The interaction of sociodemographic risk factors and measures of nicotine dependence in predicting maternal smoking during pregnancy

Parental cigarette smoking before and during pregnancy in a cohort of 21 472 pregnancies

Smoking during pregnancy is one of the leading causes for adverse pregnancy outcomes. We studied parental smoking both before and during pregnancy in a retrospective cohort of 21 472 singleton pregnancies. Although most smoking women (74%) ceased tobacco use, there was possible gestational exposure to maternal cigarette smoking in every fifth pregnancy. Continued smoking throughout pregnancy was more prevalent in the partners (22%) than in the pregnant women (7%). The smoking behaviour of the women, especially the number of cigarettes smoked per day (CPD), before and in early pregnancy predicted the continuation of smoking throughout the pregnancy and could be used in identifying high risk groups. In addition, their partner's smoking habits both before and during pregnancy, were associated with the likelihood that the woman would continue to smoke during her pregnancy (rs ≈ 0.4). Furthermore, continued smoking of both parents were associated with decreased birth weight, head circumference and Apgar score, and increased duration of hospital stay and need for special care after birth. Consequently, addressing the lifestyles of both parents in the health care and maternity clinics could help in reducing maternal cigarette smoking during pregnancy and the adverse pregnancy outcomes associated with smoking.

Polysubstance use during pregnancy: The importance of screening, patient education, and integrating a harm reduction perspective

BACKGROUND

Substance use during pregnancy is associated with poor health outcomes. This study assessed substance use, polysubstance use, and use of select prescription medications during pregnancy.

METHODS

We analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System in 25 United States jurisdictions that included questions on prescription medications, tobacco, and illicit substance use during pregnancy. Alcohol and electronic cigarette use were assessed during the last three months of pregnancy, and all other substances and medications were assessed throughout pregnancy. Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated.

RESULTS

Nearly one-fifth of respondents who reported use of any substance reported use of at least one other substance during pregnancy. Cigarettes (8.1%; 95% CI 7.6-8.7%) and alcohol (7.4%; 95% CI 6.7-8.1%) were the most frequently reported substances, followed by cannabis (4.3%; 95% CI 3.9-4.7%). Substance use was higher among individuals who reported having depression or using antidepressants during pregnancy compared with those who did not report depression or antidepressant use. Illicit drug use prevalence was low (0.5%, 95% CI 0.4-0.7%); however, respondents reporting heroin use also frequently reported use of illicit stimulants (amphetamines: 51.7%, 95% CI 32.1-71.3% or cocaine: 26.5%, 95% CI 11.9-41.1%). Although prenatal clinician screening for alcohol and cigarette use was approximately 95%, fewer respondents (82.1%) reported being screened for cannabis or illicit substance use during pregnancy.

CONCLUSIONS

One in five individuals who reported use of any substance during pregnancy engaged in polysubstance use, highlighting the importance of comprehensive screening and evidence-based interventions including harm reduction.

Tobacco Smoking during Pregnancy: Women's Perception about the Usefulness of Smoking Cessation Interventions

Tobacco consumption during pregnancy is a serious public health problem due to its negative effects on fetal development and on pregnant women's health and well-being. Thus, it is of utmost importance to plan and implement smoking cessation interventions, to prevent the negative impact of this risk factor, namely on children's health and development. This cross-sectional study aimed at exploring the perceptions and beliefs about the usefulness of smoking cessation interventions during pregnancy, in a sample of pregnant Portuguese women. The smoking use by pregnant women, as well as the risk factors associated with tobacco smoking during pregnancy, were also analyzed. The sample included 247 pregnant Portuguese women aged between 18-43-years-old (M = 30.30, SD = 5.02): 42.5% never smoked, 18.3% quit smoking before pregnancy, 19.0% quit smoking after getting pregnant and 20.2% were current smokers. The pregnant Portuguese women who smoked during pregnancy (current smokers or who quit smoking after getting pregnant) were mostly single or divorced, with lower education levels, showed a higher prevalence of clinically significant anxiety symptoms, and perceived smoking cessation interventions during pregnancy as less useful when compared to women who never smoked or quit smoking prior pregnancy. Daily or weekly smoking cessation interventions, implemented by health professionals such as doctors, nurses, or psychologists are the ones perceived as the most useful for pregnant women. These findings provide important clues for the planning of smoking cessation interventions during pregnancy, highlighting the domains that should be carefully monitored by health professionals. Specific strategies should also be used by health professionals to promote smoking cessation considering the demands of pregnancy and postpartum.

Validity of the DSM-5 tobacco use disorder diagnostics in adults with problematic substance use

BACKGROUND

DSM-5 tobacco use disorder (TUD) nosology differs from DSM-IV nicotine dependence (ND) by including craving and DSM-IV abuse criteria, a lower threshold (≥ 2 criteria), and severity levels (mild; moderate; severe). We assessed concurrent and prospective validity of the DSM-5 TUD diagnosis and severity and compared validity with DSM-IV ND diagnosis.

METHODS

The sample included U.S. adults with current problematic substance use and past year cigarette smoking (N = 396). Baseline assessment collected information on DSM-IV ND and DSM-5 TUD criteria, smoking-related variables, and psychopathology. Over the following 90 days, electronic daily assessments queried smoking and cigarette craving. Variables expected to be related to TUD were validators: cigarette consumption, cigarette craving scale, Fagerström Test for Nicotine Dependence, and psychiatric disorders. Regression models estimated the association of each validator with DSM-5 TUD and severity levels, and differential association between DSM-5 TUD and DSM-IV ND diagnoses.

RESULTS

DSM-5 TUD and DSM-IV ND were associated with most baseline validators (p-values < 0.05), with significantly stronger associations with DSM-5 TUD for number of days smoked (p = 0.023) and cigarette craving scale (p = 0.007). Baseline DSM-5 TUD and DSM-IV ND predicted smoking and craving on any given day during follow-up, with stronger associations for DSM-5 TUD (association difference [95% CI%]: any smoking, 0.53 [0.27, 0.77]; number of cigarettes smoked, 1.36 [0.89, 1.78]; craving scale, 0.19 [0.09, 0.28]). Validators were associated with TUD severity in a dose-dependent manner.

CONCLUSION

DSM-5 TUD diagnostic measures as operationalized here demonstrated concurrent and prospective validity. Inclusion of new criteria, particularly craving, improved validity and clinical relevance.

Associations of clinical, psychological, and socioeconomic characteristics with nicotine dependence in smokers

Cigarette smoking is a risk factor of mortality and morbidity from various cancerous, respiratory, and myocardial diseases. Nicotine dependence is assessed based on the degree of physical dependence. We aimed to determine the clinical, socioeconomic and psychological factors associated with the smoking status and degree of nicotine dependence of smokers. From April 2009 to September 2010, we retrospectively collected data from 17,577 subjects aged ≥ 18 years who had undergone a general health examination at a health promotion center. The instruments used included the Fagerström Tolerance Questionnaire (FTQ), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Stress Response Inventory (SRI), and Alcohol Use Disorder Identification Test (AUDIT). Of the current smokers (N = 3946), 2345 (59%), 1154 (29%), and 447 (12%) had low, moderate, and high nicotine dependence, respectively. In multiple logistic analysis, predictors of high nicotine dependence were male sex (odds ratio [OR] 3.705, 95% confidence interval [CI] 1.997–6.945), older age (≥ 65 years) (OR 1.016, 95% CI 1.004–1.029), higher body mass index (BMI) (OR 1.048, 95% CI 1.018–1.078), diabetes (OR 1.870, 95% CI 1.251–2.794), single marital status (OR 1.575, 95% CI 1.186–2.092), lower education level (OR 1.887, 95% CI 1.463–2.433), and a higher stress level (OR 1.018, 95% CI 1.997–6.945). Thus, clinical, psychological, socioeconomic status including male, older age, higher BMI, diabetes, single marital status, lower education, and higher stress should be taken into consideration by promoting smoking cessation.

Role of Neonatal Biomarkers of Exposure to Psychoactive Substances to Identify Maternal Socio-Demographic Determinants

Simple Summary

The rapid identification of newborns exposure to psychoactive drugs allows an appropriate clinical care. This study tried to identify maternal profiles that help to identify newborns exposed to psychoactive drugs during pregnancy. Mothers were interviewed using a questionnaire. The biomarkers of fetal exposure were measured in meconium samples. Statistical analysis was performed to identify the maternal characteristics that were most likely to be associated with drug use during pregnancy. Of a total of 372 mothers, 49 (13.2%) tested positive for psychoactive drugs use: 24 (49.0%) for cannabis, 11 (22.5%) for ethyl glucuronide, six (12.2%) for cocaine, and eight (16.3%) for more than one psychoactive substance. The maternal characteristics that most likely identify substance use during pregnancy are: maternal age < 24 years, lack of pregnancy care, single-mother families, and active tobacco smoking. The profiles of prenatal maternal exposure identified in a clinical setting can be used to request specific detection tests for identifying newborns exposed to these drugs.

Abstract

Background: The accurate assessment of fetal exposure to psychoactive substances provides the basis for appropriate clinical care of neonates. The objective of this study was to identify maternal socio-demographic profiles and risk factors for prenatal exposure to drugs of abuse by measuring biomarkers in neonatal matrices. Methods: A prospective, observational cohort study was completed. Biomarkers of fetal exposure were measured in meconium samples. The mothers were interviewed using a questionnaire. Univariate and multivariate logistic regression analyses were performed. Results: A total of 372 mothers were included, 49 (13.2%) testing positive for psychoactive substances use: 24 (49.0%) for cannabis, 11 (22.5%) for ethyl glucuronide, six (12.2%) for cocaine, and in eight (16.3%) more than one psychoactive substance. Mothers who consumed any psychoactive substance (29.7 ± 6.6 years) or cannabis (27.0 ± 5.7 years) were younger than non-users (32.8 ± 6.2 years, p < 0.05). Cocaine (50.0% vs. 96.9%, p < 0.05) and polydrug users (37.5% vs. 96.9%, p < 0.05) showed a lower levels of pregnancy care. Previous abortions were associated with the use of two or more psychoactive substances (87.5% vs. 37.8%, p < 0.05). Single-mother families (14.3% vs. 2.5%, p < 0.05) and mothers with primary level education (75.5% vs. 55.1%, p < 0.05) presented a higher consumption of psychoactive substances. Independent risk factors that are associated with prenatal exposure include: maternal age < 24 years (odds ratio: 2.56; 95% CI: 1.12–5.87), lack of pregnancy care (odds ratio: 7.27; 95%CI: 2.51–21.02), single-mother families (odds ratio: 4.98; 95%CI: 1.37–8.13), and active tobacco smoking (odds ratio: 8.13; 95%CI: 4.03–16.43). Conclusions: These results will allow us to develop several risk-based drug screening approaches to improve the early detection of exposed neonates.

Smoking during pregnancy: changes and associated risk factors in Spain, 1980-2016

BACKGROUND

Trends for maternal smoking rates have varied substantially across industrialized countries. The objective was to describe how the prevalence of maternal smoking evolved in Spain during 1980-2016.

METHODS

Data came from the Spanish Collaborative Study of Congenital Malformations. Our sample consisted of 40 934 mothers of newborns with no congenital defects from hospitals all across Spain. We estimated change points in trend and the mean annual change in smoking prevalence using 'joinpoint' regression. Relevant potential factors (age, country of birth, education, parity, planned pregnancy and alcohol consumption) were examined using multivariate logistic regression.

RESULTS

Maternal smoking prevalence in 1980 and 2016 were 14.3% (95% confidence interval [CI]: 11.9-17.0) and 20.4% (95% CI: 15.9-25.8). We identified four periods with distinct trends: a sharp increase during the 80s, a plateau during the 90s, a decrease starting in 2000 and a slowdown of such decrease from 2009 on. Smoking was significantly higher among young women, Spain-born, with low education, unplanned pregnancy, and alcohol consumption.

CONCLUSIONS

Currently in Spain maternal smoking remains very high. Tobacco consumption trend showed an increase during the 80s, a plateau during the 90s, and a reduction in the 2000s. Several sociodemographic and behavioural factors were associated to greater likelihood of smoking.

Association between generational status and smoking behaviors before and during pregnancy among Hispanic women

BACKGROUND

Evidence is limited on the risk of maternal smoking before and during pregnancy across generations of Hispanic immigrants.

PURPOSE

The aim of this study was to determine whether immigration generational status predicts maternal smoking behaviors before and during pregnancy among Hispanic women.

METHODS

Data on pregnancies in National Longitudinal Survey of Youth 1979 were used. Current study sample consists of Hispanic women (15-24 years) reporting pregnancy between 1979 and 2014 (n = 616). Data on birthplaces of the respondent and their parents were used to determine generation status. Maternal smoking behaviors before and during pregnancy were self-reported. Data were analyzed using weighted covariate-adjusted logistic regression models.

RESULTS

There were 24% first-generation, 20% second-generation, and 56% third or higher generation Hispanic women in the sample. Majority of participants were married (72%), with a high school degree or more (69%), and of Mexican origin (56%). After controlling for covariates, first generation Hispanic women had lower likelihood of smoking prior to (OR = 0.40, p = 0.009) and during pregnancy (OR = 0.35, p = 0.007) compared to third or higher generation women. The second-generation women had lower likelihood of smoking during pregnancy (OR = 0.46, p = 0.038) compared to third or higher generation women.

CONCLUSIONS

First generation Hispanic women are at lower risk of smoking both prior to and during pregnancy. Identification of cultural factors discouraging smoking during pregnancy among first/second generation Hispanic women and incorporating in smoking prevention interventions targeting Hispanic women could benefits the later generations of Hispanic immigrants.