Grossesse et tabac : les leçons de trois études pour améliorer les pratiques professionnelles

In France, the prevalence of women of childbearing age who smoke every day, which was 37% in 2002 according to Inserm, remains unchanged in 2010 according to INPES, and remains at 22% at the time of giving birth. The government, through measure 10 of the Premier Plan Cancer (First Cancer Plan), has implemented a strategic long-term action plan designed to better prevent and treat smoking in pregnant women. Certain aspects of implementing the recommendations of the first Pregnancy and Smoking Consensus Conference in October 2004 have been evaluated by means of three studies, which are the focus of this article. The data from these three studies confirm: reduced birth weight in 30,900 newborn babies is dose-dependent on the concentration of the carbon monoxide (CO) level measured at birth, (as high as 592 grams between mothers with normal exhaled CO levels and those with exhalation levels of more than 20 ppm in the delivery room). A smoking cessation rate of 61.9% in the 2285 women who had at least one CO test during the pregnancy, compared with a significantly lower cessation rate of 43.3% (P < 0.01) in 6856 mothers who were only assessed when giving birth in the same maternity hospitals. Only 5% of maternity hospitals have one CO tester per 200 births, 41% of maternity hospitals have no equipment for this at all. The exhaled CO measurement in the mother is a marker for foetal toxicity, but it is also the gateway for detecting and treating smoking during pregnancy. It urgently needs to be implemented systematically, in order that France does not remain, as it does currently, the country in Europe where women who give birth have the highest rate of smoking, and so that the “smoke-free pregnancy” standard actually becomes a reality. The actual availability of the tools needed to treat pregnant women who are smokers - carbon monoxide testers and nicotine substitutes - is one of the keys to the effectiveness of antenatal care. Of the pregnant women smokers who underwent carbon monoxide testing during their antenatal care, less than 5% of pregnant women who need nicotine substitutes receive them throughout the entire period these are required. Less than 3% of maternity hospitals resort to nicotine substitution therapy for all pregnant or breastfeeding women who continue to smoke.