Should Pregnant Women Be Tested for Smoking?
While British officials recommend breath tests for expectant moms, some in the US wonder whether mandatory testing helps or hurts
Should all pregnant women undergo tests to determine whether they smoke?
It could happen in the UK, where the National Institute for Health and Care Excellence, a government body, has recommended that midwives administer breath tests measuring carbon monoxide exposure to expectant moms. Those found to have high carbon monoxide levels would be referred to smoking cessation programs.
A British organization of midwives, which initially opposed the testing proposal, now supports it.
“I visited a maternity unit this week, and heard from fellow midwives just how helpful these tests can be in showing women the potential damage that smoking can have on their baby,” Cathy Warwick, the chief executive of the Royal College of Midwives, told The Guardian.
Warwick added that women should be allowed to opt out of the test. The guidelines regarding the test will be published this summer, The Telegraph reported.
Smoking during pregnancy is associated with a host of risks, including low birth weight and preterm delivery. In the US, nearly 13 percent of pregnant women smoke during their last trimester, according to the Centers for Disease Control and Prevention.
But don’t expect breath tests for pregnant women to catch on in the US, where some worry that pressure to take such a test could discourage pregnant smokers from seeing physicians in the first place. The American College of Obstetricians and Gynecologists (ACOG), meanwhile, warns that the tests can be “expensive and cumbersome.”
“The College has developed a number of resources to help ob-gyns screen for and support cessation efforts based on the belief that the best way to work with women who smoke during pregnancy is to counsel them,” the organization said in a statement.
ACOG recommends that clinicians use a question with multiple choice answers to determine whether their patients are smoking and are in need of help. The answers include responses such as “I smoke some now, but I have cut down on the number of cigarettes I smoke SINCE I found out I was pregnant.” and “I smoke regularly now, about the same as BEFORE I found out I was pregnant.” The question can be asked face-to-face—with the doctor providing the answer options—or included as part of a written survey.
Research has found that identifying smokers in this way is more effective—and provides more useful information—than simply asking “Are you smoking?”
Pennsylvania mom Mary Ellen, who asked not to have her last name used, believes that testing pregnant women for smoking is intrusive and thinks that just asking is a better alternative. Mary Ellen smoked through all three of her pregnancies. She said she was aware of the risk factors but wasn’t able to quit. She cut down on her cigarette use instead, going from a pack a day to about six cigarettes, and said that her children were born healthy.
“Smoking is not a crime,” she said. “If it’s that much of a concern, maybe they should make it illegal.”
Heidi Zauner, a mom of two in Canby, Oregon, agrees that simply talking to pregnant smokers, instead of testing them, is the way to go.
Zauner, 46, quit smoking days after she learned she was pregnant with her first child, but expressed sympathy for those who have a harder time kicking the habit.
“Encouragement, counseling, and knowledge could help (pregnant smokers) in so many ways. If a mom doesn’t have very good support in her life, this could be the ticket for her to quit and have someone with her every step of the way,” she said. “But they could do that without testing, just talking.”
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