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Exposure to Carbon Monoxide (CO) during pregnancy, even at low to moderate levels, presents a health risk to the mother and the unborn baby. In addition to Tobacco smoking, pregnant women can be exposed to CO, and potentially at highly toxic levels, from many situations in everyday life, such as in the home (e.g., faulty boiler), workplace, or elsewhere (e.g., blocked exhaust in vehicle).

Identifying elevated CO exposures, and the source of exposure, are essential for taking the appropriate preventive actions to protect the pregnant mother and her child from harm. Midwives and maternity staff sit at a critical interface with the ability to identify pregnant women who are at risk, and take appropriate public health action, during routine antenatal appointments when exhaled CO levels are above critical thresholds.

However, diagnosing CO poisoning among pregnant women can be difficult as the signs and symptoms mimic that of early pregnancy, and there is a lack of clarity amongst midwives and maternity staff on the appropriate advice and steps that should be taken when CO exposure from environmental sources is suspected.


The UK Health Security Agency (UKHSA) along with key stakeholders in NHS England, the Department for Health and Social Care, and Improving Performance in Practice have been developing new national guidance over the past two years to help midwives and maternity staff identify, and provide appropriate advice about, CO exposure among pregnant women. However, to ensure that the guidance is a practical, acceptable, and a useful tool for midwives and maternity staff, it should first be piloted within a select number of maternity clinics across England. Furthermore, the insights gained will then be incorporated into a final version as a quality improvement exercise.

As such, the project team is proposing to pilot and test the new guidance in four maternity units across England where there are varying levels of understanding and actions with regard to environmental CO, and use the insights gained to improve the final version. The program will involve:

a) Training on the new guidance through on-site or virtual sessions.

b) Testing of the new guidance through pre- and post-implementation questionnaires distributed to midwives and maternity staff, and

c) Gathering of insights to improve the final version by conducting interviews with midwives, maternity staff and pregnant women.

Our proposed piloting, testing, and improvement process will ensure that the national guidance is fit for purpose and able to protect the health of pregnant women and their unborn babies across the country. Our proposed work directly aligns with CORT’s mission statement which is to ‘reduce the incidents of death and injury from carbon monoxide (CO) exposure’, specifically by improving tools and increasing knowledge and awareness amongst midwives and maternity staff for ‘improved diagnosis’.