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19.05.05 19.05.05 13th Intern Conf HPH/Dublin 13th Intern Conf HPH/Dublin 19.05.05 19.05.05 Implementation of smoke-free Implementation of smoke-free maternity ward environments maternity ward environments PROMOTING SMOKING ABSTINENCE IN MATERNITY PROMOTING SMOKING ABSTINENCE IN MATERNITY Proposal of a method for the inplementation of a Proposal of a method for the inplementation of a Maternity Network Maternity Network Michel Delcroix, Conchita Gomez, Pierre Marquis Michel Delcroix, Conchita Gomez, Pierre Marquis

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Implementation of smoke-free maternity ward environments PROMOTING SMOKING ABSTINENCE IN MATERNITY Proposal of a method for the inplementation of a Maternity Network Michel Delcroix, Conchita Gomez, Pierre Marquis. - PowerPoint PPT Presentation

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Page 1: DECISION MAKERS

19.05.0519.05.05 13th Intern Conf HPH/Dublin 19.05.0513th Intern Conf HPH/Dublin 19.05.05

Implementation of smoke-free Implementation of smoke-free maternity ward environmentsmaternity ward environments PROMOTING SMOKING ABSTINENCE IN MATERNITYPROMOTING SMOKING ABSTINENCE IN MATERNITY

Proposal of a method for the inplementation of a Proposal of a method for the inplementation of a

Maternity NetworkMaternity Network Michel Delcroix, Conchita Gomez, Pierre MarquisMichel Delcroix, Conchita Gomez, Pierre Marquis

Page 2: DECISION MAKERS

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In October 2004, a Consensus In October 2004, a Consensus Conference on Pregnancy and Tobacco Conference on Pregnancy and Tobacco was held in France and one was held in France and one recommendation was to use a recommendation was to use a measurement of pregnant women measurement of pregnant women smokers CO to help them give up smokers CO to help them give up smoking. smoking.

Page 3: DECISION MAKERS

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DECISION MAKERSDECISION MAKERS Pregnant women (smokers and nosmokers) and their Pregnant women (smokers and nosmokers) and their

spousesspouses Senior ManagerSenior Manager Service headsService heads GPGP PhysiciansPhysicians MidwivesMidwives NursesNurses Children nursesChildren nurses Local communities and services Local communities and services Postnatal care servicesPostnatal care services

Page 4: DECISION MAKERS

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Maternal smoking during pregnancy increases Maternal smoking during pregnancy increases the risk of occurrence of :the risk of occurrence of :

Pregnancy accidents such as abruptio placentae and Pregnancy accidents such as abruptio placentae and placenta praeviaplacenta praevia

Intra-uterin growth retardationIntra-uterin growth retardation PrematurityPrematurity Sudden infant deathSudden infant death A higher overall consumption of healthcare during A higher overall consumption of healthcare during

early chilhood early chilhood

Tobacco smoking during pregnancy is the single Tobacco smoking during pregnancy is the single largest modifiable risk for pregnancy-related largest modifiable risk for pregnancy-related morbidity and mortality. morbidity and mortality.

Page 5: DECISION MAKERS

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Aims Aims To determine the characteristics of the population of To determine the characteristics of the population of

pregnant women smokers through epidemiologic pregnant women smokers through epidemiologic researchresearch

To evaluate the efficiency of a large program to prevent To evaluate the efficiency of a large program to prevent passive smoking of the fœtuspassive smoking of the fœtus

To evaluate the efficiency of a large program to prevent To evaluate the efficiency of a large program to prevent actif smoking of the women smokers.actif smoking of the women smokers.

To increase the quite of smoking by the increase To increase the quite of smoking by the increase motivation of of pregnant women smokers,motivation of of pregnant women smokers,

To reduce about 25 to 30 %, the number of pregnant To reduce about 25 to 30 %, the number of pregnant women smokers,women smokers,

To develop in this domain a policy for training health’s To develop in this domain a policy for training health’s professionals who follow the pregnant women and their professionals who follow the pregnant women and their familial environment.familial environment.

To develop the breasthfeedingTo develop the breasthfeeding To protect relation between the parents and the babyTo protect relation between the parents and the baby

Page 6: DECISION MAKERS

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856856 smoking and nonsmoking pregnant women smoking and nonsmoking pregnant women were followed during their pregnancy.were followed during their pregnancy.

Their EACO was determined in the first Their EACO was determined in the first trimester and during delivery. trimester and during delivery.

The spouses’ EACO were also measured at The spouses’ EACO were also measured at delivery. The main outcome measures was the delivery. The main outcome measures was the infants’ birth weight.infants’ birth weight.

Secondary measures included head Secondary measures included head circumference, Apgar score and heart rate at circumference, Apgar score and heart rate at delivery. delivery.

Cord blood fetal carboxyhemoglobin (FCOHb) Cord blood fetal carboxyhemoglobin (FCOHb) served as internal control. served as internal control.

Implementation strategy :Implementation strategy :Application to Maternity of ARRAS Application to Maternity of ARRAS

Region Nord-Pas-de-Calais, France.Region Nord-Pas-de-Calais, France.

Page 7: DECISION MAKERS

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MethodMethod Settle a consultation to identify a population of pregnant Settle a consultation to identify a population of pregnant

smokers and their spouses.smokers and their spouses.

Inform the women about the damages caused by tobacco Inform the women about the damages caused by tobacco not only on their health but underline the damage caused not only on their health but underline the damage caused to the fetusto the fetus

Health staff must get in charge of both the tabacco Health staff must get in charge of both the tabacco dependence issue and the prenatal care instead of direct dependence issue and the prenatal care instead of direct the pregnant mother to another service which cater for the pregnant mother to another service which cater for tabacco problemstabacco problems

To mention in hospital objectives that Smoke-free To mention in hospital objectives that Smoke-free maternity is a major targetmaternity is a major target

Allocate a specific ressources for the cessation service : Allocate a specific ressources for the cessation service : maternity, preventive medecine…maternity, preventive medecine…

Page 8: DECISION MAKERS

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Tools Tools

CO analyser methodology : easy to use, inexpensive and CO analyser methodology : easy to use, inexpensive and quickquick

the evaluation of the pregnant women : questionnairesthe evaluation of the pregnant women : questionnaires the specific training of health professionals (midwives, the specific training of health professionals (midwives,

nurses, specialists,…) nurses, specialists,…) Staff smoking habits and prevalence is monitored on a Staff smoking habits and prevalence is monitored on a

regular basisregular basis The evaluation of health professionalsThe evaluation of health professionals Nicotine Replacement Treatment Nicotine Replacement Treatment the implementation of the specfic meeting and the implementation of the specfic meeting and

consultations aimed at helping to give up smokingconsultations aimed at helping to give up smoking

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CO toxicity CO toxicity COCO

Hb Hb

O² CO

1 250Affinity Affinity

The affinity between heamoglobine and CO is 250 (two hundred fifty) more

important than between heamoglobine and oxygen.

Page 10: DECISION MAKERS

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CO analyser CO analyser

Easy to useEasy to use InexpensiveInexpensive Quick resultsQuick results AvailableAvailable

Page 11: DECISION MAKERS

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CO MeasurmentCO Measurment

Carbon monoxide (CO) is the most Carbon monoxide (CO) is the most biologically significant toxic for the foetus.biologically significant toxic for the foetus.

No particular preparation is required for the No particular preparation is required for the pregnant women smoker and/or spousepregnant women smoker and/or spouse

The patient is asked to do simple acts as :The patient is asked to do simple acts as : Breath in deeply Breath in deeply Keep the inspire air during 10 seconds Keep the inspire air during 10 seconds Exhale in the analyser CO.Exhale in the analyser CO.

Page 12: DECISION MAKERS

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> 31 ppm> 31 ppmVery Heavy Very Heavy

intoxication=intoxication=Very Heavy smokerVery Heavy smoker

11 to 30 ppm11 to 30 ppmHeavy Intoxication= Heavy Intoxication=

Heavy smokerHeavy smoker

6 to 10 ppm6 to 10 ppmLight intoxication : Light intoxication :

=light smoker =light smoker or passif smokingor passif smoking

0 to 5 ppm*0 to 5 ppm*No intoxication =No intoxication =

no-smokerno-smoker

Number of particules of carbon monoxide per million of particule air

INTERPRETATION : RESULTS

Page 13: DECISION MAKERS

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European Smoke-free Hospital codeEuropean Smoke-free Hospital code 1.1. Engage decision-makers. Inform all personnel and patients. Engage decision-makers. Inform all personnel and patients. 2.2. Appoint a working group. Develop a strategy and an implementation plan. Appoint a working group. Develop a strategy and an implementation plan. 3.3. Set up a training plan to instruct all staff on how best to approach smokers. Set up a training plan to instruct all staff on how best to approach smokers. 4.4. Organise cessation support facilities for patients and staff in the hospital and ensure Organise cessation support facilities for patients and staff in the hospital and ensure

continuity of support on discharge into the community. continuity of support on discharge into the community. 5.5. Indicate smoking zones clearly, for as long as they are considered necessary, and keep them Indicate smoking zones clearly, for as long as they are considered necessary, and keep them

away from clinical and reception areas. away from clinical and reception areas. 6.6. Adopt appropriate signage, including posters, signposts, etc and remove all incentives to Adopt appropriate signage, including posters, signposts, etc and remove all incentives to

smoke (such as ashtrays, tobacco sales, etc.). smoke (such as ashtrays, tobacco sales, etc.). 7.7. Support systems are in place to protect and promote the health of all that work in the Support systems are in place to protect and promote the health of all that work in the

hospital. hospital. 8.8. Promote smoke-free actions in the community setting. Promote smoke-free actions in the community setting. 9.9. Renew and broaden information to maintain commitment to the policy. Ensure follow-up and Renew and broaden information to maintain commitment to the policy. Ensure follow-up and

quality assurance. quality assurance. 10.10. First convince,then constrain considering legislation if needed. First convince,then constrain considering legislation if needed. Have patience! Have patience!

Page 14: DECISION MAKERS

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Results IResults I 856856 smoking and nonsmoking pregnant smoking and nonsmoking pregnant

women were followed during their women were followed during their pregnancy.pregnancy.

Birth weight dose-dependently and Birth weight dose-dependently and significantly decreased with significantly decreased with increasing level of maternalincreasing level of maternal

0-5 ppm : 3406 0-5 ppm : 3406 32; 32; 6-10 ppm : 3048 6-10 ppm : 3048 57; 57; 11-20 ppm : 2858 11-20 ppm : 2858 54; 54; >20 ppm: 2739 >20 ppm: 2739 34 g (p<0.0001) 34 g (p<0.0001)

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RESULTS IIRESULTS II Even the birth weight of newborns whose Even the birth weight of newborns whose

mother had EACO between 6 and 10 ppm was mother had EACO between 6 and 10 ppm was significantly lower than the birth weight of significantly lower than the birth weight of newborns whose mother had an EACO newborns whose mother had an EACO between 0 and 5 ppm.between 0 and 5 ppm.

Spouses’ EACO of delivering women with Spouses’ EACO of delivering women with EACO of 0-5 ppm showed similar effect. Head EACO of 0-5 ppm showed similar effect. Head circumference, Apgar score and normal term circumference, Apgar score and normal term gestational age decreased also significantly gestational age decreased also significantly with increasing maternal or spouses’ EACO. with increasing maternal or spouses’ EACO.

Page 16: DECISION MAKERS

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Newborn's characteristics according to the the mothers' expired air carbon monoxide concentration measured

during delivery

0

1

2

3

4

5

6

0 to 5 ppm 6 to 10 ppm 11 to 20ppm

> to 20 ppm

Birth Weight (g)

HbCO fetal %

The exhaled CO concentration :• is directly correlated to the HbCO

• and inversely related to the birth weight Dr Pierre Marquis, Conchita Gomez - Hospital Arras – 2003

Page 17: DECISION MAKERS

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Assements : Cessation RatioAssements : Cessation Ratio

0

5

10

15

20

25

30

35

40

45

January March May July September November

No-Smokers

Smokers

Ex-smokers

Page 18: DECISION MAKERS

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ConclusionConclusion

A A tobacco free environment is essential tobacco free environment is essential

The methodology of CO measurement is efficiency The methodology of CO measurement is efficiency for increase the quite of smoking by the increase for increase the quite of smoking by the increase motivation of pregnant women smokers.motivation of pregnant women smokers.

Pregnant women have particular capacity to quit Pregnant women have particular capacity to quit smoking cigarettesmoking cigarette

the professionals trained are able to encourage and help the professionals trained are able to encourage and help mothers to pay more attention to mothers to pay more attention to theirtheir pregnancy pregnancy

Another secondary effect expected is that professionals Another secondary effect expected is that professionals also give up smoking throught the methodology CO also give up smoking throught the methodology CO measurement.measurement.