Prevalence of smoking during pregnancy – Authors' reply
Authors: Shannon Lange, Charlotte Probst, Jürgen Rehm, Svetlana Popova
Journal: The Lancet Global Health (2018)

We thank Patrick Doorley and Joan Hanafin from Ireland and Mabel Berrueta and colleagues from Argentina and Uruguay for their comments about our Article on the global prevalence of smoking during pregnancy.1Lange S Probst C Rehm J Popova S National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis.Lancet Glob Health. 2018; 6: e769-e776Summary Full Text Full Text PDF PubMed Scopus (231) Google Scholar The comments from these researchers, who represent countries with a higher than average prevalence of smoking among pregnant women,1Lange S Probst C Rehm J Popova S National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis.Lancet Glob Health. 2018; 6: e769-e776Summary Full Text Full Text PDF PubMed Scopus (231) Google Scholar along with the results of our study, highlight the need to establish national surveillance systems on prenatal tobacco use and other substance use that can be used to monitor the prevalence of substance use over time, study risk factors associated with substance use, investigate possible associations between prenatal substance exposure and maternal and child health outcomes, and assess the effectiveness of policy measures. Integration of the epidemiological data from such national surveillance systems into regional and global datasets will help to establish standardisation and comparability between countries. Unfortunately, only a few examples are available of such ongoing population-based surveillance systems, which are predominantly in high-income countries (eg, the US Pregnancy Risk Assessment Monitoring System [PRAMS]). Without up-to-date, valid, and nationally representative epidemiological data, monitoring prenatal exposures to tobacco and other substances and their consequences on maternal and child health outcomes over time will not be possible. In the past decade, even though nearly two-thirds of countries have adopted evidence-based tobacco control policies, current trends indicate that WHO's global target to reduce tobacco use by 30% by 2025 might not be achieved.2WHOWHO global report on trends in prevalence of tobacco smoking 2015. World Health Organization, Geneva2015Google Scholar However, some countries have made notable progress, and Doorley and Hanafin1Lange S Probst C Rehm J Popova S National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis.Lancet Glob Health. 2018; 6: e769-e776Summary Full Text Full Text PDF PubMed Scopus (231) Google Scholar showed that the prevalence of smoking during pregnancy in Ireland has decreased markedly in younger cohorts. Such advances again underline the need for continuous surveillance. Despite decreasing trends in the prevalence of smoking during pregnancy in some countries and globally,1Lange S Probst C Rehm J Popova S National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis.Lancet Glob Health. 2018; 6: e769-e776Summary Full Text Full Text PDF PubMed Scopus (231) Google Scholar some countries, such as Uruguay, still have high prevalence rates. Moreover, a wider and more pressing concern is prenatal exposures to psychoactive substances, such as alcohol3Popova S Lange S Probst C Gmel G Rehm J Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis.Lancet Glob Health. 2017; 5: e290-e299Summary Full Text Full Text PDF PubMed Scopus (431) Google Scholar and illicit drugs. To achieve optimal maternal and child health outcomes, countermeasures are required to combat substance use during pregnancy,4WHOGuidelines for the identification and management of substance use and substance use disorders in pregnancy. World Health Organization, Geneva2014Google Scholar including continuous surveillance. We declare no competing interests. National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysisSmoking during pregnancy is still a prevalent behaviour in many countries. These findings should inform smoking prevention programmes and health promotion strategies, as well as draw attention to the need for improved access to smoking cessation programmes for pregnant women. Full-Text PDF Open AccessPrevalence of smoking during pregnancyShannon Lange and colleagues (July, 2018)1 report the results of a systematic review and meta-analysis of the scientific literature from 1985 to 2016 to estimate the prevalence of smoking during pregnancy by country, WHO region, and globally. Smoking during pregnancy leads to adverse effects for women and children and this much-needed report is welcome. Estimates for smoking during pregnancy were calculated via meta-analysis for 43 countries and via statistical modelling for 131 countries. At 38%, Ireland was reported to have the highest estimated prevalence of all countries. Full-Text PDF Open AccessPrevalence of smoking during pregnancyShannon Lange and colleagues1 published a systematic review and meta-analysis reporting the prevalence of smoking during pregnancy by country. As the authors highlighted, Uruguay is among the top three countries with the highest prevalence, and Argentina is situated in the group of countries with a prevalence between 10% and 15%. The burden of tobacco in pregnant women in these two countries is surprisingly high since both countries have adopted comprehensive tobacco control measures. Full-Text PDF Open Access