Abstract
IntroductionSmoking during pregnancy remains common, and the English National Health Service (NHS) has recently been directed to prioritize providing cessation support for pregnant women. We investigated the impact on prescribing of stop smoking treatments to pregnant women of the 2013 transfer of public health budgets from the NHS to administrative authorities responsible for local social care and other nonhealth services (local authorities).MethodsWe used data from the Clinical Practice Research Datalink and Hospital Episode Statistics to determine annual proportions (2005–2017) of women who smoked during pregnancy and who were prescribed, at least once before childbirth, (1) any NRT and (2) long- and short-acting NRT together (dual NRT). Segmented regression was used to quantify the impact of the 2013 transfer of smoking cessation budgets to local authorities, assessing changes in the level and the trend of the proportions post-2013 compared with pre-2013.ResultsWe identified 84 539 pregnancies in which women were recorded as smoking; any NRT was prescribed in 7.9% (n = 6704) and dual NRT in 1.7% (n = 1466). Prescribing of any NRT was declining prior to 2013 at an absolute decrease of −0.25% per year, but the rate of decline significantly increased from 2013 onwards to −1.37% per year. Prescribing of dual NRT was increasing prior to 2013 but also decreased post-2013.ConclusionsThese findings suggest that transferring responsibility for English Smoking Cessation Services from the NHS to local authorities adversely affected provision of cessation support in pregnancy. Consequently, some women may have been denied access to effective cessation treatments.ImplicationsWomen who smoke during pregnancy may be being denied potentially effective means to help them quit, contrary to NICE guidance, at what can be a teachable moment with substantial immediate and longer-term health benefits for woman and their unborn child, and economic benefits for the NHS. When the organizations responsible for offering smoking cessation support are changed, health systems should consider potential adverse effects on the delivery of support and deploy strategies for mitigating these.
Highlights
Smoking during pregnancy remains common, and the English National Health Service (NHS) has recently been directed to prioritize providing cessation support for pregnant women
We identified 84 539 pregnancies in which women were recorded as smoking; any Nicotine replacement therapy (NRT) was prescribed in 7.9% (n = 6704) and dual NRT in 1.7% (n = 1466)
We determined annual proportions of women who smoked during pregnancy who were prescribed (1) any NRT at least once during pregnancy and (2) dual NRT at least once during pregnancy; by definition, these groups were not discrete—women who were prescribed dual NRT were a subset of those prescribed any NRT
Summary
Smoking during pregnancy remains common, and the English National Health Service (NHS) has recently been directed to prioritize providing cessation support for pregnant women. Smoking in pregnancy remains common.[1] In England in the year to March 2020, 10.4% of women smoked at the time of delivery[2] and in 2015, 23.3% of UK women were estimated to have smoked (any frequency/quantity) in pregnancy.[1] Smoking in pregnancy is associated with increased risks of many adverse pregnancy, birth, and child outcomes[3] and children of smoking mothers are twice as likely to themselves start smoking.[4] Reducing smoking in pregnancy is likely to have a major impact on medical resource use and the English NHS has recently been directed to prioritize providing cessation support for pregnant women.[5]. Dual NRT, combining a nicotine patch (for a steady background nicotine supply) with a fast-acting NRT like gum (to “top-up” the nicotine dose as needed), may be more likely to lead to cessation than mono NRT,[9] though current NHS guidelines for supporting smoking cessation in pregnancy do not mention use of dual NRT as a treatment option.7(p26)
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