France: smoking in pregnancy consensus conference
The prevalence of smoking during pregnancy is still high in France despite a favourable regulatory environment (contraindication of nicotine replacement therapy (NRT) for pregnant smokers was abandoned in 1997), and clinical guidelines for smoking cessation mentioning the possibility of using NRT in pregnant smokers (1998). One possible explanation for this is the fear, both from physicians and pregnant smokers, of using NRT during pregnancy. This situation brought us to the conclusion that specific guidelines (for gynaecologists, obstetricians, and midwives) might be needed.
The French Consensus Conference on Pregnancy and Tobacco was held in Lille last October. Five hundred people from 18 countries participated in the two day conference, which was organised by Michel Delcroix from APPRI (Perinatality Prevention Research Information Association) together with the French alliance against tobacco, the European Smoke-free Hospital and Maternity Networks, the French Cancer League, and many other organisations.
This conference was run in compliance with the methodological rules recommended by ANAES, the national agency of health accreditation and assessment. Six questions were selected by the programme committee. Forty six experts presented a review of topics selected by the committee, and a literature search group assisted the conference jury with another report.
Among the conclusions and recommendations drafted by the jury were that tobacco cessation should preferably be obtained before conception, or as early as possible during pregnancy. Total cessation is recommended, and health professionals must be trained to assist women in smoking cessation, more particularly during pregnancy and after delivery, but without making women feel guilty. The full conclusions and recommendations are in French at http://www.anaes.fr/ANAES/anaesparametrage.nsf/HomePage?ReadForm. An English translation of the short version of the recommendations, with an introduction by UK experts, is available at www.treatobacco.net.