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Smoking in pregnancy


Babies born to women who smoke during pregnancy are around 40% more likely to die within the first four weeks of life, than babies born to non-smokers (Gardosi et al, 2005).


For many children the harm of tobacco smoke begins while still in their mother’s womb. Smoking during pregnancy increases the risks of miscarriage, premature birth, still birth and low birth weight babies. Exposure to smoking during pregnancy also has a detrimental effect on the development of the child after birth. Mothers who smoked during pregnancy are at greater risk of their babies dying early and suffering from respiratory illnesses, diabetes, obesity and cognitive development problems such as attention deficit and hyperactivity disorder. (PH26. 2010)


Smoking has been associated with:

  • 5-8% of premature births
  • 13-19% of cases of low birth weight in babies carried to full term
  • 5-7% of preterm-related deaths
  • 23-34% of deaths caused by sudden infant death syndrome (cot death).

(Dietz et al, 2010)

In the UK, smoking in pregnancy causes up to 5,000 miscarriages, 300 peri-natal deaths and around 2,200 premature births each year (Tobacco Advisory Group, 2010). The prevalence of women smoking at time of delivery in England is 10.6% which is equivalent to nearly 70,000 infants born to smoking mothers each year (PHE 2015/16).


Smoking at time of delivery is related to significant demographic differences and factors relating to inequalities and deprivation.  Pregnant mothers under the age of 20 are more than three times as likely to smoke as mothers over the age of 30. Those in routine and manual occupations are four times more likely to smoke through pregnancy than those in managerial occupations (29% and 7% respectively). Children born to smokers are more likely to become smokers themselves, which further perpetuates health inequalities (HSCIC, 2010, Infant feeding survey).


Treating mothers and their babies (0-12 months) with smoking related problems during pregnancy is estimated to cost the NHS between £20m and £87.5 each year (Godfrey 2010)


Smoking during pregnancy poses a high risk of harm to both mother and foetus and it is therefore important that pregnant women are supported to stop for the duration of the pregnancy and postpartum. More women quit smoking when they are pregnant than at any other time during their lives (Murin et al, 2011).  Pregnant smokers are twice as likely to attempt to quit smoking as non-pregnant women, but only about half of pregnant women actually stop smoking during pregnancy (Chen at al, 2006). Support should be offered to other family members that also smoke.


A 2009 report found that interventions from health professionals reduced the proportion of women smoking in late pregnancy by about 6% overall (Lumley et al, 2009). The most effective intervention, particularly among low income women, appeared to be providing incentives (Higgins et al, 2012),


National & Local Strategies (Best Practices)

Public Health Guidance (PH26. 2010)


Facts, Figures, Trends

Local Data

Figure 1: Smoking at time of delivery 2015/16 comparison


Smoking in Pregnancy

Source:  NHS digital (HSCIC) - Statistics on Women's Smoking Status at Time of Delivery England


Local data sets are based on returns from the Bedfordshire Clinical Commissioning Group; for that reason is represented as Bedfordshire data. Current trends show that Smoking at time of delivery is lower in Bedfordshire 10.3% than regional (11.2%) and England (10.6%) averages .


Figure 2: Mothers'smoking status at discharge by ward

Smoking in pregnancy

Source:  NHS digital (HSCIC) - Statistics on Women's Smoking Status at Time of Delivery England


The above graph confirms that Smoking at time of delivery is declining in Bedfordshire year on year.


Current Activity

The Stop Smoking Service has well established links to the Maternity Department at Bedford Hospital Trust and SEPT community services. Just over half of the community midwifery teams (53%) have been trained to deliver brief smoking interventions, take carbon monoxide readings and refer onwards to the specialist Stop Smoking Service. The national lead Smoking in Pregnancy trainer delivered the training to Midwifes around test, question and refer principals. Robust ‘opt out’ pathways are in place which means all pregnant women that smoke will be referred into the Stop Smoking Service for support unless they decline the invite.


The Specialist Service delivers a tailored programme which supports pregnant ladies with 12 weeks of pharmacotherapy, and behavioural support for up to one month, post-delivery. The financial incentive is no longer used for this group but a focused work book is in development to support the programme.


What are the unmet needs/ service gaps?

All ward midwifery teams require very brief advice and carbon monoxide training plans are already in place to do this.

Due to local demographics, niche tobacco training needs to be delivered to the maternity departments in order to ensure that mothers who chew tobacco are also supported.


Passive Smoking


What do we know?

There are over 4,000 chemicals in tobacco smoke (United States Environment Protection Agency, 1992). Exposure to other people’s cigarette smoke is called passive, involuntary or secondhand smoking. This is a combination of ‘sidestream’ smoke from the burning tip of the cigarette and ‘mainstream’ smoke that has been inhaled and then exhaled by the smoker. The toxic gases found in sidestream smoke are in higher concentrations than mainstream smoke and sidestream smoke accounts for almost 85% of the smoke in a room. There are more than 50 cancer-causing chemicals in secondhand smoke and the properties of the other gases include irritants (ASH, 2014).


Exposure to secondhand smoke has immediate and long term health effects.  In the long term it can increase the risk of a range of smoking-related diseases including lung diseases and cancers. Children are particularly susceptible with risks that include glue ear, asthma, meningitis and cot death. There is no safe level of exposure to tobacco smoke.


Local Data

ASH estimates that treating the effects of passive smoking in non-smokers costs the NHS £261,664 in Bedford Borough.


Current activity

Bedford Borough encourages parents and other adults living with children to make their homes smokefree. Training has been provided to Health Visitors, Social Workers, and Children Centre staff, enabling frontline staff to positively discuss the harm passive smoking causes. Parents can sign up to a locally developed pledge scheme.


The legislation on Smokefree Cars came into force from 1st Oct 2015 making it an offence to smoke in a private vehicle with someone under 18 years old present, and for a driver to fail to prevent smoking in a private vehicle with someone under 18 years old present. People who fail to comply could be issued with a £50 fixed penalty notice.


What are the unmet needs/ service gaps?

Review and rebranded local programme to ‘Smokefree homes’


This chapter links to the following chapters in the JSNA:

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To print a PDF version of the Tobacco Control and Smoking chapter, please click here