The practices of French general practitioners regarding screening
and counselling pregnant women for tobacco smoking and alcohol
Received: 14 September 2017 / Revised: 2 March 2018 / Accepted: 6 April 2018 / Published online: 20 April 2018
Ó Swiss School of Public Health (SSPH+) 2018
Objectives Our study aims to describe French general practitioners’ (GPs’) practices toward pregnant patients regarding
alcohol consumption and smoking and to highlight factors associated with speciﬁc practices.
Methods In 2015, a representative sample of 1414 French GPs completed a telephone survey based on a stratiﬁed random
Results 61% of GPs declared screening for alcohol use and 82% for smoking at least once with each pregnant patient;
quitting was not systematically advised either for alcohol or for smoking. GPs’ practices were signiﬁcantly better among
those who had more recent ongoing training. GPs who drank regularly were less likely to screen for alcohol use and GPs’
drinking frequency was inversely related to recommending quitting. Current and former smokers were less likely to
recommend quitting to pregnant patients smoking over ﬁve cigarettes per day.
Conclusions Screening and counselling practices for substance use during pregnancy are heterogeneous among French GPs
and are notably related to their personal consumption. GP’s role in preventing substance use during pregnancy could be
strengthened by actions regarding their own consumption and by modiﬁcations in their initial and ongoing training.
Keywords General practitioners Á Pregnancy Á Alcohol consumption Á Tobacco smoking Á Screening Á Counselling
Alcohol use and tobacco smoking during pregnancy induce
serious health risks for both the mother and the baby.
Alcohol use can cause low birth weight, preterm birth or
miscarriage (Feodor Nilsson et al. 2014; Miyake et al.
2014; Valero De Bernabe et al. 2004) and can also induce a
range of physical and cognitive disorders known as foetal
alcohol spectrum disorders (FASD) (BMA 2016). Smoking
during pregnancy is associated with pregnancy complica-
tions, such as ectopic pregnancy, preterm premature rup-
ture of the membrane, miscarriage, preterm birth, and is
also linked to health problems of the new born such as low
birthweight, sudden infant death syndrome, delay in foetal
growth and neuro-development (Castles et al. 1999; Her-
rmann et al. 2008; Malloy et al. 1992; U.S. Department of
Health and Human Services 2014). As a result, in France,
ofﬁcial recommendations are no consumption of either
alcohol or tobacco during pregnancy (Sante
France 2018a, b). Yet, in 2010, in France, 23% of pregnant
women stated that they had drunk alcohol at least once
while they were pregnant, among them 3% did before
knowing they were pregnant (Saurel-Cubizolles et al.
2013). It has been estimated that FASD prevalence in
France in 2009 was about 0.5 for 1000 births, this ﬁgure is
probably underestimated due to difﬁculties of diagnosis
and data reporting (Bloch et al. 2008). Meanwhile, 17% of
pregnant women smoked tobacco during the 3rd trimester
of pregnancy (Blondel et al. 2012). Even though since 2003
a reduction of smoking among pregnant women is seen in
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00038-018-1103-9) contains supplementary
material, which is available to authorized users.
Agence Nationale de Sante
The National Public Health Agency, 12 Rue Du Val D’Osne,
94415 Saint-Maurice Cedex, France
gional de La Sante
Des Pays de La Loire,
tel de La Re
gion, 1 Rue de La Loire, 44966 Nantes, France
International Journal of Public Health (2018) 63:631–640