Prevalence Of Smoking In Pregnancy Research Articles

Smoking Status in Pregnancy: A Retrospective Analysis in Northern Greece.

Background and Objectives: Smoking has adverse effects on both maternal and fetal health and its incidence varies among different countries. The aim of this study was to identify the prevalence of smoking during pregnancy and to identify factors associated with smoking. Materials and Methods: This was a retrospective study conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, during an 11-year period (2013-2023). All women receiving antenatal care in our unit were eligible to participate when they attended the prenatal unit for the first trimester nuchal translucency scan (11+0-13+6 weeks). Results: Of the 12,074 pregnant women included in the study, 5005 (41.5%) reported themselves as smokers before pregnancy; the smoking cessation rate due to pregnancy was 70.2% (3516/5005) and the prevalence of smoking in pregnancy was 12.3% (1489/12,074). Multiparity was associated with less odds of smoking before pregnancy (OR: 0.79; 95% CI: 0.73-0.85), whereas advanced maternal age (OR: 1.17; 95% CI: 1.07-1.27) and obesity (OR: 1.44; 95% CI: 1.29-1.6) were associated with higher odds of smoking before pregnancy. Smoking prevalence in pregnancy was lower in women that conceived via assisted reproductive techniques (ARTs) (OR: 0.52; 95% CI: 0.38-0.70) and higher in cases of multiparity (OR: 1.12; 95% CI: 1.008-1.26) and maternal obesity (OR: 1.55; 95% CI: 1.20-2.00). Conception via ARTs was associated with higher odds of smoking cessation (OR: 1.9; 95% CI: 1.38-2.69), whereas multiparous (OR: 0.7; 95% CI: 0.62-0.8) and obese women (OR: 0.72; 95% CI: 0.61-0.85) were less likely to quit smoking. Conclusions: Pregnancy is a strong motivator for women to quit smoking, especially in primiparous women and those undergoing ARTs. Our findings highlight the need for more consistent smoking prevention and health promotion strategies in Greece as a very high proportion of women smoke before pregnancy and a substantial proportion continue in pregnancy.

Inequalities in smoking among pregnant women in North West London.

London has the lowest smoking prevalence among pregnant women in England. However, it was unclear whether the low overall prevalence masked inequalities. This study investigated the prevalence of smoking among pregnant women in North West London stratified by ethnicity and deprivation. Data regarding smoking status, ethnicity and deprivation were extracted from electronic health records collected by maternity services at Imperial Healthcare NHS Trust between January 2020 and August 2022. A total of 25231 women were included in this study. At the time of booking of antenatal care (mean of 12weeks), 4% of women were current smokers, 17% were ex-smokers and 78% never smokers. There were marked differences in the smoking prevalence between ethnic groups. Women of Mixed-White and Black Caribbean ethnicity and White Irish women had the highest prevalence of smoking (12 and 9%, respectively). There was an over 4-fold increase in the prevalence of smoking between the most and the least deprived groups (5.6 versus 1.3%). Even in a population with an overall low prevalence of smoking in pregnancy, women experiencing deprivation and from certain ethnic backgrounds have a high smoking prevalence and hence are the most likely to benefit from smoking cessation interventions.

A single-center, prospective, observational study on maternal smoking during pregnancy in Greece: The HELENA study.

INTRODUCTIONThe unequivocal association between exposure to smoke and numerous complications of pregnancy, demonstrated in the last decades, has led to a significant decrease of smoking rates in pregnancy. The aim of the present study was to determine the prevalence of maternal smoking and to elucidate factors predisposing to it among pregnant women in Athens, Greece.METHODSA population of 1700 pregnant women (mean age: 31.2±5.5 years) who visited consecutively the Cardiology Department of Helena Venizelou Maternity Hospital in Athens, Greece, between September 2016 and August 2017, was prospectively analyzed. Data regarding changes in the future mother’s smoking habit as well as different sociodemographic factors potentially related to these changes were recorded.RESULTSOf the 1700 participants, 704 (41.4%) were smokers, and of those 52.4% quit smoking after knowledge of their pregnancy status. The overall prevalence of smoking in pregnancy was 19.7%. Prevalence was higher in women who were aged <20 years (p=0.038), were multipara (p=0.032), had ≤12 years of education (p=0.044) and had a partner who was a smoker (p=0.047). Women aged ≤20 years were more likely to be persistent smokers at the beginning of pregnancy and demonstrated a higher prevalence of smoking during pregnancy (42.2% vs 19.7% in the overall study population).CONCLUSIONSOur data demonstrate that maternal smoking during pregnancy still remains a major public health issue in Greece with a prevalence higher than most other industrialized countries.

Factors Affecting Smoking Behaviors and Smoking Prevalence in Pregnancy and Postpartum Period of Women.

AimThis study aimed to determine the factors affecting smoking behaviors and smoking prevalence among women during pregnancy and postpartum period.MethodThis cross-sectional study was conducted between May 2012 and October 2012 on a sample of 640 women who had children aged between one and three years and who enrolled in any one of the 23 family health centers located in the province of Sivas in Turkey. The data were collected through the questionnaires created by the researchers by interviewing the participants face to face in own homes. The data obtained were analyzed using the Statistical Package for the Social Sciences Statistics 15.0 (SPSS Inc.; Chicago, IL, USA) package program and evaluated using number, percentage distribution, chi square test, logistic regression analysis and Kaplan-Meier survival analysis.ResultsSmoking prevalence was found to be 8% during pregnancy and 15.6% in the postpartum period. It was determined that 17.2% of the women smoked before their last pregnancy (n=110), more than half of the smokers quit smoking during pregnancy (n=59), and 46.4% of them continued to smoke during pregnancy. It was determined that 79.7% of the participants who quit smoking during pregnancy relapsed within the first one to three years of the postpartum period, and only 20.3% continued not to smoke. The Kaplan-Meier survival analysis showed that women who breastfed quit smoking for a significantly longer time (27.6 months) compared with those who did not breastfeed (12 months). According to the logistic regression analysis, the risk of postpartum relapse among women aged 30 years or more was 10.99-fold higher than women between the ages of 19 and 29.ConclusionThe rate of pre-pregnancy smokers decreased in the pregnancy and increased in the postpartum period.

Smoking during pregnancy. Results of the cross-sectional KiGGS Wave 2 study and trends

Abstract Background Maternal smoking during pregnancy represents a significant risk, increasing the adverse consequences for mothers and newborns. Different national targets have been developed in Germany to reduce smoking rates during pregnancy. To monitor the achievement of these goals, this study aims to assess social differences and temporal trends of smoking behaviour during pregnancy in mothers living in Germany. Methods Data of children aged 0 to 6 with valid information on maternal smoking habits during pregnancy were subtracted from German Health Interview and Examination Survey for Children and Adolescents (KiGGS)(KiGGS baseline 2003-2006, n = 6,525 and KiGGS wave 2 2014-2017, n = 4,838). The information on maternal smoking during pregnancy was recorded retrospectively as part of a self-administered written questionnaire. We estimated the prevalence of smoking in pregnancy and multivariable logistic regression models to assess the association with the age of the mother at the time the child was born, the socioeconomic status of the family and the migration background. In addition, to analyse trends over time, we compare the current data with the KiGGS baseline study. Results The prevalence of mothers who smoked during pregnancy decreased statistically significant from 19.9% (KiGGS baseline) to 10.9% (KiGGS wave 2). Younger mothers aged up to 24 years were more likely to smoke during pregnancy (OR 1.74; 95%CI 1.04-2.89), similar to those with intermediate (OR 5.52; 95%CI 2.90-10.48) or low socioeconomic status (OR 22.43; 95%CI 10.84-46.39), and those without (OR 4.18; 95%CI 2.27-7.70) or with one-sided migration background (OR 2.47; 95%CI 1.26-4.84), in comparison to the groups of reference. Conclusions Our findings, present the reduction of smoking prevalence during pregnancy, recognising the effectiveness of the tobacco control programs in Germany. However, more emphasis on the prevention strategies for young and socially disadvantaged women are still required. Key messages Smoking prevalence during pregnancy has decreased in Germany over time, though still represents a challenge for public health and tobacco control. The prevention strategies should reduce the social breach, to extend the benefit among women and their offspring.

The influence of acculturation on the risk of stillbirth in migrant women residing in Western Australia

ObjectiveTo investigate the influence of acculturation, demonstrated by age on arrival, length of residence, interpreter use and having an Australian-born partner, on disparities observed in the risk of stillbirth between migrant and Australian-born populations in Western Australia (WA).MethodsA retrospective cohort study using linked administrative health data for all non-Indigenous births in WA from 2005–2013 was performed. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Adjusted odds ratios (aOR) for stillbirth in migrants from six ethnicities of white, Asian, Indian, African, Māori, and ‘other’, with different levels of acculturation, were compared with Australian-born women using multivariable logistic regression analysis and marital status, maternal age group, socioeconomic status, parity, plurality, previous stillbirth, any medical conditions, any pregnancy complications, sex of baby, and smoking during pregnancy as the covariates.ResultsFrom all births studied, 172,571 (66%) were to Australian-born women and 88,395 (34%) to migrant women. Women from African, Indian and Asian backgrounds who gave birth in the first two years after arrival in Australia experienced the highest risk of stillbirth (aOR 3.32; 95% CI 1.70–6.47, aOR 2.71; 95% CI 1.58–4.65, aOR 1.93; 95% CI 1.21–3.05 respectively) compared with Australian-born women. This association attenuated with an increase in the length of residence in Asian and Indian women, but the risk of stillbirth remained elevated in African women after five years of residence (aOR 1.96 [1.10–3.49]). Interpreter use and an Australian-born partner were associated with 56% and 20% lower odds of stillbirth in migrants (p<0.05), respectively.ConclusionsAcculturation is a multidimensional process and may lower the risk of stillbirth through better communication and service utilisation and elevate such risk through increase in prevalence of smoking in pregnancy; the final outcome depends on how these factors are in play in a population. It is noteworthy that in women of African background risk of stillbirth remained elevated for longer periods after immigrating to Australia extending beyond five years. For migrants from Asian and Indian backgrounds, access to services, in the first two years of residence, may be more relevant. Enhanced understanding of barriers to accessing health services and factors influencing and influenced by acculturation may help developing interventions to reduce the burden of stillbirth in identified at-risk groups.

Association of Tobacco Use During Pregnancy, Perceived Stress, and Depression Among Alaska Native Women Participants in the Healthy Pregnancies Project.

In general population samples, higher levels of stress and depression have been associated with increased prevalence of smoking in pregnancy. Little is known about the association of prenatal tobacco use, stress, and depression among American Indian or Alaska Native (AI/AN) women. The Healthy Pregnancies Project is a cluster-randomized controlled trial, evaluating a community-level intervention compared with usual care, for reducing tobacco use during pregnancy and postpartum among AN women in 16 villages in western Alaska. This cross-sectional study analyzed baseline data from enrolled pregnant women. Baseline measures included the self-reported, 7-day, point-prevalence current use of any tobacco, Perceived Stress Scale (PSS), and the Center for Epidemiological Studies-Depression (CES-D). Generalized estimating equations (GEE) analyses adjusted for village, participant age, and gestational age. Participants (N = 352) were on average (SD) 25.8 (5.0) years of age and at 26.8 (9.8) weeks gestation. 66.5% were current tobacco users, of which 77% used Iqmik, a homemade form of smokeless tobacco. Compared with nonusers, tobacco users reported lower PSS score (p = .020) and less clinical levels of depression (CES-D ≥ 16) (18.1% vs. 9.3%, p = .21). Findings were not accounted for by nicotine dependence severity or self-reported tobacco use before pregnancy. In this sample of pregnant AN women, tobacco users report less stress and clinical levels of depression than nonusers. A potential challenge with tobacco treatment for pregnant AN women is to provide alternative ways of deescalating stress and affect management instead of using tobacco. This study contributes novel information on the association of tobacco use, perceived stress, and depression among Alaska Native women enrolled in a clinical trial to promote healthy pregnancies. Most prior studies addressing this topic were conducted among general population samples of pregnant women who smoked cigarettes. Little is known about these associations with prenatal smokeless tobacco, or among American Indian or Alaska Native women. The results are contrary to findings reported previously, because current tobacco use was associated with less stress and depression than nonuse. The study findings have implications for cessation treatment for this tobacco-use disparity group.

Stopping smoking in pregnancy

Smoking is a significant and modifiable cause of adverse pregnancy outcomes. Although the prevalence of smoking in pregnancy is declining in England there is significant geographic and socioeconomic variation and prevalence remains high in some areas. When patients present to their GP for preconception counselling or antenatal care it is an ideal opportunity to discuss the benefits of smoking cessation for pregnancy and beyond.

Smoking in pregnancy and after childbirth: An update

Figures show that progress to reduce the rates of smoking in pregnancy has slowed over the last year. Hilary Wareing looks at the role of the health visitor in achieving the government's aim to reduce the prevalence of smoking in pregnancy from 10.7% to 6%.

Serious Psychological Distress and Smoking During Pregnancy in the United States: 2008-2014.

The current study examined the relationship between acute (past 30 day) and recent (past year but not past 30 day) serious psychological distress (SPD) and smoking during pregnancy among women in the United States overall, stratified by demographic characteristics, and described the change in the prevalence of prenatal smoking among women with and without SPD, from 2008 to 2014. Data were drawn from the National Survey on Drug Use and Health (NSDUH), an annual cross-sectional study of US persons aged 12 and over. SPD and smoking in the past 30 days among pregnant women, aged 18 and older, were examined using logistic regression models. Heterogeneity in this association by demographic characteristics, trends over time, and level of cigarette consumption was also examined. Prenatal smoking was common. Almost 40% of pregnant women with acute SPD reported smoking, 23% of pregnant women with recent SPD smoked, and 11.7% of pregnant women without recent SPD smoked. No significant change was found in the prevalence of prenatal smoking from 2008 to 2014 in any of these groups. Robust relationships were found between acute (OR = 5.05 [3.64-6.99]) and recent SPD (OR = 2.37 [1.74-3.24]) and smoking; these findings remained after adjusting for demographics. SPD and smoking during pregnancy are strongly associated; this relationship is present across all sociodemographic groups and the prevalence of smoking in pregnancy has remained relatively unchanged over the past decade both in the presence and absence of SPD. SPD and smoking in pregnancy are robustly linked; the prevalence of smoking in pregnancy is extremely high in women with SPD. Screening women with mental health problems for prenatal smoking, as well as screening pregnant smokers for mental health problems, seems warranted and may assist more women in seeking and utilizing treatment options. Efforts to reduce the prevalence of smoking during pregnancy might specifically target women with SPD, where the potential for impact is substantial.

Weight Gain in Women after Smoking Cessation in Pregnancy

Introduction: Smoking during pregnancy is associated with adverse outcomes. Tobacco cessation in the general population is associated with weight gain. Aims: We sought to compare gestational weight gain (GWG) in women who quit smoking during pregnancy with those who continued smoking and non-smokers in two countries with high smoking prevalence in pregnancy. Methods: This study uses baseline data from a brief cessation intervention clustered randomised controlled trial; data were collected from clinical records and through questionnaires at post-partum hospitalisations during October 2011–May 2012. Women had attended one of 20 selected clusters of publicly funded prenatal care clinics in Argentina and Uruguay. Self-reported cessation was verified biochemically. Results: Of 2636 pregnant women, 29.9% were smokers at the beginning of pregnancy; among them 41.9% quit and 58.1% continued smoking. Most women (60.7%) had a normal pre-pregnancy body mass index (BMI). Adjusted mean weight gain was higher in quitters than in continuing smokers and non-smokers. Cessation increased GWG by 2.4 kg (95% confidence interval 1.3–3.4) after adjusting by pre-pregnancy BMI and other confounders in comparison with women who continued smoking(p &lt; 0.001). Conclusions: GWG was slightly higher in women who quit smoking at any time during pregnancy.

Maternal smoking and the risk of still birth: systematic review and meta-analysis.

BackgroundSmoking in pregnancy is known to be associated with a range of adverse pregnancy outcomes, yet there is a high prevalence of smoking among pregnant women in many countries, and it remains a major public health concern. We have conducted a systematic review and meta-analysis to provide contemporary estimates of the association between maternal smoking in pregnancy and the risk of stillbirth.MethodsWe searched four databases namely MEDLINE, EMBASE, Psych Info and Web of Science for all relevant original studies published until 31st December 2012. We included observational studies that measured the association between maternal smoking during pregnancy and the risk of stillbirth.Results1766 studies were screened for title analysis, of which 34 papers (21 cohorts, 8 case controls and 5 cross sectional studies) met the inclusion criteria. In meta-analysis smoking during pregnancy was significantly associated with a 47% increase in the odds of stillbirth (OR 1.47, 95% CI 1.37, 1.57, p < 0.0001). In subgroup analysis, smoking 1-9 cig/day and ≥10 cig/day was associated with an 9% and 52% increase in the odds of stillbirth respectively. Subsequently, studies defining stillbirth at ≥ 20 weeks demonstrated a 43% increase in odds for smoking mothers compared to mothers who do not smoke, (OR 1.43, 95% CI 1.32, 1.54, p < 0.0001), whereas studies with stillbirth defined at ≥ 24 weeks and ≥ 28 weeks showed 58% and 33% increase in the odds of stillbirth respectively.ConclusionOur review confirms a dose-response effect of maternal smoking in pregnancy on risk of stillbirth. To minimise the risk of stillbirth, reducing current smoking prevalence in pregnancy should continue to be a key public health high priority.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1552-5) contains supplementary material, which is available to authorized users.

127 Trends in Smoking in Pregnancy in the Netherlands (2001–2010)

Background and aimsSmoking in pregnancy significantly increases the risk of preterm birth and fetal growth restriction. Pregnant women are encouraged to quit smoking. Smoking in general is discouraged by antismoking...

Socioeconomic correlates and trends in smoking in pregnancy in New South Wales, Australia

ObjectiveThis study describes trends (1994–2007) in smoking in pregnancy (SIP) among an Australian population sample of women. This study also examines trends in the socioeconomic distribution of SIP over the...

Comparison of CO breath testing and women's self-reporting of smoking behaviour for identifying smoking during pregnancy

BackgroundHealthcare services often use a carbon monoxide (CO) breath test to validate self-reported smoking and to assess reductions in smoking habit. A cut-off level of ≥ 8 parts per million (p.p.m.) is used to identify smoking. This cut-off requires further validation in pregnant women.MethodsData on self-reported smoking were assessed in conjunction with breath CO levels. Subjects in the study were 2548 women attending antenatal booking during 12 months.Results546/2584 (21.4%) women self-reported as current smokers. A cut-off of 8 ppm identified only 325/546 self-reported smokers (sensitivity 59.4%). 27/2002 self-reported non-smokers had levels greater than 8 ppm (specificity 98.7%). Sensitivity and specificity analysis revealed that CO cut-off levels of 2 or 3 p.p.m. resulted in the best sensitivity and specificity for discriminating apparent smokers and non-smokers. A cut-off of 2 p.p.m. would have identified 468/546 of self-reported smokers (sensitivity 86%). 206/2002 self-reported non-smokers had levels > 2 ppm (specificity 90 %). If all these women were 'true' smokers, the real prevalence of smoking in pregnancy was 26.5% (752/2548) and 27% of true smokers provided false answers to the self-reported question at maternity booking.ConclusionAt 8 ppm, many smokers are missed and there may be gross underestimating of levels of smoking in a pregnant population. Results emphasise the need to support a lower cut-off level for the breath CO test closer to 2 or 3 p.p.m. These cut-offs may be more appropriate in the antenatal clinic setting, and are in line with recent recommendations in the non-pregnant population.

Does gravidity influence smoking behaviour in pregnancy? A comparison of multigravid and primigravid women

This study used the data from a retrospective cross-sectional survey to describe the prevalence of smoking in pregnancy in a large UK sample, over more than 20 years of pregnancies. The main objective was to determine whether women in their second or subsequent pregnancy are more or less likely than primigravidae to change their smoking behaviour. The participants were 7506 ever-pregnant women, from 7702 who answered the second stage of a survey of reproductive history in 2001-02, sent to 10 828 women, aged 18-55 years on the UK electoral register. These women gave detailed information on their last pregnancy. The main outcome measure was self-reported cigarette consumption in the first trimester of pregnancy. Nineteen per cent (1417/7506) of women in this sample smoked in the first trimester of the reported pregnancy. The data showed that there had been a decrease over the last 20 years in smoking prevalence, but this trend was not statistically significant after adjustment for confounding (P(trend) = 0.07). There was evidence that multigravidae were more likely to smoke in their pregnancies than were primigravidae (adjusted OR = 1.24, [95% CI 1.01, 1.53]), with a highly significant trend with increasing pregnancy order (P(trend) < 0.0001). Over time, women who reported smoking before pregnancy (n = 1926), showed a decreasing trend in continuing to smoke the same amount after recognising their pregnancies (P(trend) < 0.0001). After adjustment, multigravid smokers were almost 75% more likely than primigravid smokers to continue to smoke with no change in consumption (adjusted OR = 1.74, [95% CI 1.32, 2.28]), with a clear trend found with increasing pregnancy order (P(trend) = 0.001). In this UK population-based study, multigravidae were more likely to smoke in pregnancy than women pregnant for the first time. If already a smoker, they were much less likely to cut down their smoking once they found out they were pregnant, regardless of age. This suggests that a great deal of the burden of morbidity associated with smoking in pregnancy is in the multigravid group.

Smoking in pregnancy in Nottingham - 11 years on

The aim of this study was to assess whether the smoking habits of women during pregnancy had changed since the baseline survey conducted in 1986 in Nottingham (Madeley et al, 1989). The study design involved a quantitative survey of all pregnant women attending the two hospital antenatal clinics in Nottingham over a six week period in 1997. A total of 1716 self-completion questionnaires were returned, representing a response rate of 80%. It was found that although the percentage of women smoking in pregnancy had fallen from 31% in 1986 to 24% in 1997, there were still similar factors associated with prevalence of smoking in pregnancy. For example, the largest proportion of smokers by age group was in the 14–20 age range but this had increased from 47% in 1986 to 56% in 1997. The study concluded that although there had been an increase in the percentage of women receiving advice about smoking and pregnancy from midwives and nurses, there are some worsening trends in the prevalence of smoking in pregnancy, particularly in the teenage population. It is therefore recommended that smoking intervention strategies are specifically targeted towards young, disadvantaged women and those with no live-in partner and those in their household.

Partner smoking behaviour change is associated with women's smoking reduction and cessation during pregnancy

Objectives. To examine whether partner smoking behaviour change is associated with women's smoking reduction and cessation during pregnancy, independently of a range of potential psychosocial confounding variables. It was hypothesized that a woman's failure to reduce or quit smoking in pregnancy would be associated independently with failure of partner to reduce or quit smoking.Design. Cohort study.Methods. A population‐based sample of 662 women who smoked, or had smoked until becoming pregnant, were recruited in early pregnancy, with follow‐up in late pregnancy. Participants completed questionnaires and self‐report measures of sychosocial variables. The primary outcome measures were women's self‐reported daily cigarette consumption before pregnancy (retrospective), and during early and late pregnancy (contemporary), from which smoking cessation, reduction and maintenance measures were derived.Results. Seventy per cent of partners smoked, and 25 per cent of all partners (34 per cent of smoking partners) reduced or quitted smoking in early pregnancy. The study hypothesis was confirmed in multivariate logistic regression models. Women's failure to quit smoking in early pregnancy was independently associated with partner failing to reduce or quit smoking, higher number of social network smokers, adult attachment style, socio‐economic status, pre‐pregnancy cigarette consumption and older age. Women's failure to reduce smoking was independently associated with partner failing to reduce or quit smoking, socio‐economic status, pre‐pregnancy cigarette consumption, and higher parity. Partner and family emotional support, joint pregnancy planning and depressive symptomatology, were not independently associated with women's smoking reduction or cessation. Follow‐up data confirmed the early pregnancy results.Conclusions. Intervention trials to reduce the prevalence of smoking in pregnancy should include targeting of behavioural change in partner smoking.

How well does epidemiological evidence hold for the relationship between smoking and adverse obstetric outcomes in New South Wales?

This study examines whether the established epidemiological relationship between cigarette-smoking exposure in pregnancy and adverse obstetric outcomes are confirmed in Australian data from the NSW Midwives Data Collection (MDC). These data were analysed to compare the obstetric complications and pregnancy outcomes between smoking and nonsmoking women confined in 1994. Results showed that smoking mothers had higher rates of antepartum haemorrhage due to placental abruption and placenta praevia. They were also at higher risk of giving birth to low birth-weight babies and preterm delivery. Infants born to smoking mothers were 17% more likely to be admitted to hospital special care nurseries or neonatal intensive care units. Moreover, the risk of reported perinatal death among babies of smoking mothers was 20% higher than babies of nonsmoking mothers. However, smoking during pregnancy was found to confer a protective effect against the development of pregnancy-induced hypertension. These results were compared with existing evidence from the literature. Published research reports on the corresponding smoking effects were identified to assess the consistency of evidence and typical risk ratios. Findings from the literature search showed a near-perfect concordance with the associations in the NSW MDC data. The paper documents the likely complications which might be prevented if smoking in pregnancy were eliminated. There remains a real need for effective programmes to reduce smoking prevalence in pregnancy.

Prevalence of modifiable risk factors for sudden infant death syndrome in British Forces Germany.

A questionnaire survey was conducted amongst parents in the military community in British Forces Germany to investigate the prevalence of known and suspected risk factors for Sudden Infant Death Syndrome. Over a thousand questionnaires were returned (response rate 58%) and these showed that the prevalence of babies being placed in the prone position to sleep is now extremely low and the use of room thermometers to help control ambient temperature is widespread. However 29% of the mothers had smoked in pregnancy and 44% of households with a new-born baby had at least one parent who smoked. Additional health promotion activity aimed at reducing the prevalence of smoking in pregnancy and amongst the parents of new-born babies is recommended.