Smoking Pregnant Women Research Articles

Tobacco smoking and alcohol intake in pregnant and breastfeeding women: preliminary data of the survey PASSI 2014

Tobacco smoking and alcohol intake in pregnant and breastfeeding women: preliminary data of the survey PASSI 2014

The Modified Reasons for Smoking Scale: factorial structure, validity and reliability in pregnant smokers.

Smoking during pregnancy can cause several maternal and neonatal health risks, yet a considerable number of pregnant women continue to smoke. The objectives of this study were to test the factorial structure, validity and reliability of the Dutch version of the Modified Reasons for Smoking Scale (MRSS) in a sample of smoking pregnant women and to understand reasons for continued smoking during pregnancy. A longitudinal design was performed. Data of 97 pregnant smokers were collected during prenatal consultation. Structural equation modelling was performed to assess the construct validity of the MRSS: an exploratory factor analysis was conducted, followed by a confirmatory factor analysis.Test-retest reliability (<16 weeks and 32-34 weeks pregnancy) and internal consistency were assessed using the intraclass correlation coefficient and the Cronbach's alpha, respectively. To verify concurrent validity, Mann-Whitney U-tests were performed examining associations between the MRSS subscales and nicotine dependence, daily consumption, depressive symptoms and intention to quit. We found a factorial structure for the MRSS of 11 items within five subscales in order of importance: tension reduction, addiction, pleasure, habit and social function. Results for internal consistency and test-retest reliability were good to acceptable. There were significant associations of nicotine dependence with tension reduction and addiction and of daily consumption with addiction and habit. Validity and reliability of the MRSS were shown in a sample of pregnant smokers. Tension reduction was the most important reason for continued smoking, followed by pleasure and addiction. Although the score for nicotine dependence was low, addiction was an important reason for continued smoking during pregnancy; therefore, nicotine replacement therapy could be considered. Half of the respondents experienced depressive symptoms. Hence, it is important to identify those women who need more specialized care, which can include not only smoking cessation counselling but also treatment for depression.

Maternal Smoking during Pregnancy and Its Impact on Postnatal Neurodevelopment

Background: Nicotine from maternal active smoking or environmental tobacco smoke (ETS) is still the most prevalent substance of abuse during pregnancy in industrialized countries. The negative effects of exposure to tobacco smoke on foetus development have been widely described: impaired foetal growth and increased risks for gestational and perinatal outcomes. Objective: The aim of this review was to provide an overview on prenatal nicotine exposure and its behavioral and neurodevelopmental deleterious effects in new-borns and children. Method: We searched MEDLINE and EMBASE for articles catalogued between 1992 and 2015. We identified relevant published studies that assessed the association between maternal smoking and neurodevelopment deleterious effects in offspring. From 33 citations, a total of 17 studies were included. Results: Literature definitively supports a strong association between exposed new-borns and signs of stress and neonatal withdrawal symptoms. Furthermore, an association between exposure to nicotine and attention-deficit/ hyperactivity disorder (ADHD) in children has been reported in many studies, as well as a wide range of externalizing outcomes, especially rule-breaking and aggressive behaviour, with increased risk of conduct disorders and crime. Conclusions: It is necessary to follow up children with prenatal exposure to ETS in order to detect neurodevelopment effects during childhood. We also recommend the implementation of campaigns to avoid smoking in pregnant women, with structured medical advice and protection of pregnant women and children from ETS.

Poster Abstracts

Background: Smoking prevalence among Indigenous pregnant women is high at 49%. Evidence-based smoking cessation interventions have not been effectively translated into the maternal Indigenous context. Aims: To explore GPs' knowledge, attitudes and practices of managing smoking in pregnant women. Methods: A random sample of 500 members of the RACGP National Faculty of Aboriginal and Torres Strait Islander Health were invited to an on-line survey. Inclusion criteria were GPs who consult with pregnant women. The response rate was low at 8% (N = 42), however alternative recruitment is ongoing. Results: One-third of the sample worked in Indigenous organisations; 62% of respondents were women. Most GPs (81%) always asked and gave brief advice about smoking in pregnancy. Less GPs (62%) always provided cessation support, assessed dependence (55%), discussed the psychosocial context of smoking (33%), followed up within 2 weeks (14%); 5% referred to the Quitline. Only 21% always recommended/prescribed nicotine replacement therapy (NRT), despite 93% agreeing that using NRT in pregnancy was safer than smoking; 71% believed NRT was moderately effective, and 69% were confident to prescribe NRT. More GPs in Indigenous organisations, compared to mainstream, agreed that discussing smoking benefits their relationship with pregnant clients (p < 0.05). Discussing psychosocial contexts was positively associated with prescribing NRT (p < 0.05). Only 10% GPs trained in smoking cessation for pregnancy; 83% agreed training was warranted, over two-thirds agreed access to oral NRT should be improved. Conclusions: Smoking cessation is a high priority for cancer prevention. NRT can be offered to pregnant smokers unable to quit. Low levels of assisted quitting may relate to scarcity of training for pregnancy, and policies governing access. Caution is advised due to small sample size. Translational research aspect: Training GPs in smoking cessation for pregnant women, and improving NRT access, may progress T2/3 translation of evidence-based methods for smokers in high prevalence groups.

Correspondence between self-reported and biochemical measures of cigarette smoking in pregnant women

Correspondence between self-reported and biochemical measures of cigarette smoking in pregnant women

Correspondence between self-reported and biochemical measures of smoking in opioid-dependent pregnant women

Aims: Smoking exacerbates adverse outcomes among opioiddependent pregnant women (e.g., a more severe neonatal abstinence syndrome in exposed neonates). Vermont birth certificate data for opioid-dependent pregnant women indicates a significant decrease in their self-reported smoking rate over the course of pregnancy, from a mean of 17.9 cigarettes per day (CPD) prior to pregnancy to 13.8, 10.9, and 9.7 in the first, second and third trimesters, respectively. This study examined self-reported smoking rate andbiochemicalmeasures of smoking to testwhether self-reported decreases in smokingwere paralleled by decreases in biochemical measures. Methods: Participants were 18 opioid-dependent pregnant women enrolled in clinical trials for smoking cessation. All women continued to smoke throughout their pregnancies. Self-reported CPD prior to pregnancy were collected at the Intake Assessment. CPD, breathCO, andurine cotininewere collected at intake, at a second assessment 1 month later (Early Pregnancy Assessment), and againat theendofpregnancy (≥28weeksgestation; LatePregnancy Assessment). Results: Like birth certificate data, self-reported smoking rates decreased from amean of 22.6 prior to pregnancy to 15.5 at intake. During pregnancy, self-reported CPD decreased significantly from 15.5, 7.5, and 9.0 at Intake and Early and Late Pregnancy Assessments, respectively (p< .001). However, parallel changes were not evident in biochemical measures of smoking. Mean CO was 13.3, 10.0, and 12.3ppm (p= .11) and mean urine cotinine was 1422.8, 1387.8, and 1294.1ng/ml (p= .71) at the three assessments. Conclusions: Discrepancies between self-report and biochemical measures may be explained by misrepresentation of self-reported smoking or reductions in CPD offset by changes in smoking topography (i.e., compensatory smoking). Further research is needed to understand changes in smoking among opioid-dependent pregnant women. Financial support:NICHDR01HD075669, NIDAR01DA014028 and R01 DA031928, and FDA/NIDA P50 DA036114.

Characteristics of smoking pregnant women in Guadalajara, Mexico

Characteristics of smoking pregnant women in Guadalajara, Mexico

What is an Odds Ratio? What does it mean?

When we read the results of healthcare research, we often read about relationships or associations between different treatments and their outcomes for patients. Health outcomes can be improved with the...

Associated Behavioral Risks in a Group of Women During Pregnancy from Mures District

Abstract Background. It is well-known that the exposure during pregnancy to lifestyle risk factors can affect thehealth both for the mother and the fetus. There are many risk factors for pregnancy, including: smoking, alcohol consumption, sedentary pattern, irregular daily meal serving plan, lack of knowledge regarding health prevention. The main objective of our study was to assess the practices, knowledge and attitudes towards lifestyle risk behaviors during pregnancy in a group of women from Tirgu-Mures area. Materials and methods. We used a cross-sectional study based on a questionnaire, assessingsmoking behavior and lifestyle patterns during pregnancy, on a group of 481 women from the urban area (58.84%), as well as from the rural area (41.16%) from Mures county. Results. In the study group, 190 women (39.5%) used to smoke before pregnancy; among which 37.36% continued to smoke even after they found out they are pregnant. In the group of pregnant women that continued to smoke during pregnancy, we have studied other behavioral factors related to lifestyle, identifying the following: 5,73% have been consuming alcohol weekly, 56.33% reduced greatly their physical activity level, 3.63% have been consuming at least 3 cups of coffee a day. During pregnancy, 12.72% did not have a regular, daily meal serving plan, and 67.26% was a little or not at all concerned about their eating habits. Only 30.9% from the smoking pregnant women group have received information from the family doctor (GP) regarding the risk factors of smoking habits, while 38.18% did not receive any information. Conclusions. Behavioral risk factors in pregnancy have to be followed closely by the HealthCare System in order to avoid complications for the mother and the child. The best way of accomplishing that is through an efficient community intervention.

Tobacco smoking during pregnancy and risk of adverse behaviour in offspring: A follow-up study.

This study examines associations between prenatal exposure to tobacco smoking and adverse behaviour in the offspring. We included 1016 pregnant women from Greenland and Ukraine (526 from Greenland and 490 from Ukraine). Serum cotinine measurements were used to identify smoking pregnant women. When the children were from five to nine years of age, the parents assessed the child's behaviour using the Strength and Difficulties Questionnaire (SDQ). Overall, smoking in pregnancy was not associated with a higher probability of adverse behaviour assessed by the total SDQ score. However, in the crude analysis smoking was associated with a higher mean difference of SDQ-total score. In Greenland the SDQ-total mean difference (MD) was (MD (95% CI)=1.31 points (0.42; 2.19)) and in Ukraine (MD (95% CI)=0.18 points (-1.2; 0.91)), whereas the adjusted mean differences were statistically non-significant. In utero exposure to tobacco smoking was not associated with a significant higher risk of adverse behaviour in the offspring, but elevated risk of adverse behaviour among children prenatally exposed to smoking cannot be excluded.

Effect of Cadmium in Cord Blood on Intrauterine Growth in Smoker Pregnant Women

Effect of Cadmium in Cord Blood on Intrauterine Growth in Smoker Pregnant Women

Clinical trials to prevent/treat childhood asthma: methodologic issues

There is currently much excitement about clinical trials for the primary and secondary prevention of childhood asthma [1–3]. For the first time in over 40 years there are real novel therapeutic possibilities that deserve testing. In thinking about the design of these trials, it is critical to consider four issues: the traditional validity threats to clinical trials, how fetal lung development influences clinical trial design, how asthma natural history and asthma subphenotypes influence trial design and finally, drug dosing for these studies. As might be suspected, fetal lung development has its greatest impact on primary prevention trials and asthma sub phenotypes have its greatest effect on secondary prevention trials. Although people often focus on the randomized controlled nature of clinical trials, the methodological issues of blinding and randomization address internal validity, and not the source population from which trial subjects are drawn. The greatest validity threat to any clinical trial is the external validity generalizability of results, can the trial results be extrapolated to the population at large and what will be the population impact of the new treatment or preventative. Concrete examples of these generalizability issues can be seen in the source population for two of the new primary prevention trials in childhood asthma: the Vitamin D Antenatal Asthma Reduction Trial (VDAART) and the recent trial of vitamin C to prevent asthma in smoking pregnant women [1,2]. In the former case, VDAART is focused on women with a prior personal, or family, history of asthma, or allergies and giving them vitamin D to prevent asthma in their offspring. If successful, it will be a generalizability leap to all pregnant women, even those with a low genetic risk of asthma in their children, to extrapolate the trial results. In the latter case of vitamin C, the source, or target population, is the 12% of pregnant women who smoke and, as yet, there is no evidence that vitamin C will prevent asthma in nonsmoking pregnant women. This issue of generalizability is important in targeting public health interventions particularly in the area of primary prevention.

Changes in Smoking During Pregnancy in Ontario, 1995 to 2010: Results From the Canadian Community Health Survey

ObjectiveThe objectives of this study were (1) to examine changes in smoking behaviour across time in pregnant women in Ontario (relative to non-pregnant women and men) and (2) to assess whether, among pregnant women, changes across time vary as a function of sociodemographic characteristics. MethodsThis study used data from the Canadian Community Health Survey. The study sample included 15- to 49-year-old residents of Ontario. Multivariable logistic regression, with interactions between time period and the characteristic of interest, was used to examine whether changes varied across time according to (1) group (pregnant women, non-pregnant women, men; two-year intervals, 2001 to 2010) and (2) pregnant subgroup (maternal age, maternal marital status, maternal education; 1995 to 2000 [n=3745], 2001 to 2005 [n=5084], and 2006 to 2010 [n=2900]). ResultsA decrease in the prevalence of smoking across time was seen in all groups but was smaller in pregnant women than in non-pregnant women (23.5% vs. 30.8%). Among pregnant women, interactions between time period and maternal age, maternal marital status, and maternal education were statistically significant. The prevalence of smoking during pregnancy decreased in older, married, and more highly educated women, but increased in younger women (by 8.2%) and less educated women (by 12.8%). Although the prevalence of smoking during pregnancy decreased in unmarried women, the change was smaller than in married women. ConclusionAlthough the prevalence of smoking in pregnant women is decreasing over time, the decrease is smaller than that in non-pregnant women. Pregnant subgroups particularly resistant to change include younger, unmarried, and less educated mothers. These findings suggest there are subgroups that should be targeted more deliberately by public health interventions.

Molecular basis of reduced birth weight in smoking pregnant women: mitochondrial dysfunction and apoptosis.

In utero exposure of fetuses to tobacco is associated with reduced birth weight. We hypothesized that this may be due to the toxic effect of carbon monoxide (CO) from tobacco, which has previously been described to damage mitochondria in non-pregnant adult smokers. Maternal peripheral blood mononuclear cells (PBMCs), newborn cord blood mononuclear cells (CBMCs) and placenta were collected from 30 smoking pregnant women and their newborns and classified as moderate and severe smoking groups, and compared to a cohort of 21 non-smoking controls. A biomarker for tobacco consumption (cotinine) was assessed by ELISA (enzyme-linked immunosorbent assay). The following parameters were measured in all tissues: mitochondrial chain complex IV [cytochrome c oxidase (COX)] activity by spectrophotometry, mitochondrial DNA levels by reverse transcription polymerase chain reaction, oxidative stress by spectrophotometric lipid peroxide quantification, mitochondrial mass through citrate synthase spectrophotometric activity and apoptosis by Western blot parallelly confirmed by TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labelling) assay in placenta. Newborns from smoking pregnant women presented reduced birth weight by 10.75 percent. Materno-fetal mitochondrial and apoptotic PBMC and CBMC parameters showed altered and correlated values regarding COX activity, mitochondrial DNA, oxidative stress and apoptosis. Placenta partially compensated this dysfunction by increasing mitochondrial number; even so ratios of oxidative stress and apoptosis were increased. A CO-induced mitotoxic and apoptotic fingerprint is present in smoking pregnant women and their newborn, with a lack of filtering effect from the placenta. Tobacco consumption correlated with a reduction in birth weight and mitochondrial and apoptotic impairment, suggesting that both could be the cause of the reduced birth weight in smoking pregnant women.

Tobacco use in pregnant women: analysis of data from Demographic and Health Surveys from 54 low-income and middle-income countries.

Worldwide, use of tobacco is viewed as an important threat to the health of pregnant women and their children. However, the extent of tobacco use in pregnant women in low-income and middle-income countries (LMICs) remains unclear. We assessed the magnitude of tobacco use in pregnant women in LMICs. We used data from Demographic and Health Surveys (DHS) done in 54 LMICs between Jan 1, 2001, and Dec 1, 2012, comprising 58 922 pregnant women (aged 15-49 years), which were grouped by WHO region. Prevalence of current tobacco use (smoked and smokeless) was estimated for every country. Pooled estimates by regions and overall were obtained from random-effects meta-analysis. Pooled prevalence of any tobacco use in pregnant women in LMICs was 2·6% (95% CI 1·8-3·6); the lowest prevalence was in the African region (2·0%, 1·2-2·9) and the highest was in the Southeast Asian region (5·1%, 1·3-10·9). The pooled prevalence of current tobacco smoking in pregnant women ranged from 0·6% (0·3-0·8) in the African region to 3·5% (1·5-12·1) in the Western Pacific region. The pooled prevalence of current smokeless tobacco use in pregnant women was lowest in the European region (0·1%, 0·0-0·3) and highest in the Southeast Asian region (2·6%, 0·0-7·6). Overall, tobacco use in pregnant women in LMICs was low; however high prevalence estimates were noted in some LMICs. Prevention and management of tobacco use and exposure to second-hand smoke in pregnancy is crucial to protect maternal and child health in LMICs. None.

Reduction in stillbirths at term after new birth induction paradigm: results of a national intervention

ObjectiveThe risk of fetal death increases steeply after 42 gestational weeks. Since 2009, Denmark has had a more proactive policy including prevention of prolonged pregnancy, and early intervention in women...

EXPERIENCES AND VIEWS OF PREGNANT WOMEN ON SMOKING

Backround: Worldwide, approximately 1 billion people, from which 200-250 million are women, smoke. Based on the Estonian Medical Birth Register data, in 2010, 7,5% of pregnant women were smokers, and in 2012, 7% of pregnant women were smoking during their pregnancy. Thus, smoking rates among pregnant women fell only 0,5%. The objective of the research was to find out the views of pregnant women who were smoking during pregnancy of the effect of smoking on the health of them and their babies, and experiences in quitting smoking, changing indicators, e.g. smoking and socioeconomical status (initial exposure to smoking, employment, long-term partnerships etc.) in 2009-2013.Methods: This research is a phenomenological study, which was being carried out from October 2009 until January 2013. Data collection methods were semi-structured interviews with 45 pregnant women smoking during their pregnancy and being registered for antenatal care in three health care institutions of Republic of Estonia. An inductive approach for qualitative analysis was used.Results: Most women smoking during pregnancy started smoking in their teens, their parents smoked, they were under 30 years old housewives or unemployed. On an average of 11-20 cigarettes were consumed each day, the pregnancy of the research group did not influence frequency and tobacco intake. The participants in the research group reported that tobacco consumption helped them relax, gave them a chance to spend time in a good company, and it was not regarded as a bad habit but a social addiction, being caused by availability of tobacco products. Although most of them had an opinion about harmful effects of smoking, e.g. a cough, asthma and rapid fatigue, on the health of them and less on their expected babies, they continued smoking.Conclusions: The smoking and socioeconomical status of women smoking during pregnancy in 2009-2013 has not changed, health awareness of them is low and has not improved. Support groups with close relatives are needed to motivate cessation. In the first place, prevention needs a good example, purposeful cooperation, which starts in daily life context – at homes, in educational institutions and in the community. Limiting the availability of tobacco products, postponing and preventing an initial exposure to smoking are thought to be of great importance. The results of the research will be introduced in health care institutions and they can be used in the health promotion process.

Maternal Second-Hand Smoke Exposure in Pregnancy Is Associated With Childhood Asthma Development

Childhood asthma development has been associated with active maternal smoking during pregnancy, but its association with maternal second-hand smoke exposure in pregnancy needs to be evaluated. We investigated longitudinal associations between maternal smoke exposure in pregnancy and childhood asthma development. In a population-based cohort of 5619 seven-year-old Toronto children, parents reported age of physician-diagnosed asthma development, maternal smoking during pregnancy, home second-hand smoke exposure from pregnancy until 7 years, demographics, and family history of atopy. By using Cox proportional and discrete-time hazard survival analyses, we evaluated associations between asthma and maternal smoking or home second-hand smoke exposure in pregnancy. During pregnancy, 5.0% of mothers smoked and 6.2% were nonsmokers and exposed to home second-hand smoke; 15.5% of children developed asthma. Children whose mothers smoked or were exposed to home second-hand smoke during pregnancy were more likely to develop asthma (adjusted hazard ratio [HR] 1.30 [95% CI, 1.06-1.60]). The association persisted for children of nonsmoking mothers with home second-hand smoke exposure during pregnancy (adjusted HR 1.34 [95% CI, 1.01-1.76]), children with asthma symptoms in the past year (adjusted HR 1.36 [95% CI, 1.03-1.79]), and after adjusting for home second-hand smoke exposure from birth to age 7 years. Maternal home second-hand smoke exposure during pregnancy is associated with incident physician-diagnosed childhood asthma, even if the mother does not smoke actively during pregnancy. Childhood asthma prevention programs should include smoking cessation strategies targeted toward smokers who live in the homes of smoking and nonsmoking pregnant women as well as pregnant women who smoke.

Simultaneous determination of cotinine and trans‐3‐hydroxycotinine in urine by automated solid‐phase extraction using gas chromatography–mass spectrometry

A gas chromatography–mass spectrometry method was developed and validated for the simultaneous automated solid-phase extraction and quantification of cotinine and trans-3-hydroxycotinine in human urine. Good linearity was observed over the concentration ranges studied (R2 > 0.99). The limit of quantification was 10 ng/mL for both analytes. The limits of detection were 0.06 ng/mL for cotinine (COT) and 0.02 ng/mL for trans-3-hydroxycotinine (OH-COT). Accuracy for COT ranged from 0.98 to 5.28% and the precision ranged from 1.24 to 8.78%. Accuracy for OH-COT ranged from −2.66 to 3.72% and the precision ranged from 3.15 to 7.07%. Mean recoveries for cotinine and trans-3-hydroxycotinine ranged from 77.7 to 89.1%, and from 75.4 to 90.2%, respectively. This analytical method for the simultaneous measurement of cotinine and trans-3-hydroxycotinine in urine will be used to monitor tobacco smoking in pregnant women and will permit the usefulness of trans-3-hydroxycotinine as a specific biomarker of tobacco exposure to be determined. © 2014 The Authors. Biomedical Chromatography published by John Wiley & Sons Ltd.

Estimating Cotinine Associations and a Saliva Cotinine Level to Identify Active Cigarette Smoking in Alaska Native Pregnant Women

Studies indicate nicotine metabolism varies by race and can change during pregnancy. Given high rates of tobacco use and limited studies among Alaska Native (AN) women, we estimated associations of saliva cotinine levels with cigarette use and second-hand smoke (SHS) exposure and estimated a saliva cotinine cutoff to distinguish smoking from non-smoking pregnant AN women. Using questionnaire data and saliva cotinine, we utilized multi-variable linear regression (n=370) to estimate cotinine associations with tobacco use, SHS exposure, demographic, and pregnancy-related factors. Additionally, we estimated an optimal saliva cotinine cutoff for indication of active cigarette use in AN pregnant women using receiver operating characteristic (ROC) curve analysis (n=377). Saliva cotinine significantly decreased with maternal age and significantly increased with cigarettes smoked per day, SHS exposure, and number of previous full term pregnancies. Using self-reported cigarette use in the past 7days as indication of active smoking, the area under the ROC curve was 0.975 (95% CI: 0.960-0.990). The point closest to 100% specificity and sensitivity occurred with a cotinine concentration of 1.07ng/mL, which corresponded to sensitivity of 94% and specificity of 94%. We recommend using a saliva cotinine cutoff of 1ng/mL to distinguish active smoking in pregnant AN women. This cutoff is lower than used in other studies with pregnant women, most likely due to high prevalence of light or intermittent smoking in the AN population. Continued study of cotinine levels in diverse populations is needed.