INCORPORATION OF A POINT-OF-CARE COTININE TEST INTO ROUTINE COMMUNITY ANTENATAL CARE TO REDUCE SMOKING IN PREGNANCY – A PILOT STUDY

J. Giles1, D. Taylor2, G. F. Cope3.


1Smoke Free Pregnancy Project Coordinator, Buckinghamshire PCT, United Kingdom
2Health Improvement Specialist, Buckinghamshire PCT, United Kingdom
3University of Birmingham, United Kingdom


Background: Integrating novel methods into routine antenatal community care is important to reduce smoking in pregnancy. A rapid urine cotinine test called SmokeScreen®, which correctly identifies smokers and provides feedback to the smoker, has been shown to improve smoking cessation advice in hospital-based antenatal care.
Aim: For community midwives to carry out the rapid test at the first antenatal visit and to assess the response of both the midwives and pregnant women to the test and whether it influenced smoking during the pregnancy.
Method: Trained midwives (n=8) from two community midwifery bases were issued with 200 semi-quantitative test kits for use on consecutive pregnant women in their homes. A questionnaire detailing attitudes to smoking in pregnancy and whether the test helped or hindered the dialogue were completed by the midwives, and questions were answered by the women about the test, whether it influenced their subsequent smoking.
Results: Significant differences were observed between the two community bases: over 60% of midwives from the first group found the test easy to use and 75% thought the test motivated pregnant smokers to stop; whereas all of the other group reported the tests were not easy to carry out, mainly due to time constraints; although 67% still felt it enriched their intervention. Over half of the midwifes thought the test should be introduced as a routine screen and in the event of a positive result, repeated at the next appointment (50% and 67% respectively). An interesting finding combining the two groups was that midwifes detected significant exposure to nicotine, indicating active smoking in 47% of their mothers, significantly higher than the 17% reported as the national prevalence of smoking in pregnancy.
Discussion: Motivated midwives found the point-of-care cotinine test helped in identify pregnant smokers and increased awareness and motivation among some pregnant smokers to change their smoking habit.