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DECISION MAKERS

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.

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DECISION MAKERS

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  1. Implementation of smoke-free maternity ward environmentsPROMOTING SMOKING ABSTINENCE IN MATERNITYProposal of a method for the inplementation of a Maternity NetworkMichel Delcroix, Conchita Gomez, Pierre Marquis 13th Intern Conf HPH/Dublin 19.05.05

  2. 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. 13th Intern Conf HPH/Dublin 19.05.05

  3. DECISION MAKERS • Pregnant women (smokers and nosmokers) and their spouses • Senior Manager • Service heads • GP • Physicians • Midwives • Nurses • Children nurses • Local communities and services • Postnatal care services 13th Intern Conf HPH/Dublin 19.05.05

  4. Maternal smoking during pregnancy increases the risk of occurrence of : • Pregnancy accidents such as abruptio placentae and placenta praevia • Intra-uterin growth retardation • Prematurity • Sudden infant death • A higher overall consumption of healthcare during early chilhood • Tobacco smoking during pregnancy is the single largest modifiable risk for pregnancy-related morbidity and mortality. 13th Intern Conf HPH/Dublin 19.05.05

  5. Aims • To determine the characteristics of the population of pregnant women smokers through epidemiologic research • To evaluate the efficiency of a large program to prevent passive smoking of the fœtus • To 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 health’s professionals who follow the pregnant women and their familial environment. • To develop the breasthfeeding • To protect relation between the parents and the baby 13th Intern Conf HPH/Dublin 19.05.05

  6. Implementation strategy :Application to Maternity of ARRAS Region Nord-Pas-de-Calais, France. • 856smoking 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. 13th Intern Conf HPH/Dublin 19.05.05

  7. Method • Settle 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 fetus • Health 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 problems • To mention in hospital objectives that Smoke-free maternity is a major target • Allocate a specific ressources for the cessation service : maternity, preventive medecine… 13th Intern Conf HPH/Dublin 19.05.05

  8. Tools • CO analyser methodology : easy to use, inexpensive and quick • the evaluation of the pregnant women : questionnaires • the specific training of health professionals (midwives, nurses, specialists,…) • Staff smoking habits and prevalence is monitored on a regular basis • The evaluation of health professionals • Nicotine Replacement Treatment • the implementation of the specfic meeting and consultations aimed at helping to give up smoking 13th Intern Conf HPH/Dublin 19.05.05

  9. Hb Hb CO O² 1 250 Affinity Affinity CO CO toxicity The affinity between heamoglobine and CO is 250 (two hundred fifty) more important than between heamoglobine and oxygen. 13th Intern Conf HPH/Dublin 19.05.05

  10. CO analyser • Easy to use • Inexpensive • Quick results • Available 13th Intern Conf HPH/Dublin 19.05.05

  11. 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 spouse • The patient is asked to do simple acts as : • Breath in deeply • Keep the inspire air during 10 seconds • Exhale in the analyser CO. 13th Intern Conf HPH/Dublin 19.05.05

  12. INTERPRETATION : RESULTS 13th Intern Conf HPH/Dublin 19.05.05 Number of particules of carbon monoxide per million of particule air

  13. 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! 13th Intern Conf HPH/Dublin 19.05.05

  14. Results I • 856smoking 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<0.0001) 13th Intern Conf HPH/Dublin 19.05.05

  15. RESULTS II • Even 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. 13th Intern Conf HPH/Dublin 19.05.05

  16. 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 13th Intern Conf HPH/Dublin 19.05.05

  17. Assements : Cessation Ratio 13th Intern Conf HPH/Dublin 19.05.05

  18. Conclusion A 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 cigarette • the professionals trained are able to encourage and help mothers to pay more attention to their pregnancy • Another secondary effect expected is that professionals also give up smoking throught the methodology CO measurement. 13th Intern Conf HPH/Dublin 19.05.05

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