Trends in prescribing of nicotine replacement therapy to pregnant women in primary care in England

Introduction: Smoking during pregnancy remains common and the English National Health Service (NHS) has recently been directed to prioritise providing cessation support for pregnant women. We investigated the impact on prescribing of stop smoking treatments to pregnant women of the 2013 transfer of public health budgets from the NHS to administrative authorities responsible for local social care and other non-health services (local authorities).Methods: We used data from the Clinical Practice Research Datalink and Hospital Episode Statistics to determine annual proportions (2005-2017) of women who smoked during pregnancy and who were prescribed, at least once before childbirth, a) any NRT and b) long- and short-acting NRT together (dual NRT). Segmented regression was used to quantify the impact of the 2013 transfer of smoking cessation budgets to local authorities, assessing changes in the level and the trend of the proportions post-2013 compared to pre-2013.Results: We identified 84,539 pregnancies in which women were recorded as smoking; any NRT was prescribed in 7.9% (n=6,704) and dual NRT in 1.7% (n=1,466). Prescribing of any NRT was declining prior to 2013 at an absolute decrease of -0.25% per year, but the rate of decline significantly increased from 2013 onwards to -1.37% per year. Prescribing of dual NRT was increasing prior to 2013 but also decreased post-2013.Conclusions: These findings suggest that transferring responsibility for English Smoking Cessation Services from the NHS to local authorities adversely affected provision of cessation support in pregnancy. Consequently, some women may have been denied access to effective cessation treatments