Trends in Prescribing of Nicotine Replacement Therapy to Pregnant Women in Primary Care in England

Introduction

Smoking during pregnancy remains common and the English National Health Service (NHS) has recently been directed to prioritise providing cessation support for pregnant women. We investigated the impact on prescribing of stop smoking treatments to pregnant women of the 2013 transfer of public health budgets from the NHS to administrative authorities responsible for local social care and other non-health services (local authorities).

Methods

We used data from the Clinical Practice Research Datalink and Hospital Episode Statistics to determine annual proportions (2005-2017) of women who smoked during pregnancy and who were prescribed, at least once before childbirth, a) any NRT and b) long- and short-acting NRT together (dual NRT). Segmented regression was used to quantify the impact of the 2013 transfer of smoking cessation budgets to local authorities, assessing changes in the level and the trend of the proportions post-2013 compared to pre-2013.

Results

We identified 84,539 pregnancies in which women were recorded as smoking; any NRT was prescribed in 7.9% (n=6,704) and dual NRT in 1.7% (n=1,466). Prescribing of any NRT was declining prior to 2013 at an absolute decrease of -0.25% per year, but the rate of decline significantly increased from 2013 onwards to -1.37% per year. Prescribing of dual NRT was increasing prior to 2013 but also decreased post-2013.

Conclusions

These findings suggest that transferring responsibility for English Smoking Cessation Services from the NHS to local authorities adversely affected provision of cessation support in pregnancy. Consequently, some women may have been denied access to effective cessation treatments.

Implications

Women who smoke during pregnancy may be being denied potentially effective means to help them quit, contrary to NICE guidance, at what can be a teachable moment with substantial immediate and longer-term health benefits for woman and their unborn child, and economic benefits for the NHS. When the organisations responsible for offering smoking cessation support are changed, health systems should consider potential adverse effects on the delivery of support and deploy strategies for mitigating these.