1
|
Tran EL, England LJ, Park Y, Denny CH, Kim SY. Systematic Review: Polysubstance Prevalence Estimates Reported during Pregnancy, US, 2009-2020. Matern Child Health J 2023; 27:426-458. [PMID: 36752906 PMCID: PMC10521102 DOI: 10.1007/s10995-023-03592-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The objective of this systematic review is to describe polysubstance studies and their prevalence estimates among pregnant people in the US. METHODS This review was not subject to protocol preparation or registration with the International Prospective Register of Systematic Reviews (PROSPERO) because outcome data were not reported. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist was followed. Four scientific literature databases were used to identify articles published from January 1, 2009 to June 3, 2020 reporting prenatal exposure to two or more substances in the US. A standardized process of title and abstract screening followed by a two-phase full-text review was used to assess study eligibility. RESULTS A total of 119 studies were included: 7 case-control studies, 7 clinical trials, 76 cohort studies, and 29 cross-sectional studies. Studies varied with respect to study design, time period, region, sampling and participant selection, substances assessed, and method of exposure ascertainment. Commonly reported polysubstance prevalence estimates among studies of pregnant people included combinations with alcohol, marijuana, and/or tobacco/nicotine. The range of prevalence estimates was wide (alcohol 1-99%; marijuana 3-95%; tobacco/nicotine 2-95%). DISCUSSION Polysubstance use during pregnancy is common, especially with alcohol, marijuana, and/or tobacco/nicotine. Future research to assess polysubstance use during pregnancy could help better describe patterns and ultimately help mitigate its effects on maternal and infant health outcomes.
Collapse
Affiliation(s)
- Emmy L Tran
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA.
- Eagle Global Scientific, LLC, 2835 Brandywine Rd, Suite 200, Atlanta, GA, 30341, USA.
| | - Lucinda J England
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| | - Youngjoo Park
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Clark H Denny
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| | - Shin Y Kim
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| |
Collapse
|
2
|
McConnell MA, Rokicki S, Ayers S, Allouch F, Perreault N, Gourevitch RA, Martin MW, Zhou RA, Zera C, Hacker MR, Chien A, Bates MA, Baicker K. Effect of an Intensive Nurse Home Visiting Program on Adverse Birth Outcomes in a Medicaid-Eligible Population: A Randomized Clinical Trial. JAMA 2022; 328:27-37. [PMID: 35788794 PMCID: PMC9257581 DOI: 10.1001/jama.2022.9703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Improving birth outcomes for low-income mothers is a public health priority. Intensive nurse home visiting has been proposed as an intervention to improve these outcomes. OBJECTIVE To determine the effect of an intensive nurse home visiting program on a composite outcome of preterm birth, low birth weight, small for gestational age, or perinatal mortality. DESIGN, SETTING, AND PARTICIPANTS This was a randomized clinical trial that included 5670 Medicaid-eligible, nulliparous pregnant individuals at less than 28 weeks' gestation, enrolled between April 1, 2016, and March 17, 2020, with follow-up through February 2021. INTERVENTIONS Participants were randomized 2:1 to Nurse Family Partnership program (n = 3806) or control (n = 1864). The program is an established model of nurse home visiting; regular visits begin prenatally and continue through 2 postnatal years. Nurses provide education, assessments, and goal-setting related to prenatal health, child health and development, and maternal life course. The control group received usual care services and a list of community resources. Neither staff nor participants were blinded to intervention group. MAIN OUTCOMES AND MEASURES There were 3 primary outcomes. This article reports on a composite of adverse birth outcomes: preterm birth, low birth weight, small for gestational age, or perinatal mortality based on vital records, Medicaid claims, and hospital discharge records through February 2021. The other primary outcomes of interbirth intervals of less than 21 months and major injury or concern for abuse or neglect in the child's first 24 months have not yet completed measurement. There were 54 secondary outcomes; those related to maternal and newborn health that have completed measurement included all elements of the composite plus birth weight, gestational length, large for gestational age, extremely preterm, very low birth weight, overnight neonatal intensive care unit admission, severe maternal morbidity, and cesarean delivery. RESULTS Among 5670 participants enrolled, 4966 (3319 intervention; 1647 control) were analyzed for the primary maternal and neonatal health outcome (median age, 21 years [1.2% non-Hispanic Asian, Indigenous, or Native Hawaiian and Pacific Islander; 5.7% Hispanic; 55.2% non-Hispanic Black; 34.8% non-Hispanic White; and 3.0% more than 1 race reported [non-Hispanic]). The incidence of the composite adverse birth outcome was 26.9% in the intervention group and 26.1% in the control group (adjusted between-group difference, 0.5% [95% CI, -2.1% to 3.1%]). Outcomes for the intervention group were not significantly better for any of the maternal and newborn health primary or secondary outcomes in the overall sample or in either of the prespecified subgroups. CONCLUSIONS AND RELEVANCE In this South Carolina-based trial of Medicaid-eligible pregnant individuals, assignment to participate in an intensive nurse home visiting program did not significantly reduce the incidence of a composite of adverse birth outcomes. Evaluation of the overall effectiveness of this program is incomplete, pending assessment of early childhood and birth spacing outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03360539.
Collapse
Affiliation(s)
- Margaret A. McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Abdul Latif Jameel Poverty Action Lab (J-PAL), Massachusetts Institute of Technology, Cambridge
| | - Slawa Rokicki
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Samuel Ayers
- Center for Education Policy Research, Harvard Graduate School of Education, Cambridge, Massachusetts
| | - Farah Allouch
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Nicolas Perreault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Michelle W. Martin
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Chloe Zera
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Michele R. Hacker
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alyna Chien
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Mary Ann Bates
- Abdul Latif Jameel Poverty Action Lab (J-PAL), Massachusetts Institute of Technology, Cambridge
- Center for Education Policy Research, Harvard Graduate School of Education, Cambridge, Massachusetts
- Now with Cradle-to-Career Data System, State of California, Sacramento
| | - Katherine Baicker
- Abdul Latif Jameel Poverty Action Lab (J-PAL), Massachusetts Institute of Technology, Cambridge
- National Bureau of Economic Research (NBER), Cambridge, Massachusetts
- University of Chicago Harris School of Public Policy, Chicago, Illinois
| |
Collapse
|
3
|
Abidi FB, Laing L, Cooper S, Coleman T, Campbell KA. Experts' Views on Behaviour Change Techniques for Smoking Cessation in Pregnancy: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217729. [PMID: 33105804 PMCID: PMC7660064 DOI: 10.3390/ijerph17217729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
Smoking during pregnancy is a global health problem which has devastating health implications. Behavioural support is an important part of smoking cessation support for pregnant women. Research has identified barriers and facilitators (B&Fs) and effective behaviour change techniques (BCTs) to aid women's quit attempts. However, the extent to which and how these BCTs are used in practice is unclear. The research aimed to establish experts' views on how behavioural support can be optimised and techniques operationalised in clinical practice, by identifying ways to address known B&Fs for smoking cessation in pregnancy. A focus group discussion took place with six experts, which highlighted how BCTs can be used in practice to support women in their quit attempts. A thematic analysis was conducted to elicit overarching themes. Five themes were found: involving the family, empowering women, using incentives to boost motivation, using practical techniques to help women with their quit attempts and managing expectations about nicotine replacement therapy. Empowering women to make their own decisions and encouraging small positive changes in smoking habits, using visual aids (e.g., growth charts) to inform women of the harms of smoking to the baby and treating families holistically were deemed important.
Collapse
|
4
|
Berveiller P, Rault E, Guerby P. [Physiological and Psychological Data influencing Pregnant Women Smoking Behavior - CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:551-558. [PMID: 32247097 DOI: 10.1016/j.gofs.2020.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Nicotine is the main addictive substance in tobacco and its addictive effects mainly involve dopamine. Nicotine is mainly metabolized (C-oxidation) in the liver to cotinine by the cytochrome P450 enzyme system. Nicotine half-life is short being about 2hours. Nicotine metabolism appears to be increased during pregnancy, mainly due to an increased cytochrome activity and maternal cardiac output. Thus, the smoking behavior of the pregnant woman is subsequently modified with an increase in withdrawal syndromes and an increased desire to smoke. These pharmacological elements should be taken into account when prescribing nicotine replacement therapy. Regarding the markers of tobacco intoxication, there is a good correlation between the importance of smoking and the measurement of expired air carbon monoxide. Although there is no evidence of decreased obstetrical complications related to its use, it is simple and non-invasive and therefore may be useful in routine practice. It gives an instantaneous value of tobacco intoxication, and represents a starting point for dialogue and management and can help to highlight the reality of withdrawal. Regarding the evaluation of tobacco addiction, the most commonly used questionnaires are the Fagerström tests (FTCD, HSI…), which are well correlated with cotinine concentration. However, there is insufficient evidence of their usefulness in reducing tobacco consumption during pregnancy to recommend them in current practice. DSM-V diagnostic criteria for addiction should be known as they can also be used to characterize the intensity of this addiction.
Collapse
Affiliation(s)
- P Berveiller
- Service de gynécologie-obstétrique, CHI de Poissy St-Germain, 78300 Poissy, France.
| | - E Rault
- Service d'obstétrique, hospices civils de Lyon, hôpital Femme-Mère-Enfant Lyon, 69500 Bron, France
| | - P Guerby
- Service de gynécologie-obstétrique, CHU de Toulouse, 31300 Toulouse, France
| |
Collapse
|
5
|
Jones AM, Carter-Harris L, Stiffler D, Macy JT, Staten LK, Shieh C. Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women. J Obstet Gynecol Neonatal Nurs 2020; 49:361-372. [PMID: 32561271 DOI: 10.1016/j.jogn.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To describe the point prevalence rates, relapse rates, smoking status, and symptoms of depression and to examine the relationship between smoking status and symptoms of depression from early pregnancy to 12 months after childbirth among low-income women. DESIGN Secondary data analysis. SETTING Data from the national Nurse-Family Partnership program. PARTICIPANTS Women who were enrolled in the national Nurse-Family Partnership program between 2011 and 2016 with histories of smoking 3 months before pregnancy (N = 1,554). METHODS We used smoking status and Edinburgh Postnatal Depression Scale scores in early pregnancy, late pregnancy, and 12 months after childbirth to identify point prevalence rates, relapse rates, smoking status, and symptoms of depression. We used chi-square and additional analyses to examine the relationship between smoking status and symptoms of depression. RESULTS The prevalence of smoking was 30.12% (n = 468) in early pregnancy, 24.39% (n = 379) in late pregnancy, and 50.58% (n = 786) 12 months after childbirth. Prevalence rates of a positive depression screening result were 30.31% (n = 471), 20.46% (n = 318), and 18.08% (n = 281), respectively. Smoking relapse rates were 2.45% (n = 38) during the third trimester and 27.86% (n = 433) at 12 months after childbirth. Eight distinct patterns of smoking and depression were identified. Women who smoked were significantly more likely to also have positive depression screening results during the third trimester and at 12 months after childbirth compared with nonsmoking women (OR = 1.37, 95% confidence interval [1.04, 1.81] and OR = 1.93, 95% confidence interval [1.47, 2.51], respectively). CONCLUSION Prevalence rates of smoking, relapse, and positive depression screening results were great in this sample of low-income women during and after pregnancy. Pivotal time points exist where the trajectory of smoking and depression screening patterns may change. It is important for smoking cessation interventions to incorporate mental health assessment and treatment.
Collapse
|
6
|
Patten CA, Koller KR, Flanagan CA, Hiratsuka V, Merritt ZT, Sapp F, Meade CD, Hughes CA, Decker PA, Murphy N, Thomas TK. Postpartum Tobacco Use and Perceived Stress among Alaska Native Women: MAW Phase 4 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3024. [PMID: 31438550 PMCID: PMC6747207 DOI: 10.3390/ijerph16173024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 01/29/2023]
Abstract
Prior research explored reasons for tobacco use among pregnant Alaska Native (AN) women but did not address the postpartum period. This study followed up with AN women one to three years postpartum who had participated in a prenatal smoking cessation intervention study (Motivate Alaska Women (MAW) Phase 3) and had consented to be re-contacted for future studies. Of 47 eligible women, 32 (68%) participated. A semi-structured phone interview was conducted a mean of 2.0 years after delivery (range 1.6-2.8). Measures assessed self-reported tobacco use status in the 12 months after delivery, at 12 months postpartum, and at the time of the interview; reasons for maintaining abstinence, continued use, or relapse; and included the Perceived Stress Scale (PSS) and Negative Affect (NA) scale. Content analysis was used to generate themes from open-ended response items. Tobacco use was reported by 23 women (72%) at delivery, 30 (94%) within the 12 months after delivery, 27 (84%) at 12 months postpartum, and 29 (91%) at the time of the interview. Among nine women not using tobacco at delivery, seven (78%) relapsed during the 12 months after delivery. Of the 29 current tobacco users, 28 (97%) smoked cigarettes. Twenty-seven participants (84%) reported stress and 15 (52%) indicated addiction as reasons for continuing, starting, or resuming tobacco use. Types of stressors were related to parenting and traumatic experiences. Among current tobacco users, mean NA score (18.7) was significantly higher (p = 0.01) than the normative mean (14.8), but no differences were detected for PSS score. In this sample of AN women, postpartum tobacco use was highly prevalent, and stress was a primary reason that women endorsed for using tobacco. These preliminary results have several practice and research implications for exploring ways to support non-tobacco use among postpartum AN women.
Collapse
Affiliation(s)
- Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Kathryn R Koller
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Christie A Flanagan
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Vanessa Hiratsuka
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK 99508, USA
| | - Zoe T Merritt
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Flora Sapp
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Crystal D Meade
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Christine A Hughes
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Neil Murphy
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK 99508, USA
| | - Timothy K Thomas
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| |
Collapse
|
7
|
Yang I, Hall L. Factors related to prenatal smoking among socioeconomically disadvantaged women. Women Health 2019; 59:1026-1074. [PMID: 30835645 DOI: 10.1080/03630242.2019.1584145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Socioeconomically disadvantaged pregnant women are especially at risk for smoking. To understand better this health behavior disparity, this systematic, integrative, comprehensive review aimed to identify factors related to prenatal smoking among socioeconomically disadvantaged women in the United States. A comprehensive literature search yielded 67 articles published between 2008 and 2016. Associated factors included any study variable related to persistent prenatal smoking. The Social Ecological Model (SEM), a multidimensional ecological framework, was used to organize the findings. Thirty-eight factors were explored in the reviewed studies and categorized according to SEM dimensions: individual, interpersonal, organizational, community, public policies and laws. At the individual level, most studies identified the socioeconomically disadvantaged prenatal smoker as older, US-born, White, unmarried, and multiparous. Other individual-level factors included alcohol abuse, nicotine dependence, and psychosocial factors such as stress and depressive symptoms. For broader levels of the SEM, associated factors included abuse/trauma, secondhand smoke exposure, lack of prenatal care, smoking cessation interventions, neighborhood risk, and state level initiatives such as cigarette taxes. The results of this review suggested multiple directions for future research to move science toward effective, scalable, and sustainable approaches that effectively address prenatal smoking among socioeconomically disadvantaged women.
Collapse
Affiliation(s)
- Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta , GA , USA
| | - Lynne Hall
- School of Nursing, University of Louisville , Louisville , KY , USA
| |
Collapse
|
8
|
Bai G, Raat H, Jaddoe VWV, Mautner E, Korfage IJ. Trajectories and predictors of women's health-related quality of life during pregnancy: A large longitudinal cohort study. PLoS One 2018; 13:e0194999. [PMID: 29614087 PMCID: PMC5882096 DOI: 10.1371/journal.pone.0194999] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/14/2018] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to identify distinct trajectories and their predictors of health-related quality of life (HRQOL) of women during pregnancy in a prospective mother and child cohort. Analyses were based on 3936 Dutch pregnant women in Rotterdam area, the Netherlands. Information on potential predictors was collected in early pregnancy by questionnaire. Latent Class Mixture Modelling and Multinomial Logistic Regression were applied to assess the trajectory and predictors of HRQOL during pregnancy. HRQOL was measured by SF-12 in early, mid- and late pregnancy; physical and mental component summary (PCS-12/MCS-12) scores were calculated. Four physical HRQOL trajectories were identified: a healthy trajectory (‘healthy’) in 63.3%, consistently low (‘vulnerable’) in 10.8%; a small increase (‘recovering’) in 12.8% and a large decrease (‘at risk’) in 13.1%. Three mental HRQOL trajectories were identified: a healthy trajectory (‘healthy’) in 86.1%; a large increase (‘recovering’) in 7.5%; and a large decrease (‘at risk’) in 6.4%. Compared with healthy trajectories, the likelihood of following the ‘vulnerable’ physical HRQOL trajectory rather than a healthy trajectory was increased by daily fatigue(OR: 4.82[2.76, 8.40]), pelvic pain (OR:4.76[2.91, 7.78]) and back pain (OR:5.29[3.21, 8.70]); pregnancy-specific anxiety increased the likelihood of following the ‘at risk’ mental HRQOL trajectory (OR:7.95[4.84, 13.05]). Healthy physical and mental HRQOL trajectories during pregnancy were most common. Predictors indicative of poor HRQOL trajectories included pregnancy-related symptoms and anxiety.
Collapse
Affiliation(s)
- Guannan Bai
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, South Holland, the Netherlands
- The Generation R Group, Erasmus MC- University Medical Center Rotterdam, Rotterdam, South Holland, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, South Holland, the Netherlands
- * E-mail:
| | - Vincent W. V. Jaddoe
- The Generation R Group, Erasmus MC- University Medical Center Rotterdam, Rotterdam, South Holland, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, South Holland, the Netherlands
- Department of Paediatrics, Erasmus MC- University Medical Center Rotterdam, Rotterdam, South Holland, the Netherlands
| | - Eva Mautner
- Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, Graz, Austria
| | - Ida J. Korfage
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, South Holland, the Netherlands
| |
Collapse
|
9
|
Kawasaki Y, Miyake Y, Tanaka K, Furukawa S, Arakawa M. Smoking and secondhand smoke exposure and prevalence of depressive symptoms during pregnancy in Japan: baseline data from the Kyushu Okinawa Maternal and Child Health Study. Tob Induc Dis 2017; 15:34. [PMID: 28747858 PMCID: PMC5525258 DOI: 10.1186/s12971-017-0139-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/13/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yuri Kawasaki
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yoshihiro Miyake
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.,Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Ehime, Japan
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.,Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Ehime, Japan
| | - Shinya Furukawa
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.,Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Ehime, Japan
| | - Masashi Arakawa
- Health Tourism Research Fields, Graduate School of Tourism Sciences, University of the Ryukyus, Okinawa, Japan
| |
Collapse
|
10
|
Damron KR. Review of the Relationships Among Psychosocial Stress, Secondhand Smoke, and Perinatal Smoking. J Obstet Gynecol Neonatal Nurs 2017; 46:325-333. [PMID: 28390924 DOI: 10.1016/j.jogn.2017.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To summarize and evaluate the recently published literature in which the relationships among psychosocial stress, smoking, and exposure to secondhand smoke during the perinatal period are examined, and to describe the characteristics and demographics of the samples. DATA SOURCES Electronic databases MEDLINE, Academic Search Complete, CINAHL, Psychology and Behavioral Sciences Collection, and PsychINFO. In addition, hand searches of reference lists supplemented the electronic search. STUDY SELECTION English language, peer-reviewed studies published between 2010 and 2015 on the relationships of self-reported or perceived stress, smoking, and secondhand smoke exposure during pregnancy and postpartum were included. Twenty-four studies met the inclusion criteria. DATA EXTRACTION Data that specified the relationships among smoking, stress, and secondhand smoke exposure during pregnancy and postpartum were extracted from the studies. A table matrix, available as supplemental material, to summarize the literature and sample characteristics and demographics was created. DATA SYNTHESIS Evidence from the included studies supported an association between psychosocial stress specific to pregnancy or from other sources and smoking or smoking relapse during pregnancy or in the postpartum period. In the studies in which it was included, exposure to secondhand smoke was cited as a barrier to abstinence. CONCLUSION It is probable that women who persistently smoke in pregnancy experience elevated stress. Further research with longitudinal designs and inclusion of secondhand smoke as a variable are needed.
Collapse
|
11
|
Oh S, Reingle Gonzalez JM, Salas-Wright CP, Vaughn MG, DiNitto DM. Prevalence and correlates of alcohol and tobacco use among pregnant women in the United States: Evidence from the NSDUH 2005-2014. Prev Med 2017; 97:93-99. [PMID: 28111096 DOI: 10.1016/j.ypmed.2017.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/04/2016] [Accepted: 01/17/2017] [Indexed: 11/18/2022]
Abstract
Alcohol and tobacco use during pregnancy are among the strongest and most preventable risk factors for adverse neonatal health outcomes, but few developmentally sensitive, population-based studies of this phenomenon have been conducted. To address this gap, the present study examined the prevalence and correlates of alcohol and tobacco use among pregnant adolescents (aged 12-17) and adults (aged 18-44) in the United States. Data were derived from the population-based National Survey of Drug Use and Health (80,498 adolescent and 152,043 adult women) between 2005 and 2014. Findings show disconcerting levels of past-month use among pregnant women with 11.5% of adolescent and 8.7% of adult women using alcohol, and 23.0% of adolescent and 14.9% of adult women using tobacco. Compared to their non-pregnant counterparts, pregnant adolescents were less likely to report past 30-day alcohol use (AOR=0.52, 95% CI=0.36-0.76), but more likely to report past 30-day tobacco use (AOR=2.20, 95% CI=1.53-3.18). Compared to their non-pregnant adult counterparts, pregnant adults were less likely to report using alcohol (AOR=0.06, 95% CI=0.05-0.07) and tobacco (AOR=0.47, 95% CI=0.43-0.52). Compared to pregnant abstainers, pregnant women reporting alcohol/tobacco use were more likely to have had a major depressive episode in the past 12months, report criminal justice system involvement, and endorse comorbid alcohol/tobacco use. Given alcohol and tobacco's deleterious consequences during pregnancy, increased attention to reducing use is critical. Findings suggest that tobacco use is especially problematic for both adolescents and adults and is strongly linked with depression and criminal justice involvement, especially among adults.
Collapse
Affiliation(s)
- Sehun Oh
- School of Social Work, The University of Texas at Austin, United States.
| | - Jennifer M Reingle Gonzalez
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, United States
| | | | - Michael G Vaughn
- College for Public Health and Social Justice, Saint Louis University, United States
| | - Diana M DiNitto
- School of Social Work, The University of Texas at Austin, United States
| |
Collapse
|
12
|
Oskarsdottir GN, Sigurdsson H, Gudmundsson KG. Smoking during pregnancy: A population-based study. Scand J Public Health 2016; 45:10-15. [PMID: 27799421 DOI: 10.1177/1403494816676034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Tobacco is a major cause of disease and mortality in modern times. The risk of smoking in pregnancy is a serious threat to the development and future health of an unborn child. The aim of this study was to explore the epidemiological factors associated with smoking during pregnancy in a primary healthcare setting. METHODS All 856 maternity records at the Glaesibaer Health Care Centre in Reykjavik during 2006-2013 were reviewed and information on smoking habits investigated. RESULTS The records showed that in 108 (12.2%) pregnancies, women smoked at first visit and 63 stopped smoking in early pregnancy, leaving 45 (5.3%) mothers smoking throughout the whole gestational period. The mean age of the smoking women was 27.8 years and for the non-smokers 29.7 years. Low social status (odds ratio (OR) = 2.66; 95% confidence interval (CI): 1.19-5.96), previous mental health diagnosis (OR = 2.7; 95% CI: 1.3-5.6), and unstable relationship with a partner (OR = 3.78; 95% CI: 2.1-7.0) were associated with smoking. Smoking fewer cigarettes was associated with a 0.04-unit lower risk of smoking during pregnancy (OR = 0.04: 95% CI: 0.02-0.08). CONCLUSIONS Our results indicated that the women who smoked during pregnancy were often heavy smokers and living without a partner. They were younger, had worse mental health, and a lower social status than those pregnant women who did not smoke. Bearing in mind the consequence of smoking in pregnancy, this subgroup should get increased assistance to quit smoking before and during early pregnancy, as well as appropriate medical and social support.
Collapse
|
13
|
Brown QL, Hasin DS, Keyes KM, Fink DS, Ravenell O, Martins SS. Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age. Drug Alcohol Depend 2016; 166:116-24. [PMID: 27422762 PMCID: PMC4983465 DOI: 10.1016/j.drugalcdep.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/22/2016] [Accepted: 07/02/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding the relationship between health insurance coverage and tobacco and alcohol use among reproductive age women can provide important insight into the role of access to care in preventing tobacco and alcohol use among pregnant women and women planning to become pregnant. METHODS We examined the association between health insurance coverage and both past month alcohol use and past month tobacco use in a nationally representative sample of women age 12-44 years old, by pregnancy status. The women (n=97,788) were participants in the National Survey of Drug Use and Health (NSDUH) in 2010-2013. Logistic regression models assessed the association between health insurance (insured versus uninsured), past month tobacco and alcohol use, and whether this was modified by pregnancy status. RESULTS Pregnancy status significantly moderated the relationship between health insurance and tobacco use (p-value≤0.01) and alcohol use (p-value≤0.01). Among pregnant women, being insured was associated with lower odds of alcohol use (adjusted odds ratio [AOR]=0.47; 95% confidence interval [CI]=0.27-0.82), but not associated with tobacco use (AOR=1.14; 95% CI=0.73-1.76). Among non-pregnant women, being insured was associated with lower odds of tobacco use (AOR=0.67; 95% CI=0.63-0.72), but higher odds of alcohol use (AOR=1.23; 95% CI=1.15-1.32). CONCLUSION Access to health care, via health insurance coverage is a promising method to help reduce alcohol use during pregnancy. However, despite health insurance coverage, tobacco use persists during pregnancy, suggesting missed opportunities for prevention during prenatal visits.
Collapse
Affiliation(s)
- Qiana L. Brown
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY,New York State Psychiatric Institute, New York, NY,Corresponding author at: Deborah S. Hasin, Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive #123, New York, NY 10032, US. Phone: 1 (646) 774-7909, Fax: 1 (646) 774-7920.
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - David S. Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Silvia S. Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| |
Collapse
|
14
|
Mumford EA, Liu W. Social Integration and Maternal Smoking: A Longitudinal Analysis of a National Birth Cohort. Matern Child Health J 2016; 20:1586-97. [PMID: 26987858 DOI: 10.1007/s10995-016-1958-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Social support and engagement are related to smoking behavior in general populations, but it is unknown whether these measures of social integration as experienced by recent mothers are related to longitudinal maternal smoking patterns. The purpose of this study is, first, to describe longitudinal patterns of maternal smoking before, during, and after pregnancy through the early childhood parenting years, as well as variation in these patterns; and second, to examine these patterns in relation to social integration, emotional, behavioral, and sociodemographic factors. Methods Among 9050 mothers of the Early Childhood Longitudinal Study-Birth Cohort (a nationally representative probability sample of children born in 2001), we estimated trajectories of maternal smoking with a general growth mixture model and examined how baseline predictors are associated with these patterns over a 5-6 year period beginning 3 months prior to pregnancy. Results A 5-class solution identified trajectories of nonsmokers (70.5 %), temporary quitters (9.4 %), pregnancy-inspired quitters (3.3 %), delayed initiators (5.1 %), and persistent smokers (11.7 %). Modifiable risk factors included postpartum alcohol consumption and behavioral cues from co-resident smokers, while breastfeeding beyond 6 months and social engagement through religious service attendance were protective characteristics. Conclusions for Practice Prevention of and treatment for maternal perinatal and postpartum smoking is best informed by mothers' emotional, behavioral and sociodemographic characteristics. Religious service attendance, but not measures of social support or social engagement, was a protective factor for maternal smoking trajectories.
Collapse
Affiliation(s)
- Elizabeth A Mumford
- Public Health Research, NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, Bethesda, MD, 20814, USA.
| | - Weiwei Liu
- Public Health Research, NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, Bethesda, MD, 20814, USA
| |
Collapse
|
15
|
Boucher J, Konkle ATM. Understanding Inequalities of Maternal Smoking--Bridging the Gap with Adapted Intervention Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E282. [PMID: 26959037 PMCID: PMC4808945 DOI: 10.3390/ijerph13030282] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 11/25/2022]
Abstract
Women who are generally part of socially disadvantaged and economically marginalized groups are especially susceptible to smoking during pregnancy but smoking rates are underreported in both research and interventions. While there is evidence to support the short-term efficacy of nicotine replacement therapy (NRT) use in pregnancy, long-term abstinence rates are modest. Current health strategies and interventions designed to diminish smoking in pregnancy have adopted a simplified approach to maternal smoking-one that suggests that they have a similar degree of choice to non-pregnant smokers regarding the avoidance of risk factors, and overlooks individual predictors of non-adherence. As a result, interventions have been ineffective among this high-risk group. For this reason, this paper addresses the multiple and interacting determinants that must be considered when developing and implementing effective strategies that lead to successful smoking cessation: socioeconomic status (SES), nicotine dependence, social support, culture, mental health, and health services. Based on our review of the literature, we conclude that tailoring cessation programs for pregnant smokers may ultimately optimize NRT efficacy and reduce the prevalence of maternal smoking.
Collapse
Affiliation(s)
- Julie Boucher
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, ON K1N 6N5, Canada.
| | - Anne T M Konkle
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, ON K1N 6N5, Canada.
- School of Psychology, University of Ottawa, Ontario, ON K1N 6N5, Canada.
| |
Collapse
|
16
|
Abstract
This integrative review provides an overview of nicotine dependence measures used with perinatal women and an evaluation of their psychometric properties. Fifty-five articles that met inclusion and exclusion criteria were identified from five different databases. Most of the studies used the Fagerström Test for Nicotine Dependence (FTND). Other approaches included diagnostic tests, the Wisconsin Inventory of Smoking Dependence Motives (WISDM), the Tobacco Dependence Screener, and single-item measures. This review indicated that the FTND may not be the best option for measuring nicotine dependence in this population. The WISDM is a newer instrument that has excellent psychometric properties and captures nonnicotinic dimensions of nicotine dependence relevant to women. Future research is needed to assess its reliability in the perinatal population. Other recommendations from this review include the use of biomarker validation, thorough psychometric reporting on nicotine dependence instruments, and the use of multiple instruments to maximize comparability between nicotine dependence instruments.
Collapse
|
17
|
Clark CAC, Espy KA, Wakschlag L. Developmental pathways from prenatal tobacco and stress exposure to behavioral disinhibition. Neurotoxicol Teratol 2015; 53:64-74. [PMID: 26628107 DOI: 10.1016/j.ntt.2015.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/04/2015] [Accepted: 11/23/2015] [Indexed: 12/25/2022]
Abstract
Prenatal tobacco exposure (PTE) and prenatal stress exposure (PSE) both have been linked to externalizing behavior, although their effects generally have been considered in isolation. Here, we aimed to characterize the joint or interactive roles of PTE and PSE in early developmental pathways to behavioral disinhibition, a profile of cognitive and behavioral under-control that presages severe externalizing behavior. As part of a prospective, longitudinal study, 296 children were assessed at a mean age of 5 years. Exposures were assessed via repeated interviews across the prenatal period and bioassays of cotinine were obtained. Behavioral disinhibition was assessed using temperament measures in infancy, performance-based executive control tasks and measures of disruptive and inattentive behavior. PSE was associated with a higher probability of difficult temperament in infancy. Each exposure independently predicted poorer executive control at age 5 years. Difficult temperament and executive control difficulties in turn predicted elevated levels of disruptive behavior, although links from PTE and PSE to parent-reported attention problems were less robust. Children who experienced these prenatal exposures in conjunction with higher postnatal stress exposure showed the lowest executive control and highest levels of disruptive behavior. Findings highlight the compounding adverse impact of PTE and PSE on children's behavioral trajectories. Given their high concordance, prenatal health campaigns should target these exposures in tandem.
Collapse
Affiliation(s)
- C A C Clark
- Department of Psychology, University of Arizona, United States
| | - K A Espy
- Department of Psychology, University of Arizona, United States; Developmental Cognitive Neuroscience Laboratory, University of Nebraska-Lincoln, United States
| | - L Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Policy Research, Northwestern University, United States
| |
Collapse
|
18
|
Smedberg J, Lupattelli A, Mårdby AC, Øverland S, Nordeng H. The relationship between maternal depression and smoking cessation during pregnancy--a cross-sectional study of pregnant women from 15 European countries. Arch Womens Ment Health 2015; 18:73-84. [PMID: 25352316 DOI: 10.1007/s00737-014-0470-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 10/18/2014] [Indexed: 12/16/2022]
Abstract
Epidemiologic studies have reported an association between depression and continuing smoking during pregnancy. However, differences in study design and methodology challenge study comparability. The purpose of this study was to examine the relationship between maternal depression and continuing smoking among pregnant European women while adjusting for maternal characteristics. This multinational, web-based study evaluated pregnant women in 15 European countries recruited from October 2011 to February 2012. Data on depression status, smoking habits, maternal socio-demographic characteristics, and life-style factors were collected via an anonymous online questionnaire. Associations were estimated with logistic regression. Of 4,295 women included, 1,481 (34.5 %) reported smoking before pregnancy, and 391 (26.4 %) continued smoking during pregnancy whereof 127 (32.5 %) were depressed. The association between depression and continuing smoking during pregnancy were uniform across the European countries (OR 2.02, 95 % CI 1.50-2.71), with about twice the prevalence of continuing smoking among the depressed. There was a strong relationship between continuing smoking in pregnancy and low education level (OR 4.46, 95 % CI 2.72-7.32), which coincided with risky pregnancy behavior such as failure to attend pregnancy/birth preparation courses (OR 1.80, 95 % CI 1.19-2.72) and follow recommended use of folic acid (OR 1.81, 95 % CI 1.23-2.65). Women who perceived the risk for the fetus of continued smoking during pregnancy as higher were the least likely to continue smoking during pregnancy (OR 0.72, 95 % CI 0.68-0.77). This underlines the clustering of risk in some pregnant women, and the results should guide antenatal care of depressed women struggling to quit smoking during pregnancy.
Collapse
|
19
|
Abstract
BACKGROUND Persistent maternal smoking during pregnancy, reduction or cessation during pregnancy, and smoking initiation or resumption postpartum impel further research to understand these behavioral patterns and opportunities for intervention. OBJECTIVES We investigated heterogenous longitudinal patterns of smoking quantity to determine if these patterns vary across three maternal age groups, and whether the influence of individual and contextual risk factors varies by maternal age. METHODS Separate general growth mixture models were estimated for mothers ages 15-25, 26-35, and 36+, allowing different empirical patterns of an ordinal measure of smoking behavior at six time points, from preconception through child entry to kindergarten. RESULTS We identify five classes for mothers ages 15-25, four classes for ages 26-35, and three classes for ages 36+. Each age group presents classes of nonsmokers and persistent heavy smokers. Intermediate to these ends of the spectrum, each age group exhibited its own smoking classes characterized by the extent of pregnancy smoking reductions and postpartum behavior. In all three age groups, class membership can be distinguished by individual sociodemographic and behavioral characteristics. Co-resident smokers predicted nearly all smoking classifications across age groups, and selected neighborhood characteristics predicted classification of younger (15-25) and older (36+) mothers. CONCLUSIONS The design, timing, and delivery of smoking prevention and cessation services, for women seeking to become pregnant and for women presenting for prenatal or pediatric care, are best guided by individual characteristics, particularly maternal age, preconception alcohol consumption, and postpartum depression, but neighborhood characteristics merit further attention for mothers at different ages.
Collapse
|
20
|
Meghea CI, Rus IA, Cherecheş RM, Costin N, Caracostea G, Brinzaniuc A. Maternal smoking during pregnancy and birth outcomes in a sample of Romanian women. Cent Eur J Public Health 2015; 22:153-8. [PMID: 25438390 DOI: 10.21101/cejph.a3947] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Smoking during pregnancy is causally associated with reduced birth weight and is strongly related to preterm birth. Smoking cessation in early pregnancy seems to reduce these risks, although the research evidence is limited. In a sample of Romanian women, differences in birth outcomes were assessed between non-smokers and women who continued to smoke during pregnancy and non-smokers and women who stopped smok- ing when they found out about the pregnancy. Pregnant women were recruited in two urban clinics (N= 474). A baseline questionnaire collected information on their smoking status, depressive symptoms, stress, demographics, and other characteristics at recruitment. The women reported the newborn weight and birth term by phone in the first weeks following birth. Descriptive statistics and multivariate regressions were used to ana- lyze the relationship between smoking status during pregnancy and birth outcomes. Over 61% (N = 290) women were non-smokers, 15% (N= 72) smoked during pregnancy, and 24% (N= 112) quit smoking when they found out about the pregnancy. Compared to non-smokers, continuous smokers delivered babies 165 grams lighter (95% CI -313, -17). Women who stopped smoking when they ascertained the pregnancy had higher odds of delivering a newborn who was small for gestational age compared to non-smokers (OR= 2.16, 95% CI 1.05, 4.43). Elevated maternal stress was associated with reduced birth weight (-113 grams, 95% CI -213, -11), and higher odds of a preterm birth (OR=2.8, 95% CI 1.17, 6.76). In a predominantly urban sample of Romanian women, continuous maternal smoking during pregnancy was a risk factor for restricted foetal growth. Smoking cessation when the pregnancy was ascertained did not seem to reduce this risk. Smoking prevention efforts should therefore begin before pregnancy and should integrate psychological components, addressing maternal stress in particular.
Collapse
|
21
|
Luger TM, Suls J, Vander Weg MW. How robust is the association between smoking and depression in adults? A meta-analysis using linear mixed-effects models. Addict Behav 2014; 39:1418-29. [PMID: 24935795 DOI: 10.1016/j.addbeh.2014.05.011] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 04/29/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Our objective was to use meta-analytic techniques to assess the strength of the overall relationship and role of potential moderators in the association between smoking and depression in adults. METHODS Two popular health and social science databases (PubMed and PsycINFO) were systematically searched to identify studies which examined the association between adult smoking behavior and major depressive disorder (MDD) or depressive symptoms. A total of 85 relevant studies were selected for inclusion. Studies were analyzed using a linear mixed effects modeling package ("lme4" for R) and the Comprehensive Meta-Analysis program version 2. RESULTS Multiple nested linear mixed-effects models were compared. The best fitting models were those that included only random study effects and smoking status. In cross-sectional studies, current smokers were more likely to be depressed than never smokers (OR=1.50, CI=1.39-1.60), and current smokers were more likely to be depressed than former smokers (OR=1.76, CI=1.48-2.09). The few available prospective studies, that used the requisite statistical adjustments, also showed smokers at baseline had greater odds of incident depression at follow-up than never smokers (OR=1.62, CI=1.10-2.40). CONCLUSIONS In cross-sectional studies, smoking was associated with a nearly two-fold increased risk of depression relative to both never smokers and former smokers. In the smaller set of prospective studies, the odds of subsequent depression were also higher for current than never smokers. Attesting to its robustness, the relationship between smoking and depression was exhibited across several moderators. Findings could help health care providers to more effectively anticipate co-occurring health issues of their patients. Several methodological recommendations for future research are offered.
Collapse
|
22
|
|
23
|
Mumford EA, Hair EC, Yu TC, Liu W. Women’s longitudinal smoking patterns from preconception through child’s kindergarten entry: profiles of biological mothers of a 2001 US birth cohort. Matern Child Health J 2014; 18:810-20. [PMID: 23797269 PMCID: PMC3858416 DOI: 10.1007/s10995-013-1305-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To identify longitudinal patterns of women’s smoking during the pre-conception, perinatal, and early parenting period and describe risk factors distinguishing the different profiles. We conducted longitudinal latent class analysis of maternal smoking status over a 6–7 year period in a sample of 8,650 biological mothers of the Early Childhood Longitudinal Study-Birth Cohort, nationally representative of US births in 2001. Five latent classes were identified: pregnancy-inspired quitters (4.3 %), delayed initiators (5.1 %), persistent smokers (8.5 %), temporary quitters (10.4 %), and nonsmokers (71.7 %). These classes were distinguished by age, race/ethnicity, education, poverty status, marital status, parity, drinking behavior, and depression. For example, when compared to those with college degrees, those with less than a high school degree were at least five times as likely to be in the delayed initiator, temporary quitter, or persistent smoker classes (vs. the nonsmoker class). Heterogeneous longitudinal smoking patterns indicate the need for both prevention messages and cessation treatment continuing past parturition, tailored to fit individual profiles in order to achieve better health outcomes for both mothers and children.
Collapse
Affiliation(s)
- Elizabeth A. Mumford
- Senior Research Scientist, NORC at the University of Chicago, 4350 East-West Highway, Suite 800, Bethesda, MD 20814, Telephone: (301) 634- 9435 Fax: (301) 634-9301
| | - Elizabeth C. Hair
- Senior Research Scientist, NORC at the University of Chicago, Telephone: (301) 634-9386
| | - Tzy-Chyi Yu
- Research Scientist, NORC at the University of Chicago, Telephone: (301) 634-9513
| | - Weiwei Liu
- Research Scientist, NORC at the University of Chicago, Telephone: (301) 634-9559
| |
Collapse
|
24
|
Forray A, Gotman N, Kershaw T, Yonkers KA. Perinatal smoking and depression in women with concurrent substance use. Addict Behav 2014; 39:749-56. [PMID: 24447885 DOI: 10.1016/j.addbeh.2013.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 11/21/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this report was to examine the course of smoking among pregnant women with concurrent substance use, and to assess the impact of depression on smoking. METHODS Data were gathered as part of a randomized controlled trial assessing the efficacy of substance abuse treatment in pregnant women. Women (n=176) were recruited before 28 completed weeks of pregnancy, and followed until 3months postpartum. Depression was assessed using the Inventory of Depressive Symptomatology and the MINI Neuropsychiatric Interview. Our outcome was the average number of cigarettes smoked per day. Linear mixed effects regression was used to measure differential changes in smoking. RESULTS 66% of women smoked in the three months before pregnancy, 42% of pre-pregnancy smokers achieved abstinence before delivery and 60% of the baseline cohort smoked postpartum. Smoking did not differ significantly between depressed and non-depressed groups. After delivery both groups increased smoking at similar rates. CONCLUSION Smoking was common among our cohort of pregnant women with a history of substance use. Women were able to discontinue or decrease smoking during pregnancy, but were likely to resume or increase smoking postpartum. Having clinically significant depressive symptoms or a diagnosis of depression did not have an obvious effect on smoking behaviors.
Collapse
|
25
|
Street drug use during pregnancy: potential programming effects on preschool wheeze. J Dev Orig Health Dis 2012; 4:191-9. [DOI: 10.1017/s2040174412000670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Street drug use during pregnancy is detrimental to fetal development. Although the prevalence of wheeze is high in offspring of substance-abusing mothers, nothing is known about the role of street drug use during pregnancy in its development. We investigated the impact of maternal street drug use and distress during pregnancy on the development of wheeze and allergy in preschool children. Questionnaire data were accessed from the Community Perinatal Care trial of 791 mother–child pairs in Calgary, Alberta. Using logistic regression, the association between maternal substance use and distress during pregnancy, and wheeze and allergy at age 3 years was determined in boys and girls. After adjusting for alcohol use during pregnancy, pre- and postnatal tobacco use, preterm birth, duration of exclusive breastfeeding, daycare attendance and maternal socioeconomic status, maternal street drug use during pregnancy [odds ratio (OR): 5.02, 95% confidence interval (CI): 1.30–19.4] and severe maternal distress during pregnancy (OR: 5.79, 95% CI: 1.25–26.8) were associated with wheeze in girls. In boys, an independent association was found between severe distress during pregnancy (OR: 3.85, 95% CI: 1.11–13.3) and allergies, but there was no association with maternal street drug use. In conclusion, we found an association between maternal street drug use and wheeze in preschool girls that could not be accounted for by maternal distress, smoking or alcohol use during pregnancy. Prenatal programming effects of street drugs may explain this association.
Collapse
|
26
|
Massey SH, Compton MT. Psychological differences between smokers who spontaneously quit during pregnancy and those who do not: a review of observational studies and directions for future research. Nicotine Tob Res 2012; 15:307-19. [PMID: 22949579 DOI: 10.1093/ntr/nts142] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although remarkable interindividual differences among pregnant smokers' decision/ability to quit have been documented, the psychological factors that may account for these differences have received less attention and comprised the primary aim of this review. METHODS We searched the medical and behavioral sciences literature from 1996 to November 2011 using PubMed and PsycINFO(®). Fifty-one articles were identified based on titles or abstracts. These articles were reviewed in full and searched for quantitative observational studies of population-based or clinical samples, with the main topic of comparing smokers who quit spontaneously during pregnancy with those who did not, utilizing multivariable analyses. RESULTS The eight pertinent studies reviewed herein included four longitudinal studies and four cross-sectional analyses. Amidst significant variability among measures used, social support, depressive symptoms, and anxiety appeared unrelated to smoking cessation during pregnancy. Furthermore, when severity of nicotine dependence was controlled, maternal history of attention-deficit/hyperactivity disorder, depression, bipolar disorder, and schizophrenia all showed no independent relationship with smoking cessation during pregnancy, whereas maternal history of conduct disorder did. Secure attachment, prosocial personality, self-esteem, and perceived parenting competence were additional predictors of cessation during pregnancy. CONCLUSIONS A greater understanding of psychological factors that differentiate smokers who spontaneously quit during pregnancy from those who do not is crucial to the design of more effective prenatal smoking cessation interventions and also may elucidate causal mechanisms that underlie the well-established link between maternal smoking during pregnancy and offspring behavioral problems. Directions for future research and public health and policy implications are discussed.
Collapse
Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences Washington, DC 20037, USA.
| | | |
Collapse
|
27
|
Abstract
The current study examined predictors of past 30-day cigarette use among a US nationally representative sample of pregnant women over the age of 18 (N = 1,782). The study consisted of secondary data analysis of the 2005-2007 survey years of the National Survey on Drug Use and Health (NSDUH). Logistic regression analyses indicated that low-income women, those who experienced mental health problems in the past year, and women who experienced legal problems were more likely to smoke during pregnancy. Limitations to the study as well as implications for future research are discussed.
Collapse
Affiliation(s)
- Lisa M Kratz
- Department of Counseling and Educational Psychology, Indiana University, Bloomington, Indiana 47405, USA.
| | | |
Collapse
|
28
|
Meghea CI, Rus IA, Rus D. Risk factors associated with nicotine dependence in a sample of Romanian pregnant smokers. Eur J Obstet Gynecol Reprod Biol 2012; 163:22-6. [PMID: 22537737 DOI: 10.1016/j.ejogrb.2012.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 02/08/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To fill the gap in assessing nicotine dependence during pregnancy in an unexplored population in Central and Eastern Europe and to analyze the associations of maternal characteristics and prenatal risk factors with moderate-heavy nicotine dependence among pregnant smokers. STUDY DESIGN A questionnaire was applied to pregnant smokers in Romania to assess nicotine dependence and other related risks poorly documented in Central and Eastern Europe. The response rate was >80% and the valid sample included 137 pregnant smokers. Descriptive statistics and logistic regressions were used to assess nicotine dependence and to analyze the associations of maternal characteristic and prenatal risk factors with moderate-heavy nicotine dependence. RESULTS Approximately 43% of the pregnant smokers in our sample (59 of 137) had moderate to heavy nicotine dependence. Depressive symptoms were associated with moderate-heavy nicotine dependence among pregnant smokers (OR=3.07, p<0.05). Women carrying an unwanted pregnancy had higher odds of moderate-heavy nicotine dependence (OR=2.59, p<0.05) compared to other pregnant women. High stress, lack of social support, and socioeconomic status were not associated with nicotine dependence. CONCLUSIONS A large proportion of women had moderate-heavy nicotine dependence in a sample of Romanian pregnant smokers. The more dependent pregnant smokers were more likely to have depressive symptoms. Prenatal care should include brief nicotine dependence assessments and mental health screening and referrals for pregnant women who smoke. Special and intensive efforts, including psychosocial components, may be needed for the nicotine dependent pregnant smokers.
Collapse
Affiliation(s)
- Cristian I Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology, and Institute for Health Care Studies, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | | | | |
Collapse
|
29
|
Mitra M, Lu E, Diop H. Smoking among pregnant women with disabilities. Womens Health Issues 2012; 22:e233-9. [PMID: 22265182 DOI: 10.1016/j.whi.2011.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 11/14/2011] [Accepted: 11/15/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to examine the prevalence of smoking before, during, and after pregnancy among a representative sample of Massachusetts women with and without disabilities. METHODS Data from the 2007 to 2009 Massachusetts Pregnancy Risk Assessment Monitoring System survey were used to estimate the prevalence of smoking by disability status. MAIN FINDINGS Disability prevalence was 4.8% (n = 204) among Massachusetts women giving birth during 2007 through 2009. The prevalence of smoking during the 3 months before pregnancy among women with disabilities was 37.3% (95% CI, 28.3-47.2%) compared with 18.3% (95% CI, 16.6-20.1%) among women without disabilities. Similarly, 25.2% (95% CI, 17.3-35.2%) of women with disabilities, compared with 9.4% of women without disabilities (95% CI, 8.1-10.8%), smoked during the last trimester of their pregnancy, and 32.1% of women with disabilities (95% CI, 23.5-42.1%) compared with 12.5% of women without disabilities (95% CI, 11.1-14.1%), smoked after pregnancy. In the multivariate logistic regression models, women with disabilities had significantly higher risks of smoking before, during and after pregnancy than women without disabilities (adjusted relative risk [aRR], 1.7 [95% CI, 1.2-2.2]; aRR, 1.9 [95% CI, 1.3-2.8]; aRR, 1.8 [95% CI, 1.3-2.5], respectively) while adjusting for race/Hispanic ethnicity, marital status, education, age, household poverty status, and infant's birth year. IMPLICATIONS Women with disabilities are more likely to smoke before, during, and after their pregnancy and less likely to quit smoking during pregnancy. Efforts to integrate and target pregnant women with disabilities in smoking-cessation programs are vital.
Collapse
Affiliation(s)
- Monika Mitra
- Center for Health Policy and Research/Department of Family Medicine and Community Health, University of Massachusetts Medical School, Shrewsbury, MA, USA
| | | | | |
Collapse
|
30
|
Meghea CI, Rus D, Rus IA, Summers Holtrop J, Roman L. Smoking during pregnancy and associated risk factors in a sample of Romanian women. Eur J Public Health 2010; 22:229-33. [DOI: 10.1093/eurpub/ckq189] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|