Aboriginal and Torres Strait Islander Health Performance Framework - 2010

2.19 Tobacco smoking during pregnancy

Page last updated: 26 May 2011

Why is it important?:

Smoking is a risk factor for adverse events in pregnancy, and is associated with poor perinatal outcomes such as low birthweight (less than 2,500 grams) (AIHW 2004c), pre-term birth, fetal growth restriction, congenital anomalies and perinatal death. Low birthweight infants are at a greater risk of dying during the first year of life and are prone to ill health in childhood. Smoking during pregnancy is also associated with increased risk of spontaneous abortion and ectopic pregnancy. Obstetric complications such as pre-term labour and ante partum haemorrhage are more common in smoking mothers than non-smoking mothers (Laws & Sullivan 2005). Nicotine, carbon monoxide and other chemicals in tobacco are passed on to the baby through the placenta, which reduces the oxygen supply to the unborn fetus (AMA 1999).

The negative health effects of tobacco smoking on the unborn fetus may continue after childbirth if one or both of the parents smoke. Passive ‘environment’ smoking of tobacco around a newborn is considered to be one of the major risk factors for sudden infant death syndrome (SIDS or cot death). Exposure to second-hand smoke in the atmosphere also increases an infant’s risk of ear infections and developing asthma (AMA 1999). Where the mother smokes, harmful chemicals are passed in the breast milk to newborn babies. This increases the risk of respiratory illness, such as bronchitis or pneumonia, during the first year of life (NSW Multicultural Health Communication Service 2004).

Interventions for smoking during pregnancy are complex due to some mothers having a lack of knowledge about the health impacts of smoking, and the need to maintain good relationships between expectant mothers and health professionals (Wood et al. 2008).

Findings:

In 2007, approximately half of Aboriginal and Torres Strait Islander mothers smoked during pregnancy. When the effect of different age structures in the two populations was controlled for, the proportion of Aboriginal and Torres Strait Islander mothers who smoked during pregnancy was more than 3 times that of non-Indigenous mothers (51% compared with 15%). South Australia had the highest smoking prevalence at 62% of Indigenous mothers, while New South Wales and Western Australia had around 4 times the smoking rate compared to non-Indigenous mothers. Of Indigenous mothers who reported smoking during pregnancy, 47% smoked up to 10 cigarettes per day, 43% smoked 10 or more cigarettes per day and around 5% did not smoke during the second half of their pregnancy. Survey data from the ABS NATSISS 2008 reveal that 57% of mothers of children aged 0–3 years who had used tobacco during pregnancy used less of it during their pregnancy.

Although differences in reporting methods affect the comparability of these figures, the proportion of Aboriginal and Torres Strait Islander mothers who smoke during their pregnancy (as recorded in the National Perinatal Data Collection) (51%) appears similar to the prevalence of smoking by Indigenous women overall (47% of Indigenous females aged 18 years and over).

For non-Indigenous mothers, there were large differences in smoking rates by remoteness and age groups (e.g. 38% of the under 20 year age group smoking, compared to around 10% from 30 years and over). In contrast, the proportion of Indigenous mothers who smoked during pregnancy was similar across geographic areas and all age groups, that is, not just high among younger mothers.

In 2007, smoking during pregnancy for both Indigenous and non-Indigenous mothers, is associated with around 40% higher prevalence of pre-term birth and an almost 100% higher proportion of low birthweight babies. Smoking by Indigenous mothers is also associated with an almost 20% higher rate of perinatal deaths, which occur at around double the rate for non-Indigenous births (measure 1.20). Pre-term birth, low birthweight and perinatal deaths were higher for babies born to Indigenous mothers than to non-Indigenous mothers, regardless of whether or not the mother was a smoker. These findings indicate that smoking is only one factor associated with these outcomes. Figures reported for 2007 show very little change in overall prevalence of smoking during pregnancy by Indigenous mothers since 2005.

Implications:

For Aboriginal and Torres Strait Islander women the prevalence of smoking during pregnancy is similar to that reported for the adult Indigenous population overall. This suggests the need for new approaches for culturally appropriate and effective health promotion and primary health care interventions specifically related to smoking during pregnancy. Collecting national data on smoking during pregnancy will be an important element of continued monitoring of progress in this area.

Reducing Indigenous smoking was one of the key priorities under the National Drug Strategy Aboriginal and Torres Strait Islander Peoples Complementary Action Plan 2003–2009 (Ministerial Council on Drug Strategy 2006). The commitment to reducing smoking has now been significantly extended through the Indigenous Tobacco Control Initiative (2008) and the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (see measure 2.18).

The Indigenous Early Childhood Development National Partnership, the New Directions Mothers and Babies Services, the Australian Nurse Family Partnership Program and the Healthy for Life programs all have a focus on improving healthy behaviours during pregnancy including the reduction of tobacco smoking.

In addition, the issues discussed under measure 3.01 Antenatal care are relevant to implementing smoking cessation strategies for pregnant mothers. The National Evidence-Based Antenatal Care Guidelines, currently under development, will include culturally appropriate guidance and recommendations regarding smoking during pregnancy.

Figure 116 – Proportion of mothers who smoked during pregnancy, by Indigenous status and selected jurisdictions, 2007


Figure 116 – Proportion of mothers who smoked during pregnancy, by Indigenous status and selected jurisdictions, 2007
Source: AIHW analysis of National Perinatal Statistics Unit National Perinatal Data Collection
Text description of figure 116 (TXT 1KB)

Figure 117 – Proportion of mothers who smoked during pregnancy, by Indigenous status and age of mother, 2007


Figure 117 – Proportion of mothers who smoked during pregnancy, by Indigenous status and age of mother, 2007
(a) Age-standardised data based on directly age-standardised proportions using the population of women aged 15–44 years who gave birth in all states as the standard.
Source: AIHW analysis of National Perinatal Statistics Unit National Perinatal Data Collection
Text description of figure 117 (TXT 1KB)

Table 54 – Smoking during pregnancy by Indigenous status and baby outcomes, NSW, Qld, WA, SA, Tas., ACT and NT, 2007

Outcome:
Indigenous women
Non-Indigenous women
Ratio (a)
Smoked
Did Not Smoke
Smoked
Did Not Smoke
Percentage of babies:
Pre-term birth
15.4
11.1
10.4
7.2
1.5*
Low birthweight
16.0
8.2
10.0
5.0
1.6*
Apgar score:
0-3
0.6
0.7
0.4
0.3
1.6*
4-6
1.7
1.6
1.2
1.0
1.5*
7+
97.2
97.5
98.1
98.6
1.0
Rate per 1,000 births:
Perinatal deaths
20.8
17.5
11.6
8.0
1.8*
Source: AIHW analysis of National Perinatal Statistics Unit (NPSU) National Perinatal Data Collection

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