BACKGROUND AND IMPLEMENTATION CHALLENGES: The North East and North Cumbria (NENC) had historically higher maternal smoking rates with Smoking at time of delivery (SATOD) rate of 19.8% in 2010 compared with 14% in England. Smoking is the single most modifiable risk factor associated with adverse pregnancy outcomes. Women who smoked during pregnancy are 2.6 times more likely to experience premature births , as well as lower birth weight and increased stillbirth rates. In NENC approximately 15% of admissions to Neonatal Units (NNU) were reported to be mother’s tobacco dependent at time of pregnancy booking, around 1076 babies with an estimated cost of $29,000 per baby.
INTERVENTION OR RESPONSE: A comprehensive programme of work to improve the public health focus in maternity service delivery is now in place across NENC, complementing the national healthcare commitments. This has been as a result of more than a decade of work to increase the focus on maternal smoking as part of a whole systems approach to tobacco control to ensure that this is addressed as a clinical priority.
A robust tobacco use in pregnancy pathway has been embedded across all 8 maternity services, alongside changing the narrative from smoking as a lifestyle choice to treating tobacco dependency as part of routine clinical maternity care. A comprehensive training programme has been rolled out and other key drivers include the introduction of financial incentives in 2022 to complement the maternity tobacco dependency treatment pathway.
RESULTS AND IMPACT: Through this whole systems approach, SATOD rates have declined from 12.3% in 2022 to 8.1% at present, accounting for an overall 4.2 % drop.
CONCLUSIONS: A collaborative approach to maternal smoking is having impact, and the key recommendations from the programme will be outlined with notable drivers for success. The ongoing challenges to ensure that this is embedded clinically will be highlighted and lessons for other programmes shared.