Smoking in Pregnancy Clinical Forum

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Smoking in Pregnancy Clinical Forum
A Joint initiative of the National Expert
Advisory Committee on Tobacco (NEACT) Womens
Hospitals Australasia (WHA)
Shane Higgins RWH, Melbourne
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Introduction

• In populations of women with a high prevalence of
  smoking, it is estimated that cessation during
  pregnancy could prevent
• 10 of perinatal deaths
• 35 of low birth-weight births
• 15 of preterm deliveries
• US Department of Health and Human Services 1990

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Epidemiology

• Estimated that 25 women of reproductive age in
  developed countries smoke
• Prevalence of smoking during pregnancy difficult
  to determine, primarily due to underreporting
• Biochemical markers (exhaled CO, urinary
  cotinine) suggest nondisclosure rates of 25 50

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Smoking in Pregnancy / Exposure to ETS

• Subfertility
• Implantation failure
• Congenital anomalies (gastroschisis, CL/CLP, anal
  atresia, transverse limb reduction defects)
• FGR, LBW, PTD
• Placenta praevia, abruption
• SIDS

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Smoking in Pregnancy / Exposure to ETS

• Childhood behavioural problems
• Childhood blood pressure problems
• Childhood respiratory disorders
• Breast cancer risk

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smoking is the most important modifiable risk
factor associated with adverse pregnancy
outcomeHeffner. L, et al. Clinical and
Environmental Predictors of PTL. Obstet Gynaecol
1993 81750
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Background

• Exercise in
• Willingness
• Data identification
• Data collection
• Of / from member hospitals
• Data collation
• Benchmarking

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Current status of pregnancy related smoking data
/intervention packages and pregnancy outcome in
member hospitals
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3rd Antenatal visit smoking status  
3rd Antenatal visit smoking status  
Summary of Responses from Hospitals unable to
provide data  
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Number of women delivered
  No data provided
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No data provided
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1st Antenatal Visit
Hospital
Data Provided by Hospitals
1 Full year data 1/7/02 30/6/03, 2 3 month
data 1/4/03 30/6/03 3 105 Charts audited from
randomly chosen UR numbers between 1/7/02
30/6/03 4 1 Month data- June 2003, 5 100
Randomly audited charts
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1st Antenatal Visit  
  No data provided
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1 Full year data 1/7/02 30/6/03 2 3 month
data 1/4/03 30/6/03 3 105 Charts audited from
randomly chosen UR numbers between 1/7/02
30/6/03 4 1 Month data- June 2003 5 100
Randomly audited charts
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1st Antenatal Visit
No data supplied
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1st Antenatal Visit






No data provided
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1st Antenatal Visit
No data provided
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1st Antenatal Visit
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3rd Antenatal visit smoking status  
3rd Antenatal visit smoking status  
3rd Antenatal Visit
Data not provided/not available
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Health Outcome

Raw data
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Health Outcome

Raw data
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Health Outcome

Raw data
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Health Outcome

Raw data
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Health Outcome

Raw data
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Health Outcome

A B C D E F
G H I J
Raw data
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Health Outcome

Raw data
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Health Outcome

Raw data
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Conclusions

• Meaningful data
• Does it appear that we provide appropriate advice
  and counselling to patients throughout pregnancy?
• What conclusions can we draw from the data
  presented?