No Smoke without Fire… no Smoke without Damage. Concern Raised over Smoking in Pregnancy at County Public Health Panel

Towards the end of last year a report on smoking in pregnancy was presented to the County’s Public Health Cabinet Panel by Herfordshire’s Director of Public Health. Encouraging changes in behaviour to improve public health is a difficult and sensitive process. An authoritarian approach or attitudes by professionals that come across as scolding or blaming are counter productive and worse than useless. People engaging in behaviour that is risky – to themselves or to others – must be treated with the respect that is due to everyone. That means trusting the individual and focussing on the problem – her addiction to nicotine – and providing sympathetic help to escape from the situation.

Smoking is the single most important risk factor for an adverse outcome in pregnancy that can be quickly removed by a behavioural change. In Hertfordshire in 2018/19, 6% of pregnant women smoked to the end of their pregnancy. This compares with a figure of 10% for all England. Unfortunately pregnancy smoking showed a rise in Hertfordshire in Q1 2019/20, especially in the East & North Herts CCCG area where it reached 9%.

This is serious, especially for the child, its perinatal and lifetime health and its opportunities and life chances.

The consequences of smoking in pregnancy include:

[ but if you are smoking in pregnancy and reading this, . The risks are low in the first place, but . So stop smoking immediately, stop drinking alcohol as well if you were doing that to and mention it to a health professional that you’ve been smoking. ]

Smoking in general is the leading cause of the gap in life expectancy between socioeconomic groups in the UK. Half the difference in life expectancy between the richest and the poorest is attributable to smoking. Rates of smoking in pregnancy increase strongly as the age of the mother goes down and also increases as indicators of disadvantage and poverty increase.

Hertfordshire has identified the reduction of smoking in pregnancy as a key public health objective, has identified factor which indicate mothers who could be helped and have drawn up a list of 20 actions to be taken by appropriate professionals to deliver that help with supporting information and improved communication.

In particular they instituted a pilot scheme involving 300 of the most vulnerable mothers to test the effectiveness of traditional methods of support being supplemented by financial incentives to encourage smoking cessation. This will be modelled on a randomised controlled trial carried out in 2015 in Scotland by Tappin and Bauld, which was in turn built on experience in the USA where relatively trivial financial rewards significantly improved the rate of abstinence from narcotics.

The scheme is running from January 2020 to March 2021 and a progress report is expected this Autumn. Officers are hoping that the smoking quit rate (as validated by blood tests) for pregnant women will be increased to 35% at a trial cost of £50,000. Historical experience and standard calculations indicate that over 100 additional perfect health years of life for should result from this trial for mothers and their children at a cost of about £500 per one of those extra years. The current financial decision threshold in the NHS for saving one year of perfect health is, by comparison, £20,000. The total cost of ill-health per year due to smoking is estimated to be around £240 million pounds in Hertfordshire alone. We look forward to that progress report with great interest.