Can carbon monoxide testing be used as a biomarker for assessing risk in pregnant smokers?
Pam James, Smoking & Pregnancy Sdviser, Dudley Stop Smoking Service, Dudley PCT, UK

Abstract
Dudley Stop Smoking Service carried out a CO pilot during a 12 week period Apr -Jul 2008, within Russells Hall Hospital Antenatal Clinic. The aim of the pilot was to raise clinicians and midwives awareness that high risk pregnancies could be predicted by accurately identifying current smoking status. A total of 1377 women were CO tested showing a 1 in 5 smoking prevalence. During the pilot phase the referrals to DSSS increased by 32%. Findings also identified that smokers had more antenatal clinic visits than non smokers and that 76% of mothers presenting with Intrauterine Growth Retardation (IUGR) were validated smokers. The pilot also highlighted the need for standardised care in treating pregnant smokers and that a risk assessment protocol should be developed for pregnant smokers to enable clinicians and midwives to have a clear pathway of care. Routine antenatal care should include a biomarker (serum cotinine & CO) for accurately recording smoking status of pregnant women.