The Smoking in Pregnancy Challenge Group released a report about vaping during pregnancy. It was last week to review the current state of smoking rates among pregnant women. In 2012 the group was established in response to a challenge from the Health Minister at the time and recommendations were made on how the targets set out in the Government’s tobacco strategy could be met.
Updated 6th March 2020
This latest report covers the progress made over the past 5 years and particularly since recommendations which were made in 2015. It also lays out new targets and discusses what can be done to realise this ambition.
The government’s ambition is to reduce smoking rates among pregnant women to less than 6% by 2022. Bauld is concerned that there is a “serious risk” that this target will not be met and stated: “This report should be a wake-up call for national and local government and NHS organisations.”
Professor Linda Bauld explained that 8500 fewer pregnant women are now smoking than in 2013. However, she did express concern that “rates of smoking in pregnancy have not fallen for the last 12 months.”
For the target to be met, estimates show that 30,000 fewer pregnant women would be smoking, but how can this target be met?
Nicotine in pregnancy
The use of nicotine in pregnancy has remained a slightly grey area over previous years. The report suggests that studies ‘routinely find that women are reluctant to use Nicotine Replacement Therapy during pregnancy’. This is supposedly down to nicotine use being seen as risky for the development of the baby by some. However, the report states that “UK evidence to date does not support these concerns.”
While the report does concede that “There is currently little evidence on the safety or efficacy of using e-cigarettes in pregnancy for smoking cessation”, it does suggest that “completing switching to e-cigarettes may have benefits for women struggling to stop smoking.”
The following recommendations where therefore made regarding vaping:
Department of Health should develop a sophisticated communications strategy to ensure both health care professionals and women have a better understanding of the potentially positive role of nicotine containing products, such as NRT and e-cigarettes, in a quit attempt.
Commissioners need to ensure services are providing pregnant smokers with the right levels of NRT and supporting their choice to use e-cigarettes if that is their preferred way to quit.
Health Education England should work to improve training and understanding of the role of nicotine (separate from tobacco) is needed for key professionals including obstetricians, midwives, primary care professionals and health visitors.
Leicester Stop Smoking Service embraces vaping
The Stop Smoking Service in Leicester has been particularly pro-active in utilising e-cigarettes to help pregnant women quit smoking. A case study was conducted and the results are encouraging. “In 2016/17 85 out of 228 pregnant service users used an e-cigarette, with or without NRT with a success rate of 60%. This compares with a success rate of 32% for NRT alone (139 women out of 228 used NRT only).”
The approach involves proactively offering smokers e-cigarettes during pregnancy and ensuring all midwives are trained to understand about vaping and the associated benefits and risks.
Some of the views from women who have utilised e-cigarettes as part of the service are as follows:
“I know it’s not without risks, but it’s got to be safer than smoking when you look at the chemicals in each”
“It gives me the freedom to smoke, without actually smoking” (quitter, e-cig only) “It helps me to manage social situations where everyone else is smoking”
“The patches help, but I’ve only ever had slip ups when I’ve not had my e-cigarette – I can cope if I forget to put my patch on but not if I forget my e-cigarette”
“I decided not to use one because I felt like I would be replacing one habit with another”
Do Midwives need further training?
One of the main points of the report is that ALL health professionals including midwives need to be trained to the same high standard.
Gill Walton, Chief Executive of the Royal College of Midwives said: “As a profession we are committed to ensuring the women we care for have the safest possible pregnancy. Stopping smoking is part of achieving this. However, the provision in place around the country is not consistent. Some Midwives have access to excellent training, the equipment they need and have high quality stop smoking services available for the women they support. Investment is needed to ensure that this is universal.”
The Smoking in Pregnancy Challenge Group is chaired by Francine Bates, Chief Executive of The Lullaby Trust, and Professor Linda Bauld of UKCTAS and the University of Sterling. The report is endorsed by leading health organisations including the Royal Society for Public Health (RSPH) and Action on Smoking and Health (ASH).
It is good to see these organisations coming together and actively tackling this issue. It is concerning that pregnant women are continuing to smoke however the actions set out will hopefully combat this.