Research

New strategies needed to prevent smoking relapse in new mothers

Published 4 December 2012

About half of the mothers who quit smoking during pregnancy relapse to smoking during the first few weeks after delivery and new strategies are needed to reduce this, according to an epidemiological study by Anjum Memon, Senior Lecturer and Consultant in Public Health Medicine, and Clare Harmer, Public Health, NHS East Sussex.

In a new research paper, published in Nicotine and Tobacco Research, Dr Memon explains that 47 per cent of the 512 mothers in the study who had quit smoking during the pregnancy relapsed within six weeks of their babies being born. He said those living with another smoker were shown to be six times more likely to relapse.

Around 23,000 pregnant women in England have used the NHS Stop Smoking Service this year. By widening its counselling and support services, not just to prospective new mothers but to those smokers who live with them, Dr Memon said the research suggests that relapse rates could be reduced, thereby improving the health of the whole family and making the £85m Stop Smoking Service more effective.

The study, thought to be one of the largest on the subject, was based on an analysis of the Child Health Surveillance System (CHS) in the United Kingdom.

It showed that women who relapsed to smoking within few weeks of delivery are more likely to be living in deprived urban areas, have two or more children, live with other smokers, and have not breast fed their babies.

In the study, continued smoking by a partner or another household member was the strongest risk factor for smoking relapse, with new mothers living with a smoker being six times more likely to relapse.

Health implications of smoking relapse to the mothers' health include increased risk of cancer, heart and lung diseases, adverse pregnancy outcomes and fertility problems. Children exposed to second-hand smoke are at an increased risk of sudden infant death syndrome (SIDS), respiratory and middle ear infection, asthma, and reduced lung function and meningitis.

Dr Memon, senior lecturer in public health at the Brighton and Sussex Medical School which is run jointly by Brighton and Sussex universities, said: "Preventing smoking relapse is an important public health issue because of the serious health consequences for mother and child. This research shows that women who are most vulnerable to relapse can be identified in the antenatal period as requiring extra support/counselling after the delivery to maintain a smoke-free status.

"While designing smoking cessation counselling and/or intervention services for pregnant women, it is important to take account of, and involve other smokers in the household, to highlight their crucial role and support for the expectant mother in quitting and maintaining smoke-free status during the pregnancy and preventing relapse after delivery. These interventions may be more effective if they include strategies aimed at assisting other household members to give up smoking as well."

Clare Harmer said "It is suggested that breast feeding is a strong incentive not to relapse into smoking, but several factors such as the mother's age, ethnicity, number of children, level of education, socio-economic and marital status, smoking status (before and after delivery), are associated with the nature and duration of breast feeding. Therefore, more research is needed to determine the direction of association between breast feeding and smoking relapse."

Dr Diana Grice, Director of Public Health for East Sussex, said "It is clear that there is more that we can and should do to protect the health of pregnant women and their children. Stopping smoking is one of the best things anyone can do to improve their health. This important research provides crucial insight into the factors which influence smoking during and after pregnancy and informs the actions all services can take to improve the health of pregnant women and their families."

Notes

Research paper: Clare Harmer, M.Sc. & Anjum Memon, D.Phil. Factors Associated With Smoking Relapse in the Postpartum Period: An Analysis of the Child Health Surveillance System Data in Southeast England. Nicotine and Tobacco Research. This can be viewed at: http://ntr.oxfordjournals.org/content/early/2012/10/06/ntr.nts221.full.pdf.

NHS Stop Smoking Services statistics from Statistics on NHS Stop Smoking Services: England, April 2012 to June 2012 (Q1 - Quarterly report) see: www.ic.nhs.uk/searchcatalogue?productid=9013.

For more information contact Gordon Kay, Communications Manager, Brighton and Sussex Medical School: 01273 877844, 07816 518819, g.m.kay@bsms.ac.uk.