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Improving the effectiveness and reach of NHS support for smoking cessation in pregnancy

Maternal smoking in pregnancy is the biggest avoidable cause of fetal harm in the UK with 255,000 pregnancies exposed annually in England. Infants and children of smokers suffer higher morbidity and mortality and are more likely to become smokers themselves. Pregnancy motivates many women to try stopping smoking but very few use the effective NHS SSSP (stop smoking services for pregnant women); most try to stop without help. ‘Self-help’ cessation methods are effective in pregnancy but are not systematically delivered by SSSP.

This programme aims to increase the uptake and effectiveness of NHS Stop Smoking Services for pregnant women by determining when and how NHS cessation support is best offered in pregnancy, refining and testing ‘self-help’ cessation methods which are attractive to and, therefore, likely to be used by the vast majority of mothers who do not currently access SSSP and investigating how ‘self-help’ support is best delivered by the NHS.

The project will survey all English SSSPs, determining use of self-help, referral pathways or methods of engaging with smokers, and principal models and costs of service provision; combining these with routinely available data on SSSP effectiveness to determine service design factors which most influence (cost) effectiveness. A cohort of pregnant women will be surveyed to identify i) times in pregnancy when they are most receptive to and ii) predictors of propensity to engage with SSSP support (inc. self-help).

The link between effectiveness and cost-effectiveness of two different strategies for identifying, referring and engaging pregnant smokers for SSSP support will be evaluated using linked mother / infant primary care medical records cohort to monitor national trends in nicotine replacement therapy (NRT) use in pregnancy, compare women prescribed / not prescribed NRT and investigate impacts on infrequent fetal outcomes of NRT use in pregnancy.

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