Modelling of the public health effects of smoking in pregnancy in Wales

Abstract

BackgroundWales has higher rates of smoking in pregnancy than does any other UK country. 33% of women in Wales smoked before or during their pregnancy compared with 26% in the UK, and 16% of women in Wales continued to smoke throughout their pregnancy. There is guidance from the UK National Institute for Health and Clinical Excellence (NICE) for smoking cessation during and after pregnancy, but a full health economic analysis of the costs and benefits of smoking cessation during pregnancy is limited by the absence of comprehensive data for the wider public health effects for the mother, child, and family associated with smoking cessation during pregnancy. We aim to provide a conceptual framework for a model to estimate the wider public health effects of smoking cessation during pregnancy. MethodsWe will construct a model and populate it with parameters estimated from the Wales Electronic Cohort of Children (WECC). WECC contains anonymised records of the 804 290 children living in Wales between 1990 and 2008. It is compiled from eight different datasets, which are record linked with the Secure Anonymised Information Linkage (SAIL) instrument. This analysis will focus on the effect of smoking during pregnancy on several birth outcomes (gestational age, birthweight, stillbirth), including the effects of maternal age and social deprivation measured with Townsend scores. This model will allow us to explore the effect of smoking in pregnancy on birth outcomes and predict where an increase in uptake of smoking cessation services would have most effect. Use of the linked datasets enables us to include a range of variables and outcomes by linking health and social care sources. This approach will help us to make the best use of resources in Wales to have maximum effect on the public health effects of smoking in pregnancy. Programme budgeting and marginal analysis will complement the modelling, informing where current resources could be best targeted. FindingsDescriptive analysis from the WECC data will be reported later in 2012 and used to populate the model, which will be developed by spring, 2013. InterpretationOnce developed, the model can be extended to include early years outcomes for the child beyond the time of birth, including asthma and upper respiratory tract infections, and developmental outcomes such as school readiness. The basis of this model can then be used for other public health areas—eg, the effect of maternal obesity on outcomes for the mother and child. FundingNone.