Statistics on Women's Smoking Status at Time of Delivery: England, Q1 2025/26

Smoking during pregnancy can cause serious pregnancy-related health problems. These include complications during labour and an increased risk of miscarriage, premature birth, still birth, low birth-weight and sudden unexpected death in infancy.

Reducing smoking during pregnancy was one of the three national ambitions in the Tobacco Control Plan published back in July 2017. A new Tobacco and Vapes Bill was introduced in 2024 and it is anticipated that new strategies around reducing smoking in pregnancy are being developed under the latest government.  

The SATOD v1 data collection has ceased from Q1 2025-26 with SATOD reporting having now been replaced with SATOD v2 data from MSDS. This is not to be mistaken with a similar measure labelled as ‘Smoking at Delivery CQIM’ (Clinical Quality Improvement Metric) which is published separately every month as part of the Maternity Services Monthly Statistics publication series which was developed back in 2019. The methodology for this metric can be found in the Maternity Services Monthly Statistics Metadata file and will be aligned with the new methodology for SATOD v2 as soon as practicable.

Due to lack of funding and in order to reduce burden on the NHS, there was a strong rationale to replace the existing SATOD (SATOD v1) using data from MSDS (SATOD v2), especially as the data quality in MSDS has matured over time since its introduction in 2015. Data from MSDS will now be the main source of SATOD (SATOD v2).

The new SATOD v2 metric is based on the existing Smoking at Delivery CQIM methodology with a few refinements to align it with the SATOD v1 methodology. The National Speciality Advisor chaired a Working Group to review this metric and methodology, consisting of OHID, NHSE policy colleagues, clinical colleagues and analysts. The main changes were: 

• Reviewing the list of clinical codes on self-declared smoking and non-smoking statuses to agree which ones to accept for this analysis.
• Discounting any records with data only submitted for carbon monoxide readings and/or cigarettes smoked per day, in the absence of a self-declared smoking status.
• Prioritising information submitted to MSD302 Care Activity (Labour and Delivery) ahead of information submitted to MSD202 (Care Activity Pregnancy), as the former is more likely to be associated specifically with Smoking at Time of Delivery.
• Treating any conflicting self-declared smoking statuses in the +/-3 days from the labour onset date as an unknown smoking status.

In future, we will consider aligning the methodologies for SATOD and the Saving Babies Lives (v3) initiative which looks at Smoking in pregnancy at 36 weeks, when we review existing metrics or construct new ones. 

Saving Babies’ Lives is designed to tackle stillbirth and early neonatal death and is a significant driver for delivering the ambition to reduce the number of stillbirths, bringing six elements of care together with one of them being Reducing smoking in pregnancy. For more information, see the Saving Babies' Lives Care Bundle version 3.