Bowden C. Are we justified in introducing carbon monoxide testing to encourage smoking cessation in pregnant women?. Health Care Anal. 2019; 27:128-145

Campbell KA, Cooper S, Fahy SJ ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support. Tob Control. 2016; 0:1-7

Test all pregnant women for smoking, say NHS chiefs. 2017. (accessed 5 June 2019)

Jones S, Bell R, Araujo-Soares V Pregnant smokers' views on babyClear: a package of measures including universal carbon monoxide monitoring and opt-out referral to support their quit. Tob Induc Dis. 2018; 16

NHS Digital. Statistics on Smoking England. 2018. (accessed 5 June 2019)

Stopping smoking in pregnancy and after childbirth [PH26].London: NICE; 2010

Royal College of Midwives. Support to Quit Smoking in Pregnancy. 2019a. (accessed 5 June 2019)

Royal College of Midwives. Majority of maternity services without a stop smoking specialist midwife, say RCM. 2019b. (accessed 5 June 2019)

Royal College of Obstetricians and Gynaecologists. Information for you: smoking and pregnancy. 2015. (accessed 5 June 2019)

Smoking and pregnancy

02 July 2019
Volume 27 · Issue 7


Although the evidence shows the benefits of smoking cessation, there are still barriers to successful interventions. George Winter examines the challenges

The adverse effects of smoking in pregnancy include miscarriage, ectopic pregnancy, stillbirth and birth defects (Royal College of Obstetricians and Gynaecologists, 2015). According to NHS Digital (2018), around 11% of pregnant women in England were known smokers at the time of giving birth in 2017/18, down from 16% in 2006/07. The Royal College of Midwives (RCM) (2019a) also noted that 15% and 16% of pregnant Northern Irish and Welsh smokers, respectively, continued to smoke in pregnancy, while in Scotland, 29.8% of pregnant women in the most deprived areas were smokers at booking, compared to 6.0% in the least deprived areas.

The guidance from the National Institute for Health and Care Excellence (NICE) (2010) for midwives to identify pregnant women who smoke and refer them to NHS Stop Smoking Services, from which they can opt out, is welcome. Midwives should ‘[a]ssess the woman's exposure to tobacco smoke through discussion and use of a carbon monoxide (CO) test. Explain that the CO test will allow her to see a physical measure of her smoking and her exposure to other people's smoking’ (NICE, 2010: 9).

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