The Healthy Start theme focuses on maternal and child health. This includes the health and wellbeing of women who are pregnant and/or have young children, the children themselves, and their significant others.

The first objective in the Marmot review (2010) states that every child should be given the best start in life. Furthermore, action to reduce health inequalities must start before birth and be followed through the life course of the child. Thus, research around a healthy start, specific to the local needs of Staffordshire and Stoke-on-Trent, is important.

Current CHAD projects that sit within this theme are:

• Gestational Diabetes
• Evaluation of the Supporting a Smokefree Pregnancy Scheme

Fair Society, Healthy Lives: The Marmot Review (2010).

Gestational Diabetes

Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance with onset in pregnancy.  GDM affects up to 3-5% of all pregnancies in the UK. Although a temporary condition whilst pregnant, there are multiple risks associated with GDM, including:

1. Maternal increased risk of gestational hypertension and pre-eclampsia during pregnancy
2. Greatly increased maternal risk of type 2 diabetes after pregnancy
3. Children born after GDM-affected pregnancy are more likely to be born ‘large for gestational age’ and have birth defects
4. Higher risk of child developing obesity and glucose intolerance in early adulthood.

CHAD are working closely with colleagues at Staffordshire University and University Hospitals of North Midlands to develop a tool to promote physical activity in women with or at risk of GDM. We are currently engaging pregnant women, families and health professionals in qualitative research to explore attitudes towards physical activity for this cohort.

Evaluation of the Supporting a Smokefree Pregnancy Scheme

The Supporting a Smokefree Pregnancy Scheme (SaSFPS) in Stoke (co-ordinated by Stoke-on-Trent City Council) is an innovative intervention aimed at increasing smoking cessation in pregnancy. It aims to improve the health of pregnant women and to reduce the risks to their unborn children by increasing the number of pregnant women who stop smoking. Within this, specific goals are:

• To support pregnant smokers to set a quit date and achieve a Carbon Monoxide (CO) validated 4 week quit (<10ppm)
• To provide enhanced support to those women who have set a quit date and achieved a 4-week quit, within the scheme, to remain smoke-free throughout the pregnancy and for 12 weeks post-partum.

Information on smoking is routinely collected from pregnant women and nationally measured at time of delivery (SATOD). Stoke-on-Trent’s SATOD rates are above England’s average. There is a commitment to improving these rates, given the adverse effects that smoking is known to have on the outcomes of pregnancy which include increasing the overall risk of infant mortality by an estimated 40%, increasing the risk of miscarriage, premature birth, stillbirth, placental abnormalities, low birth-weight and sudden unexpected death in infancy (e.g., Dietz et al, 2010; Royal College of Physicians, 2010). Therefore, attempts to improve understanding about effective Schemes to help pregnant women to stop smoking are required.

CHAD is carrying out a mixed methods evaluation of the scheme, using programme data and primary qualitative data collection with clients and staff to explore their views and experiences of the scheme as well as its impact on quit rates.

We aim to report on the evaluation by May 2018.

References

Dietz, P.M., England, L.J., Shapiro-Mendoza, C.K., Tong, V.T., Farr, S.L., Callaghan, W.M. (2010). Infant morbidity and mortality attributable to prenatal smoking.  Am J Prev Med. 39(1):45-52. doi: 10.1016/j.amepre.2010.03.009.

Royal College of Physicians. (2010). Passive smoking and children. A report by the Tobacco Advisory Group. London: Royal College of Physicians.