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Feedback from a point-of-care test for nicotine intake to reduce smoking during pregnancy

Background: Smoking is the most important modifiable risk factor for adverse pregnancy outcome in the UK. New tools are needed to improve smoking cessation advice. The aim was to investigate a point-of-care urine test for smoking, to provide feedback to women, to improve awareness about the effects of smoking during pregnancy and to relate the test results to pregnancy outcome. Methods: A cross-sectional randomized controlled trial involving 856 pregnant women. All intervention patients were interviewed at their initial visit and tested for smoking. The test provided visual and numerical feedback. Smokers were followed up and retested at subsequent visits. The control group received anti-smoking counselling as part of routine care, but their smoking was monitored using the test. Both groups were interviewed and retested at 36 weeks' gestation. Results: Self-reported cigarette consumption fell significantly (P < 0.001) in the intervention group, with 16.2% giving up and 33.3% significantly reducing their cigarette consumption. There was a significant fall in test results from 'booking' to 36 weeks' gestation (P < 0.0001). In the control group, only 8% reported stopping and 23% reducing their cigarette consumption. Combined smoking test results at 36 weeks correlated significantly with birth weight (P = 0.006) and body length (P = 0.011). Conclusions: Point-of-care testing and feedback coupled with counselling can significantly reduce smoking during pregnancy and increase birthweight.