Would mandatory testing stop pregnant women smoking?

Photo: Shutterstock
Photo: Shutterstock 

As of July this year, pregnant women in the UK will be asked to take a carbon monoxide test in hospital to determine whether they or their partner smoke. This new screening aims to encourage mothers-to-be to give up smoking for the health of themselves and their baby.

It's common knowledge that smoking is bad for our health. It's the cause of many cancers and disease and lowers our life expectancy. In pregnancy, smoking is associated with lower birth weight and increased incidence of stillbirth.

While the intention behind the screening is good, it presents a number of problems.

Presently, pregnant women are asked if they smoke and taken on their word. Yet, the screening suggests that their word isn't worth much. It suggests that women can't be trusted to be honest or make the best decisions for themselves and their baby.

For smokers in particular, screening is likely to bring a feeling of judgement. These women may be struggling to give up and don't need this additional intimidation and stress. They need an environment that offers support on a more personal level. 

Midwife, Karen Faulkner, agrees.

"This is a very intrusive approach to screening and not one I've seen used before," she says. "Screening should be voluntary and not coercive and not a disempowering experience with blaming and shaming

"My concern with this approach is that it will cause mums-to-be to default antenatal visits and this could drive the stillbirth rates up even further."

Faulkner says that screening could help raise awareness of smoking risks in pregnancy, whether it be passive or active, and its impact on fetal growth and pregnancy and birth outcomes, especially stillbirth risk. However, she thinks there are better approaches.

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"Health promotion advertisements on free to air and cable TV could be just as effective in raising general awareness about smoking risks in pregnancy," she says.

"I think this would have a more positive impact than the big brother approach being considered. This way the whole family, including partners and grandparents can play a supportive role in helping the mum-to-be quit."

Dr Mai Frandsen is a research fellow with the Cancer Council of Tasmania and the University of Tasmania. She's been involved in projects to help pregnant women quit smoking and believes that screening could be a positive thing.

"Smoking during pregnancy remains the number one preventable cause of poor pregnancy outcomes," she says.

"It makes sense to include carbon monoxide testing in pregnancy, along with other checks such as blood glucose and blood pressure."

Dr Frandsen notes that women who've participated in screening trials like this were largely supportive of it, especially when they learnt that carbon monoxide poisoning (an odourless, colourless gas) can occur from faulty household appliances, and that passive smoking can have similar effects to mum and baby's health as smoking directly.

Carbon monoxide testing is done using a simple hand-held device which a woman breathes into. It immediately reads the level of carbon monoxide in the woman's system, as well as the level of exposure to the baby.

"It's an extremely motivating tool for women who want to quit but need that extra boost," says Dr Frandsen.

"It's also an especially powerful tool for pregnant women who live or socialise with smokers to be able to explain why they don't want to be around them when they smoke."

Only time will tell if this screening will be adopted in Australia. In the meantime, perhaps we should trust that women are honest.

And, for those women struggling to quit, let's offer them gentle support and help. Pregnancy's hard enough without additional judgement and stress too