Smoking Status In Pregnant Women Research Articles

The effect of active and passive smoking during pregnancy on birth outcomes: A cohort study in Shanghai.

China is the largest tobacco consumer in the world, and tobacco poses a serious threat to the health of pregnant women. However, there are relatively few domestic studies on smoking during pregnancy and childbirth outcomes among pregnant women. The purpose of this study was to analyze the effect of active and passive smoking on pregnant women and their pregnancy outcomes, providing evidence and recommendations for intervention measures. This was a cohort study in Shanghai from April 2021 to September 2023. According to the smoking status of pregnant women, they were divided into three groups: active smokers, passive smokers and non-smokers. A self-designed questionnaire was utilized to conduct the survey, and their pregnancy outcomes were tracked and followed up. A total of 3446 pregnant women were included in this study, among which 2.1% were active smokers, 43.5% were passive smokers, and 54.4% were non-smokers. The average age of the pregnant women was 29.9 years, and 41.2% had a university degree or higher. The education level of active smokers and passive smokers was significantly lower than that of non-smokers (p<0.05).The average gestational age of non-smokers was 38.6 weeks, and the birth weight was 3283.2 g, which was higher than those of active smokers and passive smokers (p<0.05). Logistic regression analysis showed that passive smoking increased the likelihood of preterm birth (AOR=1.38; 95% CI: 1.05-1.81), low birth weight (AOR=1.53; 95% CI: 1.10-2.12), and intrauterine growth restriction (AOR=1.35; 95% CI: 1.02-1.79), while active smoking increased the likelihood of preterm birth (AOR=2.98; 95% CI: 1.50-5.90), low birth weight (AOR=4.29; 95% CI: 2.07-8.88), intrauterine growth restriction (AOR=2.70; 95% CI: 1.37-5.33) , and birth defects (AOR=2.66; 95% CI: 1.00-6.97). Our findings illustrate that active and passive smoking can lead to adverse pregnancy outcomes. This study provides data on the relationship between smoking during pregnancy and delivery outcomes among pregnant women. In the future, we need more effective strategies to protect pregnant women from the harm of tobacco.

Sparse latent factor regression models for genome-wide and epigenome-wide association studies.

Association of phenotypes or exposures with genomic and epigenomic data faces important statistical challenges. One of these challenges is to account for variation due to unobserved confounding factors, such as individual ancestry or cell-type composition in tissues. This issue can be addressed with penalized latent factor regression models, where penalties are introduced to cope with high dimension in the data. If a relatively small proportion of genomic or epigenomic markers correlate with the variable of interest, sparsity penalties may help to capture the relevant associations, but the improvement over non-sparse approaches has not been fully evaluated yet. Here, we present least-squares algorithms that jointly estimate effect sizes and confounding factors in sparse latent factor regression models. In simulated data, sparse latent factor regression models generally achieved higher statistical performance than other sparse methods, including the least absolute shrinkage and selection operator and a Bayesian sparse linear mixed model. In generative model simulations, statistical performance was slightly lower (while being comparable) to non-sparse methods, but in simulations based on empirical data, sparse latent factor regression models were more robust to departure from the model than the non-sparse approaches. We applied sparse latent factor regression models to a genome-wide association study of a flowering trait for the plant Arabidopsis thaliana and to an epigenome-wide association study of smoking status in pregnant women. For both applications, sparse latent factor regression models facilitated the estimation of non-null effect sizes while overcoming multiple testing issues. The results were not only consistent with previous discoveries, but they also pinpointed new genes with functional annotations relevant to each application.

Arterial hypertension in pregnant women: the effect of body mass index and smoking

Abstract Aim To evaluate the effect of body mass index (BMI) and smoking, as well as their combination on the development of arterial hypertension (AH) during pregnancy. Materials The study included 312 pregnant women with hypertension (group I), with an average age of 32 [28–36] years. The diagnosis of moderate and severe hypertension was established before pregnancy on the basis of the national guidelines. The control group consisted of 358 pregnant women without hypertension (group II), with an average age of 28 [24–32] years. The study included the assessment of anthropometric data at 6–8 weeks of pregnancy, questionnaires and assessment of the smoking status of pregnant women (pack-years), ambulatory blood pressure monitoring (ABPM). Results At admission, the mean systolic blood pressure (SBP) in group I was 147 [140–164] mmHg, and the diastolic blood pressure (DBP) was 95.8 [84–100] mmHg. According to the ABPM data, the mean SBP was 142 [135–164] mmHg, and the mean DBP was 95.8 [84–98] mmHg When registered for pregnancy in the group 1, the BMI was significantly higher compared to the control group, 30.2 (25–34,9) and 22.3 (20.2–25.6), p&amp;lt;0.001, respectively. Obesity and smoking were statistically more common in group I compared to the control group, p&amp;lt;0.001 and p=0.01, respectively. The index of the smoker in the group with AH was 7.5 [2.5–15] pack-years, in the control group – 1.9 [1.0–7.5], p&amp;lt;0.001. Smoking pack-years ≥10, increased the chance of developing hypertension by 13.1 (5.5–29.9) times, in turn, with pack-years &amp;lt;10 (compared to non-smokers), the chance of developing hypertension increased by 2.6 (1.6–3.9) times. Obesity significantly increased the chance of hypertension, Odds Ratio=12 (7.6–19.1). Among women with a normal BMI, smoking increased the chance of developing hypertension by 5 (2.7–9.3) times compared to its absence. The combination of smoking and an above-normal BMI compared to no smoking and a normal BMI increased the chance of developing hypertension by 31 (15.3–62) times. In women with a normal BMI, smoking (pack-years &amp;lt;10) increased the chance of developing hypertension by 3.6 (1.8–6.8) times compared to its absence. Also in this group, smoking (pack-years ≥10) increased the chance of developing hypertension by 5 (1.2–21) times compared to IPL&amp;lt;10 and by 17.7 (4.7–67) times compared to no smoking. In women with normal BMI, smoking (pack-years &amp;lt;10), compared with non-smoking women, did not significantly affect the chance of developing hypertension. In obese women, pack-years did not significantly affect the chance of developing hypertension (p=0.07). Conclusions An increase in body mass index and smoking, either single or in combination, can increase the chance of developing hypertension. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Russian Medical Academy of Continuous Professional Education, Novokuznetsk

Assessment of the Relationship Between Smoking and Depression in Pregnant Women

Smoking during pregnancy has negative effects on both maternal and fetal health. One of these negative maternal effects is the potential for depression. A high rate of cigarette smoking in pregnancy is an important public health issue since it affects not only the pregnant woman but also the newborn and its healthy development. The aim of this study is to investigate the relationship between smoking, influencing factors, and depression prevalence in pregnant Syrian refugees and pregnant citizens of the Republic of Turkey (TR). Pregnant citizens in the TR and pregnant Syrian refugees who were registered at health centers between 15.04.2017 and 15.10.2017 in the border city of Ceylanpınar in the Province of Şanlıurfa in Syria were visited in their living areas in the district center and at a tent village, respectively. A total of 414 pregnant women agreed to participate in the study and were included in the survey. To collect data for the cross-sectional study, a sociodemographic and pregnancy characteristics questionnaire was used, in addition to the Fageström Test for Nicotine Dependence (FTND) and the Beck Depression Inventory (BDI). The rate of smoking in all pregnant women was determined to be 49.3% (n = 204) before pregnancy and 37.9% (n = 157) during pregnancy. A statistically significant difference was found between age groups and educational status in relation to smoking status (p = 0.005, p = 0.001). There was also a statistically significant difference between the smoking status of pregnant women and that of their partners and family members (p = 0.001, p = 0.002). The percentage of pregnant women who were passive smokers was 80.2% (n = 332), and a statistically significant difference was found between passive smoking and smoking status (Fisher; 0.000). The presence of risk for depression was detected in 49.8% (n = 206) of all pregnant women surveyed; the rate of depression risk was 50.5% (n = 104) in pregnant TR citizens and 49.5% (n = 102) in pregnant refugees, with no significant difference between the two groups. There was a statistically significant difference between smoking status in pregnancy and the presence of depression risk (p = 0.001). 32.5% of pregnant women were highly nicotine dependent. A moderate positive correlation was determined between the FTND and BDI scores of pregnant women (r = 0.346; p = 0.001). It was found that one-third of all pregnant women smoked and that one of every two showed a risk for depression. A statistically significant correlation was found between smoking status and risk for depression. No statistically significant difference was determined between the two groups, despite high levels of smoking, nicotine dependence, and depression in both. These data suggest the need to develop new preventive strategies in regard to smoking among pregnant women.

Association between neighborhood socioeconomic status, tobacco store density and smoking status in pregnant women in an urban area

Smoking during pregnancy can lead to serious health consequences. Given such health risks, an understanding of factors that influence maternal smoking behaviors during pregnancy is critical. The objective of this study is to assess the relationship between tobacco store density, neighborhood socioeconomic status, and neighborhood rates of maternal smoking during pregnancy. Fifty-five community areas in Baltimore City were summarized using data from the Neighborhood Health Profiles. Associations between tobacco store density and smoking while pregnant in a community were determined using Moran's I and spatial regression analyses to account for autocorrelation. The fully adjusted model took into account the following community-level socioeconomic variables as covariates: neighborhood median income, percentage of those living in poverty, percentage of uninsured, and percentage of persons with at least a college degree. In regards to the findings, the percentage of women by community area who identified as actively smoking while pregnant was 10.4% ± 5.8%. The tobacco store density was 21.0 ± 12.7 per 10,000 persons (range 0.0–49.1 tobacco store density per 10,000 persons). In the adjusted model, an increase in density of 1 tobacco store per 10,000 persons was associated with a 10% increase in women who reported smoking during pregnancy (β = 0.10, p = 0.04). In conclusion, tobacco store density and neighborhood socioeconomic factors were associated with prevalence of maternal smoking while pregnant. These findings support the need to further assess and develop interventions to reduce the impact of tobacco store density on smoking behaviors and health risks in communities.

Smoking Prevalence and Secondhand Smoke Exposure during Pregnancy and Postpartum-Establishing Risks to Health and Human Rights before Developing a Tailored Programme for Smoking Cessation.

Both smoking during pregnancy and secondhand smoke exposure are associated with reduced health outcomes. However, limited consistent evidence exists of risks of secondhand smoke exposure in pregnancy. Currently, inadequate smoking cessation services exist in Irish maternity hospitals. To identify the number of pregnant women smoking during pregnancy and to identify their exposure to secondhand smoke, we conducted a cross-sectional observational pilot study in one regional maternity hospital in Ireland in July/August 2018. Respondents were (1) women attending antenatal clinics and (2) postpartum women before discharge. Variables measured included smoking status of pregnant women and partner status, demographic variables, secondhand smoke exposure, and support for hospital smoke-free policy and development of smoking cessation services. The overall response rate was 42.2% in this study. The response rate was 56.5% (111/196) from postnatal wards and 37.3% (215/577) from antenatal clinics. Over 40% of respondents reported they had smoked during their lifetime. The majority of women (70%) reported quitting smoking before their pregnancy. Few women were active smokers. Almost 40% reported exposure to tobacco smoke in the previous week (38.5%); 16.9% reported living with a smoker, a critical factor in increased risk (Odds Ratio (OR) 3.89, 95% CI = 1.86–8.15, p < 0.001). Approximately 10% of postnatal mothers reported that their newborn would travel home with a smoker. Support for a no-smoking hospital policy was very high as was support for the development of cessation services. No documentation of secondhand smoke exposure for pregnant women or newborns is sought or recorded routinely in the hospital. A systems approach to develop smoking cessation programmes in maternity care should include screening and documenting of secondhand smoke exposure risks for women during pregnancy, and for their newborns at discharge, to improve health outcomes and protect human rights.

Does Current General Mental Health Status Relate to Current Smoking Status in Pregnant Women?

Purpose Research shows that smoking during pregnancy is related to mental health diagnoses. The purpose of this study was to assess whether current general mental health status is related to current smoking status in pregnant women after controlling for other factors related to both mental health and tobacco use during pregnancy. Methods This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance Survey (BRFSS) data for 621 pregnant women aged 18-38 from Florida (N=136), Kansas (N=116), Minnesota (N=105), Nebraska (N=90), New York (N=78), and Utah (N=96). Multiple logistic regression analysis was used to assess the relationship between current mental health status and current tobacco use, while controlling for state, depression diagnosis, routine checkup, healthcare plan, age, marital status, ethnicity/race, education level, income level, and employment status. Results Overall, very few participants reported current smoking (6%) and about one-third reported low or moderate mental health status in the past 30 days. Adjusted results indicated that those who reported high mental health status were about 3 times less likely (OR=0.29, 95% CI=0.09, 0.88) to report current smoking status compared to those who reported low mental health status. Conclusions Overall, current mental health status was highly related to current smoking status in pregnant women. Clinicians in obstetrics may expect a very low proportion of pregnant women to report smoking and up to one-third to report low or moderate current general mental health status. Given that current mental health issues and current tobacco use may harm both mother and child, be highly related in pregnant women, and change throughout the pregnancy, pregnant women should be screened automatically for both at each visit.

Concept and connotation of oxidative stress in preeclampsia.

BACKGROUND:Preeclampsia (PE) is a systemic pregnancy-related disorder characterized by hypertension, proteinuria, and edema. Free radicals seem to play an important role in the induction of endothelial dysfunction in PE.AIM:The aim of the present study was to investigate serum levels of nitric oxide (NO), peroxynitrite (ONOO−), paraoxonase (PON-1), malondialdehyde (MDA), and lipid profile in preeclamptic patients compared to the women with normal pregnancy.MATERIALS AND METHODS:A total of 68 pregnant women were recruited. They were divided into two groups - Group A, 40 women were a newly diagnosed with PE and Group B, 28 women with normal pregnancy. Anthropometric measurements including body mass index and blood pressure in accordance with biochemical measurements including NO, ONOO−, PON-1, MDA, and lipid profile were done for preeclamptic pregnant women compared to the controls.RESULTS:Pregnant women with pre-eclampsia illustrated insignificant differences in the age (31.22±2.87) compared to the age of control P > 0.05. There were significant changes in the body mass index (BMI), type of delivery and smoking status of pregnant women with pre-eclampsia compared to the control P < 0.05. Both systolic and diastolic blood pressures were high in pregnant women with pre-eclampsia compared to the control P < 0.01. PON-1 and NO serum levels were significantly decreased (P < 0.01) while ONOO− and MDA serum levels were significantly increased in PE compared to the women with normal pregnancy.CONCLUSIONS:This study concluded that PE is associated with the augmentation of oxidative stress and reduction of endogenous antioxidant capacity regarding PON-1.

Smoking status of pregnant women in Elazig, an eastern province of Turkey

This study was conducted to determine the smoking situation of pregnant women in Elazig. Pregnant women registered at 173 family medicine centers in all the districts of Elazig comprise this descriptive research. 12.3% (n=77) of pregnant women had smoked regularly before pregnancy, 84.6% (n=531) of them stated that they never smoked and, 3.2%(n=20) had quit smoking before pregnancy. 87.7% (n=551) of pregnant women stated that they did not smoke at all during pregnancy, 4.2% (n=26) continued smoking during pregnancy, 6.7% (n=42) quit smoking as soon as they learned of their pregnancy, and 1.4% (n=9) smoking for a while and then quit smoking during pregnancy. 72.5% (n=37) of pregnant women who quit smoking, did so by themselves without any advice, 21.6% (n=11) by nurse advice and 5.9% (n=3) by doctor advice. 35.0% of pregnant women stated that they were exposed to second-hand smoking during pregnancy. The rate of smoking during pregnancy increased with decreasing income (p<0.05). The rate of smoking in pregnant women is low. The rate of pregnant women taking advice from health personnel about smoking cessation is low. The risk of smoking during pregnancy should be dwelt on by health personnel and relevant education should be given to pregnant women.

A National Audit of Smoking Cessation Services in Irish Maternity Units.

There is international consensus that smoking cessation in the first half of pregnancy improves foetal outcomes. We surveyed all 19 maternity units nationally about their antenatal smoking cessation practices. All units recorded details on maternal smoking at the first antenatal visit. Only one unit validated the self-reported smoking status of pregnant women using a carbon monoxide breath test. Twelve units (63%) recorded timing of smoking cessation. In all units women who reported smoking were given verbal cessation advice. This was supported by written advice in 12 units (63%), but only six units (32%) had all midwives trained to provide this advice. Only five units (26%) reported routinely revisiting smoking status later in pregnancy. Although smoking is an important modifiable risk factor for adverse pregnancy outcomes, smoking cessation services are inadequate in the Irish maternity services and there are variations in practices between hospitals.

Initial assessment of smoking status of pregnant women enrolled in a clinical trial for smoking cessation

Initial assessment of smoking status of pregnant women enrolled in a clinical trial for smoking cessation

Factors Related to Smoking Status of Pregnant Women Aged 15-49 in Turkey

Factors Related to Smoking Status of Pregnant Women Aged 15-49 in Turkey

Smoking Cessation during Pregnancy and Relapse after Childbirth: The Impact of the Grandmother’s Smoking Status

Smoking during pregnancy can result in negative effects in exposed children. It is well established that the smoking status of husbands is a major predictor of smoking among pregnant women. It was investigated whether the smoking status of the women's parents and parents-in-law has an impact on smoking cessation during pregnancy and relapse after birth above the smoking status of the husband. An initial sample of 458 women and their husbands was assessed prospectively during a 17-month period after birth regarding smoking habits. Five months after birth the women and their husbands reported the smoking status of their own parents. Smoking during pregnancy was related to the smoking status of the women's husband and mother. Women with a husband and mother who smoke were more likely to continue smoking. Relapse after smoking cessation during pregnancy was related to the smoking status of the husband and the mother-in-law. The smoking status of the women's father and father-in-law was not related to smoking cessation or relapse. The smoking status of the pregnant women's mothers and mothers-in-law is related to fetal and newborn's nicotine exposure. The findings suggest benefits of taking the smoking status of pregnant women's mothers and mothers-in-law into account in smoking prevention programs for pregnant women and mothers with infants.

Predictors of smoking cessation during pregnancy among the women of Yamato and Ayase municipalities in Japan

Cigarette smoking during pregnancy affects the unborn fetus. This study aimed to investigate: (1) the smoking status of pregnant women before, during and after pregnancy in the Yamato and Ayase municipalities, Kanagawa, Japan; (2) the characteristics that differentiate successful spontaneous smoking quitters from continuous smokers during pregnancy; and (3) the awareness of risks of smoking that may influence smoking cessation during pregnancy. A community-based, cross-sectional survey of 420 postpartum women, who delivered their babies from July 2002 to October 2002, was performed. Out of 420 respondents, 275 (65.4%) did not smoke before and during pregnancy. Of the 145 women who smoked before pregnancy, 101 (69.3%) quit successfully while pregnant. Smoking prevalence during pregnancy was 10.4%. Out of 101 successful quitters during pregnancy, 22 (21.8%) women resumed smoking after childbirth. A multiple regression analysis showed that the independent predictors of smoking cessation during pregnancy were primiparous women and women living with non-smokers in the household. Although maternal age predicted smoking cessation in a simple regression analysis, this predictive value was lost in the multiple analysis. A simple analysis showed no significant association between the awareness of smoking risks and smoking cessation during pregnancy. It is suggested that Japanese smokers are more likely to quit while pregnant than women in other countries. In the future, smoking cessation programmes should be designed to help multiparous women and women living with smokers to give up smoking.

Comparison of Self‐Reported Smoking and Urinary Cotinine Levels in a Rural Pregnant Population

(a) to assess the accuracy of self-reported smoking status in pregnant women from rural and small metropolitan statistical areas who stated they were smokers at the onset of pregnancy, (b) to compare the characteristics of these women who self-reported a nonsmoker status at the first prenatal visit with those who reported a smoker status, and (c) to determine the characteristics that predict self-reported smoking status and positive/negative urinary cotinine assays. Seven private obstetric offices serving rural and small metropolitan statistical areas in upstate New York. A convenience sample of 94 pregnant women who stated they were smokers at the onset of their pregnancies. Their mean age was 23 years and mean level of education was 11.9 years; 95% were White, 65% were single, and 65% were Medicaid-funded. Descriptive correlational design. At the first prenatal visit, the sensitivity and specificity of smoking and nonsmoking status were determined by comparing self-reports of smoking status with urinary cotinine assays. Data were also analyzed for relationships among demographic variables and for predictors of smoking status and urinary cotinine. The discordance rate between self-reports of smoking status and urinary cotinine assays at the first prenatal visit for the total sample was 16.6%, significant at p < .001, chi-square = 27.80, df = 1. Based on biochemical assays of >200 ng/ml of cotinine indicating active smoking, 34.7% of women who denied smoking (specificity of 65.3%) and 10.4% of women who stated that they smoked (sensitivity of 89.5%) inaccurately reported their status (significant at p < .001). The number of cigarettes smoked per day was positively correlated with age, gravidity, parity, and number of smokers in the household. Gravidity and the number of smokers in the household were significant predictors of positive self-report of smoking status and of positive urinary cotinine assay. These results substantiate the unreliability of self-report on smoking status in the pregnant population and in women who are recent quitters. Such findings have implications for clinical practice, such as (a) changes are necessary in how the prenatal interview assesses past and present tobacco use, (b) pregnant smokers who are multigravidae and who live with other smokers need more tailored interventions, and (c) more research is needed on how self-report can be ethically and efficiently validated.

130 Smoking status in pregnant women: Is self-report fact or fiction?

130 Smoking status in pregnant women: Is self-report fact or fiction?

A simple high-pressure liquid chromatography cotinine assay: validation of smoking status in pregnant women.

Smoking during pregnancy is a significant public health issue, and studies of the effectiveness of interventions to reduce maternal smoking require accurate measurement of smoking status. This study addresses some key issues in improvement of the effectiveness and efficiency of chemical validation of smoking status using a simplified high-pressure liquid chromatography urine cotinine method. Urine samples were collected from pregnant women enrolled in a smoking cessation trial and from non-pregnant volunteers exposed to environmental tobacco smoke (ETS). Analysis of ETS samples produced a maximum cotinine of 28 microg/mmol creatinine, which was established as the cut-off point for this method. This method is a relatively fast and inexpensive technique with which to analyse large batches of cotinine samples and can reliably measure smoking status.

Smoking status in pregnant women assessment of self-report against carbon monoxide (CO).

Smoking according to self-report and to carbon monoxide (CO) were examined in 7,405 pregnant women who agreed to complete a breath test and questionnaire. The sensitivity and specificity of self-report against CO, and predictors of a high CO among reported nonsmokers, were examined. The prevalence of reported smoking was 23% (95% CI: 19.4-26.4), and 20% had a CO of 9 or more (95% CI: 17.0-23.1). The sensitivity and specificity against CO were 87% (95% CI: 83.1-91.6) and 93% (95% CI: 91.9-94.6). The positive predictive value was 76% (95% CI: 73.2-79.8), reflecting CO's inability to detect light smoking. The negative predictive value was 97% (95% CI: 95.6-97.8). The best predictors of high CO among reported nonsmokers were being divorced/separated (9.8% had high CO), quitting during pregnancy (8.5% had high CO), being third trimester, and high passive exposure. Some pregnant women may report inaccurately despite validation. Difficulties remain in determining the contributions of passive exposure and inaccurate report to inconsistencies between biochemical and self-report measures.

The accuracy of self-report of smoking status in pregnant women

Little is known about the accuracy of usual-care providers' detection of pregnant smokers. This study explored the proportion of pregnant women misclassified as nonsmokers by midwives in a public antenatal clinic. A sample of 204 women whom midwives classified as nonsmokers were asked to complete a self-administered questionnaire and to provide a urine specimen for cotinine analysis. Results indicate that midwives failed to detect a significant proportion of smokers. The conservative estimate of the proportion of midwife-identified nonsmokers who could be reclassified as smokers on the basis of the questionnaire and urinalysis procedures was 7.4% (95% CI 3.8–10.9%), the medium estimate was 8.8% (95% CI 4.9–12.7%) and the worst-case estimate was 15.2% (95% CI 10.3–20.1%). To increase the coverage achieved by smoking-cessation programs, antenatal clinics should consider incorporating biochemical measurements into routine screening procedures. Future studies examining smoking status in pregnancy should detail the methods used to classify subjects and document response rates in relation to each self-report and biochemical measurement.

Smoking cessation interventions in pregnancy: practice and views of midwives, GPs and obstetricians

A questionnaire survey of general practitioners, midwives and obstetricians was carried out in 1992 in order to measure the delivery of, and attitudes towards, smoking cessation interventions in pregnancy. Most professionals were found to ask about the smoking status of pregnant women, record smoking status and explain the risks of smoking while pregnant. Fewer professionals gave pregnant smokers advice on how to stop or monitored and reviewed smoking status throughout pregnancy. Most experienced difficulty and a lack of enjoyment while giving smoking cessation counselling. Over half (53%) perceived themselves to be insufficiently trained, whilst few (28%) thought that they possessed the necessary skills. There is therefore a need to increase the coverage and frequency of smoking cessation counselling and to increase the level of training and skills among professionals.