nhs.uk/document.php?
o=1073
MHRA
Nicotine Replacement Therapy leaflet—available to
download:
www.mhra.gov.uk/Publications/Postersandleaflets/
CON2023571
 How to stop smoking in pregnancy and following
ASH
www.ash.org.uk/files/documents/ASH_112.pdf
Factsheet: smoking and reproduction. Information
about the effects of smoking on fertility and
maternal and child health. Available to download.
childbirth (PH26). NICE Public Health Guidance,
2010. www.nice.org.uk/guidance/PH26
 Behaviour change at population, community and
individual levels (PH6). NICE Public Health
Guidance, 2007 www.nice.org.uk/guidance/PH6
No Smoking Day
www.nosmokingday.org.uk/organisers/
settingsguides.htm
Guides for various settings to use No Smoking Day
as an aid to helping smokers quit (e.g. midwives,
pharmacy, workplace, mental health).
 Brief interventions and referral for smoking
cessation in primary care and other settings
(PH1). NICE Public Health Guidance, 2006
www.nice.org.uk/guidance/PH1
Training
Websites
Free online training in giving Very Brief Advice to
patients who smoke, takes under 30 minutes
and you get a CPD certificate (aimed at
healthcare professionals). www.ncsct.co.uk/vba
North Yorkshire Stop Smoking Service offers
training on smoking cessation interventions from
brief interventions through to the Registered
Smoking Advisor programme. For more
information:

NHS Choices
www.nhs.uk/planners/pregnancycareplanner/pages/
smoking.aspx
A service that helps you to make the most of your
health and get the best out of the NHS.
0300 303 1603.
Production Team:
Helen Christmas, Health Improvement Manager
Georgina Wilkinson, Health Improvement Manager 01609 535857
Jacqui Fox, Public Health Information Specialist
Improving Health Together
Smokefree
Smoking & Pregnancy
www.smokefree.nhs.uk/smoking-and-pregnancy/
For expert advice on the health risks of smoking
when you are pregnant and advice on ways to go
smokefree, please call the NHS Pregnancy
Smoking Helpline on 0800 169 9 169
01609 535900
4
Public Health—HAS
North Yorkshire County Council
County Hall | Northallerton |
DL7 8AD
www.northyorks.gov.uk/health
Issue 6.1— Updated February 2012