Smoking Prevalence trends: An analysis of smoking at pregnancy registration and at discharge from a midwife Lead Maternity Carer, 2008-2010

Abstract

Background: Smoking during pregnancy has a detrimental effect on both maternal and neonatal health. The government has agreed a long term goal for New Zealand (NZ) to become a smoke-free nation by 2025, with smoking cessation during pregnancy a government priority. Contemporary information, reviewing the prevalence and demographics of women who smoke during pregnancy, is important so that change can be monitored and cessation support appropriately targeted. Aim: To examine the prevalence of smoking for 81,821 pregnant women who registered with a midwife Lead Maternity Carer (LMC) between the years 2008 to 2010. Methods: A retrospective observational design using aggregated clinical data from the New Zealand College of Midwives clinical outcomes research database (COMCORD) for the years 2008 to 2010. Women's self-reported smoking or smoke-free status was recorded at registration with, and at discharge from, a midwife LMC. Findings: A trend of reduced smoking prevalence at registration was found for this NEW ZEALAND RESEARCH cohort (reduced from 19.5% in 2008 to 18.4% in 2010). Women who identified as Māori had the highest rates of smoking (42.9%) followed by Pasifika (15%) and NZ European ethnicity (13.4%). Women in the 16 to 19 years age group had the highest rate of smoking (39.4%) followed by the under 16 years age group (35.7%). Increasing parity was also associated with an increased likelihood of smoking at registration. By discharge from midwifery care there were reduced rates of smoking across all groups. Conclusion: Overall smoking during pregnancy prevalence rates are trending down with reduced rates of smoking across all groups by discharge from a midwife. Cessation messages and support need to be targeted to young women (under 25years), multiparous women and women of Māori ethnicity.

Transitions in Smoking Across a Pregnancy: New Information from the Growing Up in New Zealand Longitudinal Study

“…The prevalence of maternal smoking prior to pregnancy in the Growing Up in New Zealand cohort was 20.3%, consistent with the New Zealand rates for women of child bearing age from national surveys of 19.5% (CI: 16.8%-22.4%)(Ministry of Health 2013). Women in the Growing Up in New Zealand cohort were more likely to smoke prior to pregnancy if they lived in more poverty-stricken areas, identified as Maori, were young, less educated and lived with another smoker, consistent with earlier studies (Ministry of Health 2013; Andrews, Dixon et al 2014).…”

“…In New Zealand, a 2003 study investigated the factors influencing cessation during pregnancy for forty nine women who quit smoking in the first trimester, and found that unemployed women, Maori women, women with previous pregnancies and less socioeconomically advantaged women were all less likely to quit smoking during pregnancy (McLeod, Pullon et al 2003). A more recent analysis of 81,821 women enrolled from 2008 to 2010 with a midwife Lead Maternity Carer across New Zealand showed that women under 20 years of age, Maori women and multiparous women were more likely to smoke during pregnancy, although there was no reporting of factors associated with cessation of smoking during pregnancy (Andrews, Dixon et al 2014). A qualitative study of 60 pregnant Maori self-identified smokers recruited during 2002 and 2003 found all lived with another smoker and identified this as a factor that made it harder to stop smoking (Glover and Kira 2011).…”

“…In New Zealand, Craig et al 2012 (Craig, Dell et al 2012) showed that 16.5% of babies born in 2009-10 had a mother who smoked at two weeks after delivery, however this estimate was thought to be prone to selection bias (omissions were more likely from younger, Pacific or Maori babies from lower socio-economic areas) (Craig, Dell et al 2012), and no relapse rates were calculated. Andrews et al 2014 (Andrews, Dixon et al 2014) suggest research is needed to establish relapse rates for New Zealand. Internationally, relapse is associated with a range of socio-demographic, pregnancy and smoking-related factors.…”

The recent fall in postperinatal mortality in New Zealand and the Safe Sleep programme

“…On average, 27% of the estimated vulnerable infant population of New Zealand received a new ISSD in the four years 2012–2015 (based on 43% of Māori smoking in pregnancy and 13% for non‐Māori) . Coverage is likely to be extended considerably due to sharing of ISSDs in communities, a practice that is encouraged, although levels of reuse are not known.…”

Hypomethylation inFASTKD1detected in the association betweenin uterotobacco exposure and conduct problem in a New Zealand longitudinal study

“…The use of tobacco during pregnancy is one of the leading causes of perinatal compromise for developing offspring, and one of the most preventable [1]. For example, low birth weight [2], congenital heart anomalies [3], asthma/respiratory illness [4, 5], and sudden infant death syndrome (SIDS) [6] are all associated with maternal tobacco use during pregnancy, the rate of which remains relatively high in New Zealand (18.4% [7]), despite declining tobacco use rates overall [8].…”