Smoking and Pregnancy

It is widely accepted that smoking during pregnancy is harmful to both mother and baby.  As mentioned in the Birthweight and Gestation section, maternal smoking is associated with preterm and/or low birthweight babies. See Small Babies in Scotland for information on outcomes for these groups of babies.

Smoking in pregnancy is also associated with increased risk of miscarriage, stillbirth and Sudden Infant Death Syndrome (SIDS). The Scottish Stillbirth Perinatal and Infant Mortality and Morbidity Report  provides information on the incidence of stillbirth and SIDS.

Smoking behaviour in pregnancy is collected at a woman's first antenatal booking  appointment which usually takes place within the first three months of pregnancy. These booking appointments take place either at hospital or in the community and are  recorded on the Scottish Morbidity Record (SMR02).  Information on maternal smoking is also recorded at the pulic health nurse/health visitor's First Visit to the mother and baby which usually takes place about 10 days after the birth. Data from the First Visit is recorded on the Pre-school component of the Child Health Systems Programme (CHSP-PS). CHSP-PS is used in 12 NHS Board areas, and covers approximately 89 percent of Scotland's pre-school population.

In recent years, there have been concerns about the completeness and quality of the SMR02 data, and to a lesser extent, the CHSP-PS data.  In the following charts, we present the data in a different way from previous years so that the reader can see the level of recording of all responses including 'unknown', and they can also compare the two systems.  It should be noted that the CHSP-PS data does not record whether the woman was a 'former' smoker.  The label of 'missing' in the CHSP-PS data is assumed to be equivalent to the label of 'Not Known' in the SMR02 data.

There is considerable pressure on women not to smoke during pregnancy, and it is anticipated that some women may not be completely truthful when describing their smoking behaviour at the booking clinic.  The public health nurses/health visitors perform their First Visit at home, however, so it is less easy for the mother to hide evidence of smoking.

Overall smoking rates

Figure 1a Smoking at Booking derived from SMR02

Figure 1b Smoking at the First Visit derived from CHSP-PS

The SMR02 data demonstrates a fall in the level of women who are smokers at booking from 29.0% in 1995 to 19.2 % in 2008.  However, the level of 'Not Known' has increased from 5.0% in 1995 to 14.1% in 2008 and may include a proportion of smokers.  Nevertheless, the SMR02 data are supported by the CHSP-PS data and suggest a reduction in the level of smoking in recent years.

Smoking by deprivation category

For the following charts, the woman's deprivation has been derived using the Scottish Index of Multiple Deprivation 2006 (SIMD).  SIMD1 is the least deprived quintile and SIMD5 is the most deprived.

Figure 2a Smoking at Booking by SIMD quintile derived from SMR02

Figure 2b Smoking at the First Visit by SIMD quintile derived from CHSP-PS

These charts demonstrate clearly the strong relationship between smoking and deprivation, with smoking at booking in 2008 ranging from 6.7% in SIMD1 to 30.0% in SIMD5.   The charts show that there is an improvement in all deprivation categories between 2000 and 2008.

Smoking at booking by NHS Board

The following charts show the variation in smoking across NHS Boards.  Figure 3a shows the level of smoking at booking within each NHS Board for 2008, and Figure 3b shows the level of smoking at the First Visit for those Boards which use the CHSP-PS system.  Please note the wide variation in the 'Not Known' category, especially in 'Smoking at Booking' data.

Figure 3a Smoking at Booking by NHS Board derived from SMR02.

Figure 3b Smoking at the First Visit by NHS Board derived from CHSP-PS

Smoking at booking by Mothers Age

Figure 4a Smoking at Booking by Mothers Age derived from SMR02

Figure 4b Smoking at the First Visit by Mothers Age derived from SMR02

This chart shows that a mother's age is indirectly correlated to her smoking behaviour.  With increasing age there is a decrease in smoking behaviour. It also clearly illustrates that smoking behaviour in all age groups has declined between 2000 and 2008.

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