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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


  • Implementation of smoke-free maternity ward environments PROMOTING SMOKING ABSTINENCE IN MATERNITYProposal of a method for the inplementation of a Maternity Network Michel Delcroix, Conchita Gomez, Pierre Marquis

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

  • DECISION MAKERSPregnant women (smokers and nosmokers) and their spousesSenior ManagerService headsGPPhysiciansMidwivesNursesChildren nursesLocal communities and services Postnatal care services

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

    Pregnancy accidents such as abruptio placentae and placenta praeviaIntra-uterin growth retardationPrematuritySudden infant deathA higher overall consumption of healthcare during early chilhood

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

  • Aims To determine the characteristics of the population of pregnant women smokers through epidemiologic researchTo evaluate the efficiency of a large program to prevent passive smoking of the ftusTo evaluate the efficiency of a large program to prevent actif smoking of the women smokers.To increase the quite of smoking by the increase motivation of of pregnant women smokers,To reduce about 25 to 30 %, the number of pregnant women smokers,To develop in this domain a policy for training healths professionals who follow the pregnant women and their familial environment.To develop the breasthfeedingTo protect relation between the parents and the baby

  • Implementation strategy :Application to Maternity of ARRAS Region Nord-Pas-de-Calais, France. 856 smoking and nonsmoking pregnant women were followed during their pregnancy. Their EACO was determined in the first trimester and during delivery. The spouses EACO were also measured at delivery. The main outcome measures was the infants birth weight.Secondary measures included head circumference, Apgar score and heart rate at delivery. Cord blood fetal carboxyhemoglobin (FCOHb) served as internal control.

  • MethodSettle a consultation to identify a population of pregnant smokers and their spouses.

    Inform the women about the damages caused by tobacco not only on their health but underline the damage caused to the fetusHealth staff must get in charge of both the tabacco dependence issue and the prenatal care instead of direct the pregnant mother to another service which cater for tabacco problemsTo mention in hospital objectives that Smoke-free maternity is a major targetAllocate a specific ressources for the cessation service : maternity, preventive medecine

  • Tools CO analyser methodology : easy to use, inexpensive and quickthe evaluation of the pregnant women : questionnairesthe specific training of health professionals (midwives, nurses, specialists,) Staff smoking habits and prevalence is monitored on a regular basisThe evaluation of health professionalsNicotine Replacement Treatment the implementation of the specfic meeting and consultations aimed at helping to give up smoking

  • CO toxicity COThe affinity between heamoglobine and CO is 250 (two hundred fifty) more important than between heamoglobine and oxygen.

  • CO analyser

    Easy to useInexpensiveQuick resultsAvailable

  • CO Measurment

    Carbon monoxide (CO) is the most biologically significant toxic for the foetus.No particular preparation is required for the pregnant women smoker and/or spouseThe patient is asked to do simple acts as :Breath in deeply Keep the inspire air during 10 seconds Exhale in the analyser CO.

  • Number of particules of carbon monoxide per million of particule airINTERPRETATION : RESULTS

  • European Smoke-free Hospital code Engage decision-makers. Inform all personnel and patients. Appoint a working group. Develop a strategy and an implementation plan. Set up a training plan to instruct all staff on how best to approach smokers. Organise cessation support facilities for patients and staff in the hospital and ensure continuity of support on discharge into the community. Indicate smoking zones clearly, for as long as they are considered necessary, and keep them away from clinical and reception areas. Adopt appropriate signage, including posters, signposts, etc and remove all incentives to smoke (such as ashtrays, tobacco sales, etc.). Support systems are in place to protect and promote the health of all that work in the hospital. Promote smoke-free actions in the community setting. Renew and broaden information to maintain commitment to the policy. Ensure follow-up and quality assurance. First convince,then constrain considering legislation if needed. Have patience!

  • Results I856 smoking and nonsmoking pregnant women were followed during their pregnancy.

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

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

  • RESULTS IIEven the birth weight of newborns whose mother had EACO between 6 and 10 ppm was significantly lower than the birth weight of newborns whose mother had an EACO between 0 and 5 ppm.Spouses EACO of delivering women with EACO of 0-5 ppm showed similar effect. Head circumference, Apgar score and normal term gestational age decreased also significantly with increasing maternal or spouses EACO.

  • The exhaled CO concentration : is directly correlated to the HbCO and inversely related to the birth weightDr Pierre Marquis, Conchita Gomez - Hospital Arras 2003






    Birth Weight (g)

    HbCO fetal %

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

    ConfCons (5)


    Charges spcifiques l'actionInscriptions

    Achats100 formations continues 240 24,000

    Prestations de services/ Frais intervenants17,000 200 formations individuelles 120 24,000

    Matires et fournituresRseau Hpital Sans tabac24,000

    Frais logistiques

    Repas -rception20,000

    Ventes livres communications6,000

    Locations salles10,000 Crdit Etat120,000

    Assurances500 (Objet de la prsente demande)

    Repas-rception22,500 Rgion(s) :


    10 000 pr-programmes19,000 Dpartement(s) :

    10 000 programmes19,000 Conseils gnraux

    Papier lettre (1000 ex.)2,000

    600 actes du colloques9,000 Commune(s) :

    Agence de communication23,000

    Charges de personnelBnvolat

    Secrtariat : Salaires et charges54,000

    CNASEA (emplois aids)

    Frais d'affranchissement15,000

    Site Internet3,000 Autres recettes attendues (prcisez)

    Frais gnraux24,000

    Demande(s) de financement communataire

    3 - Ressources indirectes affectes

    Cot total du projet218,000 Total des recettes218,000

    Emplois des contributions volontaires en natureContributions volontaires en nature

    Prestations en naturePersonnels bnvoles80,000

    Mise disposition gratuite de biens prestations10,000 Prestations en nature

    Personnels bnvoles80,000 Dons en nature10,000

    TOTAL308,000 TOTAL308,000

    Au regard du cot total du projet, l'association sollicit une subvention de : 120 000

    *Mesure n10 du Plan Cancer du gouvernement "

    "Lutter contre le tabagisme des femmes enceintes (information dans les maternits, sensibilisation du personnel soignant, accs aux consultations de sevrage)"

    Reseau Maternit sans Tabac/ Confrence Consensus/21/07/03

    &C&"Frutiger 45 Light,Gras" 3.2 Budget prvisionnel Action&12&10Confrence de Consensus&9Femme Enfant Tabac Cannabis&15&10Plan Cancer Mesure n10*


    0 5 ppm6 10 ppm11 20 ppm

    Poids de naissance (Kg)3.5063.0482.85

    0 to 5 ppm6 to 10 ppm11 to 20 ppm> to 20 ppm

    Birth Weight (g)3.5063.0482.852.5

    HbCO fetal %1.462.383.45.66






    Birth Weight (g)

    HbCO fetal %

    Corrlation taux de monoxyde de carbone expir maternel et HbCO foetale



  • Assements : Cessation Ratio

  • ConclusionA tobacco free environment is essential The methodology of CO measurement is efficiency for increase the quite of smoking by the increase motivation of pregnant women smokers.Pregnant women have particular capacity to quit smoking cigarettethe professionals trained are able to encourage and help mothers to pay more attention to their pregnancyAnother secondary effect expected is that professionals also give up smoking throught the methodology CO measurement.

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