NICE guidance aims to protect unborn babies from tobacco harm

In collaboration with Adfero

Midwives should encourage pregnant women to have their carbon monoxide levels tested to determine whether they smoke or are exposed to secondhand smoke, new guidance suggests.

Smoking during pregnancy is known to increase the risk of miscarriage, premature birth, still-birth and sudden unexpected infant death, as well as respiratory and psychological problems in childhood.

Active smokers typically have high carbon monoxide levels, but these are also found in people who are regularly exposed to secondhand smoke, such as those living with smokers.

New guidance from the National Institute for Health and Clinical Excellence (NICE) suggests that testing pregnant mothers would help to ensure they receive appropriate support they need to quit for good or reduce their exposure to secondhand smoke.

The guidance says that midwives should urge women to have the breath test at their first antenatal appointment.

Smokers who are pregnant or have recently given birth should be offered a range of options to help them quit, including referral to NHS Stop Smoking Services, contact details for the NHS Pregnancy Smoking Helpline, and personalised, non-judgemental support from professionals.

Partners who smoke should also be advised to contact NHS Stop Smoking Services for advice on how to quit.

The guidance also recommends that healthcare and smoking cessation staff receive formal training to help them give advice in a non-judgemental way.

Professor Mike Kelly, director of NICE's Centre for Public Health Excellence, said: "We've known for many years that smoking and passive smoking can cause serious illnesses like lung cancer. During pregnancy, smoking puts the health of the women and her unborn baby at great risk both in the short and long term, and small children who are exposed to secondhand smoke are more likely to suffer from respiratory problems."

The professor insisted that the carbon monoxide test is not designed to "penalise" women who smoke, but to show them how smoking and passive smoking raise their levels of the gas.

Deborah Arnott, chief executive of Action on Smoking and Health (ASH), said: "Only a very small proportion of women smokers carry on smoking after getting pregnant, but those who do tend to be the heaviest and most addicted smokers who need support and help from healthcare professionals to quit.

"We welcome the NICE guidance which is designed to be practical and encouraging and not to condemn pregnant smokers for their addiction."

Robin Hewings, Cancer Research UK's tobacco control manager, commented: "It is good news that NICE has made such a thorough examination of the different options to help pregnant women quit smoking. Smoking in pregnancy does real harm to unborn children - including premature birth and still-birth as well as sudden unexpected death in infancy.

"Pregnant women should receive as much help as possible to give up so they can help give the healthiest possible start to their children. It's also a good idea to help fathers to quit so children benefit from a smokefree household, reducing the risk of them becoming smokers later in life."

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