bmj.com -- Press Releases

Press Releases Saturday 12 September 1998
No 7160 Volume 317

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(1) BRITISH WOMEN PERSIST IN SMOKING DURING PREGNANCY

(2) DO PREGNANT WOMEN REALISE WHAT THEIR SCAN COULD TELL THEM?

(3) AN OVERHAUL OF GENERAL PRACTICE TRAINING IS NEEDED

(1) BRITISH WOMEN PERSIST IN SMOKING DURING PREGNANCY

(Trends in smoking during pregnancy in England, 1992-7:
quota sampling surveys)
http://www.bmj.com/cgi/content/full/317/7160/728

Even though the dangers of smoking are widely established, only one in
six women who smoke give up when they become pregnant, claims
research conducted by the Health Education Authority and published
in this week�s BMJ. In 1992 the Health of the Nation public health
report set the target that by the year 2000 a third of women who smoke
should stop smoking at the start of their pregnancy. Current levels are
clearly falling short of this target.

Dr Lesley Owen, who led the research along with colleagues from the
Health Education Authority, found that the prevalence of smoking in
pregnant women was much the same in 1997 as 1992, with the highest
rates among younger women who are either unemployed or manual
workers. The researchers also found that only one in ten women who
smoked gave up immediately before they became pregnant.

The authors conclude that "...current practice to reduce smoking during
pregnancy is either not working or lacks sufficient investment and
prioritisation to be effective".

Contact:

Dr Lesley Owen, Senior Research Manager,
Health Education Authority, Trevelyan House, London
email: lesley.owen{at}hea.org.uk
or
Dean Mahoney, Press Office, HEA

(2) DO PREGNANT WOMEN REALISE WHAT THEIR
SCAN COULD TELL THEM?

(First trimester ultrasound screening carries ethical
and psychological implications)
http://www.bmj.com/cgi/content/full/317/7160/694

Pregnant women may be offered the option of having an ultrasound
scan when their fetus is at the 10-14 week stage. This scan is used
to accurately date the pregnancy and determine the presence of one
or more fetuses. In some centres, high resolution scans are used to
diagnose major fetal abnormalities and assess the likelihood of high
risk chromosomal abnormalities. In the majority of cases the fetus
is normal (98 per cent), but what if it isn�t - would you be prepared
for the worst?

In this week�s BMJ authors of an editorial and a cluster of letters
discuss the fact that the high resolution ultrasound scanning that is
now possible during the first trimester of pregnancy raises ethical
and psychological issues. In an editorial Anne McFadyen and
colleagues ask whether women are fully informed about the level
of information that a scan could reveal - it is not simply a means
of discovering the gestational age. They are concerned that if the
full implications of the technology are not fully explained, this may
leave parents unprepared for bad news, which in turn could mean
that a difficult decision may need to be made about whether to
proceed with the pregnancy.

In a letter Katherine Hampton says that "...most women are
enthusiastic about having an ultrasound scan, perhaps because
they do not associate scans with screening". Guy Nash, a consultant
obstetrician and gynaecologist from East Sussex, argues that, on
the contrary, the majority of mothers understand that scanning is
done to detect abnormalities and that they would expect to be
informed if any are identified. "If information was not given, she
[the mother] would probably sue her obstetrician when it became
known that the abnormality had been detected earlier."

Stephen Carroll from the Fetal Medicine Unit at St Michael�s
Hospital in Bristol argues that the identification of an abnormality
is not solely to provide a basis for the decision to terminate the
pregnancy or not. He explains that if a disorder is identified then
provision can be made for a "...planned delivery in a centre with
appropriate neonatal intensive care facilities [which] will optimise
neonatal outcome".

In their editorial McFadyen et al stress that psychological support
is an important part of the ultrasound scanning process and that
counselling services should be offered more actively following
termination for fetal abnormality. This view is shared by Johanna
Layng from the Division of Primary Care and Population Health
Sciences, based at the Chelsea and Westminster Hospital in London,
who believes that health professionals should be trained to provide
counselling - especially, she says, as there is likely to be an
increasing demand for this type of service.

McFadyen and colleagues conclude that all women should receive a
clear explanation of the purposes of all antenatal testing, the
information that may be discovered and the degree of certainty
about the information that is gleaned, in order that they are able to
make an informed decision about whether to undertake tests such
as an ultrasound scan.

Contact:

Anne McFadyen, Senior Lecturer or Julia Gledhill,
Honorary Research Fellow,
Leopold Muller Department of Child and Family Mental Health,
Royal Free and University College Medical School, London
Julie Gledhill
email: j.gledhill{at}ic.ac.ukj.gledhill{at}ic.ac.uk
or
Demetrios Economides,
Senior Lecturer and Consultant in Obstetrics and Gynaecology,
Royal Free and University College Medical School, London
Katherine Hampton, Tunbridge Wells, Kent
email: katherine{at}mcmail.comkatherine{at}mcmail.com

Guy Nash, Consultant Obstetrician and Gynaecologist,
Conquest Hospital, Leonards-on-Sea, East Sussex
email: tgnash{at}aol.com

Stephen Carroll, Subspecialty Trainee in Maternal and Fetal Medicine,
Fetal Medicine Unit, St Michael�s Hospital, Bristol

Johanna Layng, The Surgery, 18 New Wokingham Road,
Crowthorne Berks
email: Layng{at}btinternet.comLayng{at}btinternet.com

Kypros Nicolaides, Professor of Fetal Medicine,
Harris Birthright Research Centre for Fetal Medicine,
Department of Obstetrics and Gynaecology,
Kings College School of Medicine and Dentistry, London

(3) AN OVERHAUL OF GENERAL PRACTICE TRAINING IS NEEDED

(Is general practice in need of a career structure?)
http://www.bmj.com/cgi/content/full/317/7160/730

Specific training for doctors to become general practitioners was first
implemented in the 1970s and has not been updated since; after their
pre-registration house officer year, potential GPs spend two years as
a senior house officer and one year in general practice. In this week�s
BMJ Dr Glyn Elwyn and colleagues from the University of Wales
College of Medicine in Cardiff suggest that the current system needs
an overhaul. They ask: "Is it any wonder that young clinicians shun a
generalist career when it is clear that the real training takes place in
the first five years as a principal?" (ie �on-the-job� learning).

The authors believe that training should be undertaken within general
practice so that the �generalist registrar� becomes the equivalent of a
specialist registrar, integrates with the multidisciplinary team and has
protected time for professional development and research. They also
believe that other important considerations include flexibility to allow
for part-time training or the ability to move areas without incurring
penalties.

Contact:

Dr Glyn Elwyn, Senior Lecturer, Department of Postgraduate
Education for General Practice and Department of General Practice,
University of Wales College of Medicine, Cardiff
email: elwynG{at}cf.ac.uk

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