Fewer premature births after smoking ban in Scotland

Posted by Patricia Wakeford on

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BBCHealth reported on research by PLoS (a peer reviewed open access journal published by the Public Library of Science)  which suggests that the smoking ban in 2006 has resulted in less pregnant women smoking. Tobacco smoke has been linked to poor foetal growth and placenta problems.

The background for this retrospective cohort study was that "the risks of smoking during pregnancy, both on mother and foetus, are well established: women who smoke during pregnancy are more likely to have a miscarriage. Smoking can cause placental problems, such as placental abruption, which can result in heavy bleeding during pregnancy, which is dangerous for both mother and baby. Other dangers of smoking during pregnancy include the baby being born too early (premature birth), the baby being below average weight (small for gestational age), birth defects, and infant death".

The researchers collected information on preterm delivery and small for gestational age in all single babies born live at 44 weeks gestation between 1 January 1996 and 31 December 2009 by using the Scottish Morbidity Record (SMR2), which collects relevant information on all women discharged from Scottish maternity hospitals, including maternal and infant characteristics and pregnancy complications. 716,968  pregnancies were eligible to be included in the study.

23.9% of women were noted to smoke pre-ban and this fell to 18.8% post 1 January 2006. A drop was noted in overall pre-term births and there was also a drop in babies born small or very small after this date. However, it was noted that premature births were increasing prior to 2006 but that there was a sudden decline prior to the start of the smoking ban, although this appeared to have been partially reversed around two years later. The study provides full details of the methods used, exclusions and results.

The reduction in premature births was both in non-smokers and women who continued to smoke when pregnant, which they say suggests passive smoke exposure is likely involved. But while their work suggests a link, it is not proof that one thing necessarily causes another. As with all retrospective studies like this, it is impossible to rule out entirely all other factors that might have influenced the finding.

However, Dr Daniel Mackay and colleagues from the University of Glasgow say their findings "add to the growing evidence of the wide-ranging health benefits of smoke-free legislation" and "lend support" to the adoption of such legislation in countries where it does not currently exist.

As an ex-midwife I can only welcome the results of this study and hope that it encourages pregnant women and there relatives to give up smoking. If there is any possibility that smoking could cause problems to an unborn child, surely that is a good enough reason to stop.

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About the Author

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Patricia is a Senior Associate, in our Clinical Negligence team, and is also a qualified midwife with many years of experience working in the NHS.

Patricia Wakeford
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