Smoking pregnant women: we must act!

On the eve of the national anti-tobacco day, it seemed logical to a group of experts in obstetrics and gynecology to recall the importance of acting to stop smoking for pregnant women, the statement already made in the 7th national meetings of Angers "Women and tobacco."

In our country over the last thirty years, the percentage of female smokers age to have children has tripled. Thus, about 36% of women smoke before pregnancy and 20 to 28% during pregnancy.

This situation is even more alarming that parental smoking severely penalizes perinatal care: increase the risk of early miscarriage, ectopic pregnancy, preterm and very preterm birth, delayed birth weight, fetal death during the third quarter, and also sudden infant death syndrome or sometimes very severe breathing problems during infancy.

In terms of perinatal care, France has indeed a situation in contrast to his overall health situation. The perinatal mortality rate (stillbirths and deaths until the seventh day), which is close to 7 per 1,000 in France is the ninth largest country of development. The perinatal plan includes a 15% reduction in perinatal mortality (for back to 5.5 miles) and 30% of sudden infant death syndrome.

However, the annual report of the Court of Auditors in terms of perinatal policy, denounces the inconsistency of government decisions: Jury Recommendations Consensus Conference "pregnancy and tobacco" organized by Anaes (National Agency for Accreditation and Health Evaluation, became the High Health Authority or HAS) in Lille not taken into account, the damage caused by alcohol and tobacco twice excluded perinatal latest plans.

Some public and private maternity hospitals still have a smoker and many of them have not yet expressed their intention to sign the Charter Maternity No Tobacco proposed by the Tobacco Free Hospital Network.

"We are in an adversarial situation to correct this situation must spend pious action" hammer experts.

According to them, the Regional Hospitalization Agencies (ARH) is responsible for the implementation of government commitments, they must be applied in gynecology obstetrics, by doctors and managers, strict compliance with the law and recommendations the High Authority of Health. "It is fiscally penalize institutions that do not fulfill their mission and enhance staffing establishments where doctors and managers apply their establishment the Evin Law and the recommendations of the consensus (repository to become a SMI Tobacco)," add- they.

Similarly, we must educate all professionals perinatal links between smoking and indicators of quality of perinatal care. All players who meet health of pregnant women must be involved: obstetricians, midwives, pediatricians, psychologists but anesthetists, GPs, dentists, pharmacists, nurses and all other health care professionals.

They must be trained in the systematic information of all women during pregnancy and return to the measurement of exhaled CO in consultation, hospitalization and birth, as they do for blood pressure. They must also be trained in prescribing effective treatments (cognitive-behavioral therapy and nicotine replacement therapy).

Are in hand, say the experts, health insurance provides free or at least reimbursement of smoking cessation during pregnancy.

"We need governments and their institutions (National Cancer Institute, National Institute for Prevention and Health Education) of the hope and resources to professionals involved (creation of a national pregnancy and tobacco observatory funding studies on smoking cessation during pregnancy.) They should also ensure that these resources are not diverted from their purpose as was often the case previously, "they conclude.