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Evaluation of a programme of intensive support to help pregnant women stop smoking
Ann Fitchett
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Abstract
The West Midlands region has one of the highest perinatal death rates in the United Kingdom. Smoking during pregnancy has been linked with major adverse consequences for both the mother and baby. The risk of pre-term birth, low birth weight, perinatal death and sudden infant death are reduced if women stop smoking during pregnancy (RCP. Smoking and the Young: London 1992). Furthermore, ectopic pregnancy and miscarriage can also be reduced by smoking cessation. Consequently, reducing rates of smoking during pregnancy is high on the public health agenda.
Many pregnant women are already aware of the risks of smoking during pregnancy and around 40% will attempt to quit, with varying degrees of success. However, those with the most success tend to be women in the higher socio-economic groups. Women in the lower socio-economic groups who tend to be young, single and on a low income are much less successful (Graham H. Smoking Prevalence among Women in the European Community 1950-1990).
Typically, smoking cessation models aimed at reducing smoking in pregnancy are based on a 7-week treatment programme, but with minimal follow-up long-term support. These programmes have resulted in quit rates at four weeks that vary from 5% to 16%. In 2004 South Birmingham Primary Care Trust specialist pregnancy stop smoking service implemented a programme of intensive support involving weekly home visits from an experienced dedicated specialist advisor for 8-10 weeks, followed by monthly home visits until the birth of the baby. Nicotine replacement was offered and issued free of charge if required with their carbon monoxide level being recorded on every visit. The pregnant women felt that this provided them with additional motivation for continued abstinence.
After twelve months the programme was evaluated using descriptive statistics. During 2004 a total of 60 women accessed the service and 29 women (48.3%) were Carbon Monoxide validated <5ppm point prevalent abstinent at four weeks, 13 of these women (44.8%) remained validated as non smoking at delivery of their baby.
A programme of continuing support provided by a dedicated stop smoking specialist, together with nicotine replacement therapy results in a higher quit rate among pregnant women when compared to less intensive long term support approaches.
Biography
After working as a night sister in a busy A/E department for 15yrs I worked as a practice nurse for about 14yrs developing in-house diabetic, asthma, hypertensive and cardiac rehab clinics. In the development of these clinics I also began to advise patients on the need for smoking cessation. Initially the consultations were on a one 2 one basis but together with the health visitor based at the GP practice we developed smoking cessation treatment programme groups. Following the success of these groups the local PCT asked us to open the groups up to other GP practice patients within the area. About 4yrs ago I moved full time into the smoking cessation service. I initiated and have developed the local pregnancy stop smoking service over the last 3yrs. Year on year the referral rates into the service have been increasing. I continue to work at improving a higher quit outcome rate.
Author 1: Ann Fitchett
Pregnancy Stop Smoking Advisor for South Birmingham PCT
Springfield Centre
Raddlebarn Rd.
Selly Oak
Birmingham
B29 6JB
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