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of public health epidemiology in Ontario

Smoking During Pregnancy Core Indicator

  • Proportion of pregnant females that smoked cigarettes during pregnancy.
Report an IssueAppendices

Related OPHS Topics

Healthy Pregnancies
 

Method of Calculation

Proportion of women that smoked during pregnancy
Number of pregnant women that smoked cigarettes at any time during their pregnancy
100
Total number of women that gave birth (live birth or stillbirth)
100

Recommended Subset Analysis Categories

Geographic Areas of Patient Residence
  • Ontario
  • Public Health Unit

Data Sources

Numerator & Denominator Alternative Data Sources
BORN Information System

Original Source:

Better Outcomes Registry Network (BORN) Ontario

Distributed by:

Better Outcomes Registry Network (BORN) Ontario

Suggested Citation:

BORN Information System [years], Date Extracted: [date].
None

Data Elements in the BORN Information System (BIS)

Name and Description

Categories

Encounter

BORN ID

Smoking
Self-reported smoking during pregnancy.
  • Not entered
  • No smoking
  • <= 20 weeks
  • >20 weeks
  • <=20 weeks and >20 weeks
  • Unknown
  • [Add encounter(s) here]

???

 

Analysis Checklist

General Checklist
  • Please follow the general analysis checklist for the BORN Information System data source.  
  • Niday Perinatal data is available from BORN upon request.
  • For analysis, create response categories:
    • No (variable = 1)
    • Yes (variable = 2 or 3 or 4)
    • Unknown (variable = 0 or 9)
  • The percent of 'unknown' will vary across public health units, making comparisons difficult. Keep 'unknown' as a separate category initially to determine if it can be excluded.
  • Public Health Units access the BORN data through public health reports or data cubes.


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Indicator Comments

General Comments
  • Breastfeeding has a number of well-documented short and long-term health benefits for both babies and mothers (1,2). It is known to reduce the risk of sudden infant death syndrome and gastrointestinal, ear and respiratory infections throughout childhood (1). Breastfeeding infants is also associated with lower levels of diabetes and obesity later in life (3).
  • Exclusive breastfeeding of infants until 6 months of age is recommended by the World Health Organization (WHO) (4). Exclusive breastfeeding is defined as no other food or drink, not even water, except breast milk (including milk expressed or from a wet nurse) for 6 months of life, but allows the infant to receive oral rehydration solution, drops and syrups (vitamins, minerals and medicines).
  • In recent years, there has been increased public health attention directed towards increasing rates of exclusive breastfeeding as part of the WHO Baby-Friendly Initiative (5). As such, public health practitioners have a unique and important role in promoting and supporting breastfeeding.
  • There are many factors known to influence breastfeeding rates including: age, income, education, living with a partner, previous pregnancies, home delivery, attitudes and comfort with breastfeeding, hospital practices, social network and return to work / school (6). Data on these factors are also available in the BORN database, although there may be high rates of missing information.
  • In the Niday Perinatal Database, the percent of non-response or "unknown" was high in some jursidictions. As a result, Niday made the "Smoking During Pregnancy" field mandatory in January 2009 which led to more complete data (1).The Niday, smoking during pregnancy data element is often recoded to "smoker" and "non-smoker". With the creation of the new BORN database in fall 2011, the indicator was changed to a binary variable.
  • Historical data from the Niday Perinatal Database varies by geographical area. Please refer to the Reproductive Health Core Indicators Documentation Report for details.
  • The data elements captured in the BORN Information System implemented in 2012 are different from the historic Niday Perinatal data and will not be comparable. The new BORN data elements quantify the amount smoked by the mother (M0020-1 and D0005) and determine exposure to second-hand smoke in the home (M0020-2 and D0010) at first prenatal visit and time of newborn's birth respectively.
  • For CCHS data, it is anticipated the sample size will be extremely small and analysis will occur at a larger area than the health unit.
  • The CCHS provides smoking during pregnancy data, asked of females 15 to 55 years old who gave birth in the past 5 years, in the ‘Breastfeeding module' (BRFA -cycle 1.1, 2000/2001); ‘Maternal Experiences' module (MEX - cycles 2.1 (2003), 3.1 (2005)) and ‘Maternal Experiences, Smoking' module (MXS, 2007 - 2010). Please refer to CCHS data dictionaries for details.
  • Smoking in pregnancy increases the risk to the fetus of: (2-8)
    • intrauterine growth restriction (IUGR)
    • low birth weight
    • preterm birth
    • spontaneous abortion
    • placental complications
    • stillbirth
    • sudden infant death syndrome (SIDS)
    • childhood asthma and respiratory illness
    • neurodevelopmental and behavioural problems
    • some childhood cancers
  • Some of the long-term health impacts for the babies born to females who smoke during pregnancy are a consequence of the perinatal complications they experience such as preterm birth and intrauterine growth restriction (8).
  • Measurement issues are complicated by cessation of use during pregnancy as well as social desirability effects.

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References

Cited References
  1. BORN Ontario. Perinatal Health Report 2008, May 2010. Available from: http://www.bornontario.ca/reports. Accessed: August 25, 2011.
  2. Cnattingius S. The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Research. 2004;6(Suppl 2):S125-140.
  3. Greaves L, Cormier R, Devries K, Bottorff J, Johnson J, Kirkland S, et al. A best practices review of smoking cessation interventions for pregnant and postpartum girls and women. Vancouver: British Columbia Centre of Excellence for Women‘s Health, 2003 [cited 17 Nov 2009]. Available from: http://www.bccewh.bc.ca/publications-resources/documents/Expecting_to_Quit.pdf.
  4. Haberg SE, Stigum H, Nystad W, Nafstad P. Effects of pre- and postnatal exposure to parental smoking on early childhood respiratory health. American Journal of Epidemiology. 2007;166(6):679-86.
  5. Lannerö E, Wickman M, Pershagen G, Nordvall SL. Maternal smoking during pregnancy increases the risk of recurrent wheezing during the first years of life. Respiratory Research. 2006:7(1):3.
  1. Danielsson J, De Boer M, Petermann F, Daseking M. Nicotine exposure during pregnancy - impact on cognitive development in preschool age[Nikotinexposition in der Schwangerschaft - Auswirkungen auf die kognitive Entwicklung im Kindergartenalter]. Geburtshilfe und Frauenheilkunde. 2009;69(8):692-7.
  2. Ng SP, Zelikoff JT. Smoking during pregnancy: subsequent effects on offspring immune competence and disease vulnerability in later life. Reproductive Toxicology. 2007;23(3):428-37.
  3. Lee S, Armson A. Consensus statement on healthy mothers-healthy babies: How to prevent low birth weight. International Journal of Technology Assessment in Health Care. 2007;23(4):505-14.

Acknowledgements

Lead Authors

Amira Ali, Ottawa Public Health 

Natalie Greenidge, Public Health Ontario

Oren Jalon

Enayetur Raheem, Windsor Essex County Health Unit

Core Indicators Reviewers

Michael Chaiton, Centre for Addiction and Mental Health

Carmen Yue, Toronto Public Health

Contributing Authors

Reproductive Health Sub-Group

  

  

Revision History

This Core Indicator Product webpage is maintained by the Reproductive Health Subgroup.  
Date Review Type Author Changes PDF
April 27, 2004 New Indicator Reproductive Health Sub-Group Indicator completed on the website.

June 22, 2012 - January 16, 2013 Ad-hoc Review Reproductive Health Sub-Group
  • Changed the data source to Niday Perinatal Database (available through the BORN Information System) from CCHS.
  • Updated indicator comments and cited references.
September 17, 2019
Website Update:
No Content Review
Caitlyn Paget,
on behalf of the CIWG 
    No changes made to indicator definitions.
    Migrated to new website structure and format, including:
  • Reorganized content to provide high-level information at a glance, and move in-depth analytic information into dedicated sections for users to access when needed.
  • Renamed "Basic Categories" section to "Recommended Subset Analysis Categories"; "Definitions" renamed to "Glossary".
  • Replaced both "Cross-References to Other Indicators" and "OPHS" sections with "Related OPHS Topics" to crosslink with relevant Core Indicators webpages including OPHS program standard(s) and associated indicator(s).
  • Added descriptive sub-headings to the Analysis Checklist and Indicator Comments sections.
  • Removed "Corresponding Health Indicator(s) from Statistics Canada and CIHI" and "from Other Sources" sections.
  • Updated Revision History table, and added PDF copy of previous version for reference.
  

 



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