And what then?
Lock her up, delivery in shackles, and
take away baby at birth (as they do with cocaine
positive women in the US).
Who is this supposed to educate - the pregnant
woman to confirm to herself that she is a liar, or
the clinician to confirm (with wide confidence
limits) that the pregnant woman is a liar.
It might well be worth detecting unanticipated
passive smoking, but I imagine that the test
sensitivity and specificity for that would be
close to zero.
Aubrey
JK> http://www.guardian.co.uk/lifeandstyle/2010/jun/24/test-pregnant-women-smoking-nice
JK> http://guidance.nice.org.uk/PH26
JK> "A carbon monoxide (CO) test is an immediate
JK> and non-invasive biochemical method for
JK> helping to assess whether or not someone
JK> smokes. However, it is unclear as to what
JK> constitutes the best cut-off point for
JK> determining smoking status. Some suggest a CO
JK> level as low as 3 parts per million (ppm),
JK> others use a cut-off point of 6–10 ppm.
JK> It is important to note that CO quickly
JK> disappears from expired breath (the level can
JK> fall by 50% in less than 4 hours). As a
JK> result, low levels of smoking may go
JK> undetected and may be indistinguishable from
JK> passive smoking. Conversely, environmental
JK> factors such as traffic emissions or leaky gas
JK> appliances may cause a high CO reading – as
JK> may lactose intolerance.
JK> When trying to identify pregnant women who
JK> smoke, it is best to use a low cut-off point
JK> to avoid missing someone who may need help to quit.
JK> Who should take action?
JK> Midwives (at first maternity booking and
JK> subsequent appointments).
JK> What action should they take?
JK> • Assess the woman’s exposure to
JK> tobacco smoke through discussion and use of a
JK> CO test. Explain that the CO test will allow
JK> her to see a physical measure of her smoking
JK> and her exposure to other people’s smoking.
JK> Ask her if she or anyone else in her household
JK> smokes. To help interpret the CO reading,
JK> establish whether she is a light or infrequent
JK> smoker. Other factors to consider include the
JK> time since she last smoked and the number of
JK> cigarettes smoked (and when) on the test day.
JK> (Note: CO levels fall overnight so morning
JK> readings may give low results.)"
JK> Jonathan
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