Smoking during pregnancy: a difficult problem to face

Introduction: Smoking tobacco during pregnancy is a preventable risk factor of adverse pregnancy outcomes. The aim of the study was to assess the impact of the information and training programme performed by the perinatal network of Auvergne, France, on smoking during pregnancy.Methods: A multicentre before-and-after population-based study, based on two cross-sectional surveys, was carried out between July 2003 and June 2004, and December 2008 and January 2010. Pregnant women aged over 18 years old, fluently writing and speaking French were eligible. The main outcome was the prevalence of pregnant women daily smoking. The preventive programme consisted of information of women and healthcare providers and training for healthcare providers. Multivariate analysis was performed by using manual logistic regression and calculated crude and adjusted Odds Ratio.Findings: Before and after surveys involved 1027 and 720 women, respectively. A higher percentage of women smoked daily in the after survey at diagnosis 43.49% vs. 51.94%, adjusted Odds Ratio 1.45 [1.10; 1.90] and during the third term 40.53% vs. 51.94%, adjusted Odds Ratio 1.62 [1.24; 2.12]. Environmental tobacco smoke exposure among the non-smokers was higher in the after survey 52.83% vs. 69.57% adjusted Odds Ratio 1.95 [1.54; 2.47].Conclusion: The programme was not associated with the decrease of tobacco consumption during pregnancy. There was an increased exposure to environmental tobacco smoke. French public health authorities should introduce a new policy aimed specifically at tackling tobacco use during pregnancy and exposure to second hand smoke that takes into account the entire environment of pregnant women