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Zhu Y, Wang L, Qi Q, Cheng Y, Zhu Z, Zeng L. Associations between gestational weight gain under different guidelines and adverse birth outcomes: A secondary analysis of a randomized controlled trial in rural western China. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002691. [PMID: 38190379 PMCID: PMC10773947 DOI: 10.1371/journal.pgph.0002691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/10/2023] [Indexed: 01/10/2024]
Abstract
Several gestational weight gain (GWG) guidelines have been established based on monocenter or multicenter researches. We aimed to examine the associations between categories of GWG under the Institute of Medicine (IOM) recommendation guideline, the Chinese National Health Commission (NHC) guideline, and weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project and adverse birth outcomes. We used data from an antenatal micronutrient supplementation trial in rural western China between 2002 and 2006. Maternal weekly average GWG during the second and third trimesters was calculated and classified into inadequate, adequate and excessive GWG according to the IOM and NHC, respectively. Weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project were grouped into three subgroups using two approaches: z-score percentile<25th, 25th to 75th, >75th and z-score <-1, -1 to 1, >1 SD. Infant birth weight and gestational age were measured using standard approaches. Generalized linear model with binomial family and logit link was applied to estimate the odds ratio (OR) and 95% confidential intervals (CI) for GWG categories and adverse birth outcomes. Among 1,239 women with normal weight (18.5 kg/m2 to 23.9 kg/m2) during early pregnancy, 18.0% and 34.2% were classified as adequate GWG according to IOM and NHC, respectively. Less than half of Chinese women reached optimal GWG by any recommendation guideline. According to NHC, excessive GWG showed a significant association with macrosomia (OR 3.75, 95% CI 1.03, 13.74), large-for-gestation-age (LGA) (OR 2.12, 95% CI 1.01, 4.45), and inadequate GWG was associated with post-term birth (OR 2.25, 95% CI 1.21, 4.16), compared with adequate GWG. Inappropriate GWG was associated with adverse birth outcomes even among women with normal weight during early pregnancy. The monitoring and interventions of weight status during pregnancy, especially for the second and third trimesters, are of great public health importance for optimal birth outcomes. Additionally, developing guideline of appropriate GWG ranges should account for the traits of regional population.
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Affiliation(s)
- Yingze Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
| | - Liang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
| | - Yue Cheng
- Department of Nutrition and Food Safety Research, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
- Center for Chronic Disease Control and Prevention, Global Health Institution, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
- Center for Chronic Disease Control and Prevention, Global Health Institution, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
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Grzeszczak K, Kapczuk P, Kupnicka P, Cecerska-Heryć E, Kwiatkowski S, Chlubek D, Kosik-Bogacka D. Calcium, Potassium, Sodium, and Magnesium Concentrations in the Placenta, Umbilical Cord, and Fetal Membrane from Women with Multiple Pregnancies. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010153. [PMID: 36676102 PMCID: PMC9861628 DOI: 10.3390/life13010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
Calcium (Ca), potassium (K), sodium (Na), and magnesium (Mg) are the elements responsible for the fundamental metabolic and biochemical processes in the cells of the body. The demand for these elements increases significantly during pregnancy, where an adequate supply protects women from the hypertension common in pre-eclampsia and preterm labor. This study aimed to evaluate the association between macro-elements (Ca, Mg, Na, and K) in the placenta, fetal membrane, and umbilical cord and the morphometric parameters of newborns from multiple pregnancies. The study involved 57 pregnant European women with healthy uncomplicated twin pregnancies (n = 52) and triple pregnancies (n = 5); 40 pairs of dichorionic diamniotic twins, 11 pairs of monochorionic diamniotic twins, 1 pair of monochorionic monoamniotic twins, 3 trichorionic triamniotic triplets, and 2 dichorionic triamniotic triplets. Placentas (n = 107), umbilical cords (n = 114), and fetal membranes (n = 112) were collected immediately following delivery, and then weighed and measured. The levels of Ca, K, Na, and Mg were determined using inductively coupled plasma atomic emission spectroscopy (ICP-OES) in a Thermo Scientific ICAP 7400 Duo (Waltham, MA, USA). The respective mean concentrations of Ca, K, Na, and Mg (mg/kg-1 dry mass) were: 2466, 8873, 9323, and 436 in the placenta; 957, 6173, 26,757, and 326 in the umbilical cord, and 1252, 7460, 13,562, and 370 in the fetal membrane. In the studied materials from northwestern Poland, we found strong positive correlations between Ca and Mg concentrations in both the umbilical cord (r = 0.81, p = 0.00) and the fetal membrane (r = 0.73, p = 0.00); between K and Mg concentrations in the umbilical cord (r = 0.73, p = 0.00); between Ca and K concentrations in the fetal membrane (r = 0.73, p = 0.00), and we found moderately positive correlations between placental Ca concentration and placental weight (ρ = 0.42, p = 0.00) and between umbilical cord Mg concentrations and the length of the pregnancy (ρ = 0.42, p = 0.00). Negative correlations were found between Na and Ca concentrations in the fetal membrane (r = -0.40, p = 0.00) and Na concentrations in the fetal membrane and Mg concentrations in the placenta (r = -0.16, p = 0.02). Negative correlations were confirmed between the length of pregnancy and head circumference (ρ = -0.42; p = 0.00), infant weight (ρ = -0.42; p = 0.00), infant length (ρ = -0.49; p = 0.00), shoulder width (ρ = -0.49; p = 0.00); and between the infant weight and head circumference (ρ = -0.62; p = 0.00), weight before delivery (ρ = -0.36; p = 0.00), infant length (ρ = -0.45; p = 0.00), shoulder width (ρ = -0.63; p = 0.00), and weight gain during pregnancy (ρ = -0.31; p = 0.01). We found statistically significant correlations between cigarette smoking before pregnancy and the women's weight before delivery (ρ = 0.32, p = 0.00), and a negative correlation between the women's ages and infant head circumference (ρ = -0.20, p = 0.02). This is probably the first study to evaluate Ca, Na, K, and Mg concentrations in the afterbirth tissues of multiple pregnancies. It adds to the knowledge of elemental concentrations in multiple pregnancies and their possible effects on fetal morphometric parameters.
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Affiliation(s)
- Konrad Grzeszczak
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Patrycja Kapczuk
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Patrycja Kupnicka
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Elżbieta Cecerska-Heryć
- Department of Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Danuta Kosik-Bogacka
- Independent Laboratory of Pharmaceutical Botany, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
- Correspondence: ; Tel.: +48-91-466-1672
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Al-Hassany L, Wahab RJ, Steegers EAP, Jaddoe VWV, Gaillard R. Smoking cessation in early-pregnancy, gestational weight gain and subsequent risks of pregnancy complications. Eur J Obstet Gynecol Reprod Biol 2020; 253:7-14. [PMID: 32745817 DOI: 10.1016/j.ejogrb.2020.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Smoking cessation is associated with weight gain. We first examined the associations of smoking cessation in early-pregnancy with gestational weight gain and subsequently evaluated the risks of pregnancy complications among women who quit smoking in early-pregnancy according to their gestational weight gain. METHODS In a population-based prospective cohort study among 7,389 women, we measured weight in each pregnancy period. Information on smoking and pregnancy complications was obtained from questionnaires and medical records. RESULTS As compared to continued smoking during pregnancy, smoking cessation in early-pregnancy was not associated with gestational weight gain. Smoking cessation in early-pregnancy was associated with decreased risks of delivering small-for-gestational-age infants (Odds Ratio (OR) 0.52 (95 % Confidence Interval (CI) 0.37, 0.75)), but with increased risks of pre-eclampsia (OR 2.07 (95 % CI 1.01, 4.27)) and delivering large-for-gestational-age infants (OR 2.11 (95 % CI 1.45, 3.09)). Among women who quit smoking in early-pregnancy with >12 kg weight gain, the risks of pre-eclampsia and delivering large-for-gestational-age infants were slightly increased. CONCLUSION As compared to continued smoking during pregnancy, smoking cessation in early-pregnancy is not associated with increased gestational weight gain. Among women who quit smoking in early-pregnancy, higher gestational weight gain does not strongly affect their risks of pregnancy complications.
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Affiliation(s)
- Lina Al-Hassany
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rama J Wahab
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eric A P Steegers
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Kocataş S, Güler N, Sezer RE. Factors Affecting Smoking Behaviors and Smoking Prevalence in Pregnancy and Postpartum Period of Women. Florence Nightingale Hemsire Derg 2020; 28:230-242. [PMID: 34263202 PMCID: PMC8152163 DOI: 10.5152/fnjn.2020.18031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/12/2019] [Indexed: 11/22/2022] Open
Abstract
Aim This study aimed to determine the factors affecting smoking behaviors and smoking prevalence among women during pregnancy and postpartum period. Method This cross-sectional study was conducted between May 2012 and October 2012 on a sample of 640 women who had children aged between one and three years and who enrolled in any one of the 23 family health centers located in the province of Sivas in Turkey. The data were collected through the questionnaires created by the researchers by interviewing the participants face to face in own homes. The data obtained were analyzed using the Statistical Package for the Social Sciences Statistics 15.0 (SPSS Inc.; Chicago, IL, USA) package program and evaluated using number, percentage distribution, chi square test, logistic regression analysis and Kaplan-Meier survival analysis. Results Smoking prevalence was found to be 8% during pregnancy and 15.6% in the postpartum period. It was determined that 17.2% of the women smoked before their last pregnancy (n=110), more than half of the smokers quit smoking during pregnancy (n=59), and 46.4% of them continued to smoke during pregnancy. It was determined that 79.7% of the participants who quit smoking during pregnancy relapsed within the first one to three years of the postpartum period, and only 20.3% continued not to smoke. The Kaplan-Meier survival analysis showed that women who breastfed quit smoking for a significantly longer time (27.6 months) compared with those who did not breastfeed (12 months). According to the logistic regression analysis, the risk of postpartum relapse among women aged 30 years or more was 10.99-fold higher than women between the ages of 19 and 29. Conclusion The rate of pre-pregnancy smokers decreased in the pregnancy and increased in the postpartum period.
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Affiliation(s)
- Semra Kocataş
- Department of Public Health Nursing, Sivas Cumhuriyet University Faculty of Health Science, Sivas, Turkey
| | - Nuran Güler
- Department of Public Health Nursing, Sivas Cumhuriyet University Faculty of Health Science, Sivas, Turkey
| | - Recep Erol Sezer
- Department of Public Health and Familiy Medicine, Yeditepe University, Faculty of Medicine, İstanbul, Turkey
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The Transdiagnostic Nature of Cravings: Smoking Cessation and Food Craving in Pregnancy. Midwifery 2020; 87:102730. [PMID: 32434103 DOI: 10.1016/j.midw.2020.102730] [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] [Received: 09/14/2019] [Revised: 03/08/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Smoking cessation prior to pregnancy is strongly encouraged due to the adverse effects of tobacco use on the developing fetus, but appears to also increase risk of excess gestational weight gain (GWG). Smoking cessation has previously been shown to cause weight gain in non-pregnant individuals, in part due to an increase in food craving frequency. Food craving frequency in pregnancy is a known predictor of excess GWG, but has not yet been examined in relation to pre-pregnancy smoking status. This study sought to test the hypothesis that pre-pregnancy smoking cessation elevates excess GWG risk via an increase in food craving frequency. METHODS Pregnant women (n = 82) completed measures of pre-pregnancy tobacco use and current general and specific food cravings. Gestational weight gain was calculated based on participant self-report of pre-pregnancy weight and data on weight prior to delivery culled from medical records. RESULTS Pre-pregnancy tobacco use was associated with significantly greater food craving frequency in pregnancy (p = .05), specifically for high-fat and fast-foods (both p < .05), compared to women who did not smoke. Emotional and physiological aspects of cravings accounted for 35% of the variance in excess GWG (p < .03). CONCLUSIONS Pre-pregnancy smoking appears predictive of food raving frequency in pregnancy and could thus contribute to excess GWG risk. Findings highlight the importance of incorporating strategies for managing cravings into behavioral interventions promoting healthy GWG for women endorsing pre-pregnancy tobacco use.
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Kreyberg I, Hilde K, Bains KES, Carlsen KH, Granum B, Haugen G, Hedlin G, Jonassen CM, Nordhagen LS, Nordlund B, Rueegg CS, Sjøborg KD, Skjerven HO, Staff AC, Vettukattil R, Lødrup Carlsen KC. Snus in pregnancy and infant birth size: a mother-child birth cohort study. ERJ Open Res 2019; 5:00255-2019. [PMID: 31803771 PMCID: PMC6885591 DOI: 10.1183/23120541.00255-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 11/16/2022] Open
Abstract
Rationale While recent studies show that maternal use of snus during pregnancy is increasing, the potential effects on infant birth size is less investigated, with conflicting results. Objectives We aimed to determine if maternal use of snus during pregnancy influences the infant anthropometric and proportional size measures at birth. Methods In 2313 mother–child pairs from the population-based, mother–child birth cohort PreventADALL (Preventing Atopic Dermatitis and ALLergies) in Norway and Sweden, we assessed nicotine exposure by electronic questionnaire(s) at 18 and 34 weeks of pregnancy, and anthropometric measurements at birth. Associations between snus exposure and birth size outcomes were analysed by general linear regression. Results Birthweight was not significantly different in infants exposed to snus in general, and up to 18 weeks of pregnancy in particular, when adjusting for relevant confounders including maternal age, gestational age at birth, pre-pregnancy body mass index, parity, fetal sex and maternal gestational weight gain up to 18 weeks. We found no significant effect of snus use on the other anthropometric or proportional size measures in multivariable linear regression models. Most women stopped snus use in early pregnancy. Conclusion Exposure to snus use in early pregnancy, with most women stopping when knowing about their pregnancy, was not associated with birth size. We were unable to conclude on effects of continued snus use during pregnancy because of lack of exposure in our cohort. Snus use in pregnancy, reported by 7.1% of 2313 women, was not associated with infant birth size. As most women stopped snus use by 6 weeks gestational age, it was not possible to assess potential birth size effects of persistent use during pregnancy.http://bit.ly/2IG8Vnk
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Affiliation(s)
- Ina Kreyberg
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Katarina Hilde
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Karen Eline S Bains
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kai-Håkon Carlsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Berit Granum
- Dept of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Oslo, Norway
| | - Guttorm Haugen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Christine M Jonassen
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.,Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Live S Nordhagen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,VID Specialized University, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Corina S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Katrine D Sjøborg
- Dept of Obstetrics and Gynaecology, Østfold Hospital Trust, Kalnes, Norway
| | - Håvard O Skjerven
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne C Staff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Riyas Vettukattil
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karin C Lødrup Carlsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Fransen MP, Hopman ME, Murugesu L, Rosman AN, Smith SK. Preconception counselling for low health literate women: an exploration of determinants in the Netherlands. Reprod Health 2018; 15:192. [PMID: 30470239 PMCID: PMC6251122 DOI: 10.1186/s12978-018-0617-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background Women from lower socioeconomic groups tend to be at greater risk of adverse perinatal outcomes, but are less likely to participate in preconception counselling compared to higher socioeconomic groups. This could be partly because of their limited skills to assess, understand and use health related information in ways that promote and maintain good health (health literacy skills). In this study we explored determinants of participation in preconception counselling among women with low health literacy in The Netherlands. Methods Potential determinants of participation in preconception counselling were derived from the literature, and mapped onto a theoretical framework, which was tested for perceived relevance and completeness in an expert review (n = 20). The framework was used to prepare face-to-face interviews with women with low health literacy and a wish to conceive (n = 139). In the interviews we explored preconception counselling awareness, knowledge, considerations, subjective norms, self-efficacy, attitude, and intention. Linear regression analyses were used to test associations with intention to participate in preconception counselling. Results Most women (75%) were unaware of the concept of preconception counselling and the provision of counselling, even if they lived in areas where written invitations had been disseminated. Common considerations for participation were: preparation for pregnancy; perceived lack of information; and problems in a previous pregnancy. Considerations not to participate were mostly related to perceived sufficient knowledge and perceived low risk of perinatal problems. Respondents generally had a positive attitude towards participation in preconception counselling for themselves, and 41% reported that they would participate in preconception counselling. Conclusion Women with low health literacy were generally unaware of the concept and provision of preconception counselling, but seemed to be interested in participation. Further research should investigate how to effectively reach and inform this group about preconception counselling. This knowledge is essential for evidence-based development of interventions to increase the accessibility and understanding of preconception counselling. Electronic supplementary material The online version of this article (10.1186/s12978-018-0617-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mirjam P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Miriam E Hopman
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Laxsini Murugesu
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ageeth N Rosman
- Rotterdam University of Applied Sciences, School for Healthcare Studies, Department of Master Physician Assistant Midwifery, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands
| | - Sian K Smith
- The University of New South Wales, Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, Lowy Research Centre, Sydney, NSW, 2052, Australia
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Gunnerbeck A, Raaschou P, Cnattingius S, Edstedt Bonamy AK, Wickström R. Maternal snuff use and cotinine in late pregnancy-A validation study. Acta Obstet Gynecol Scand 2018; 97:1373-1380. [DOI: 10.1111/aogs.13410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Gunnerbeck
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - Pauline Raaschou
- Clinical Pharmacology Unit; Department of Medicine Solna; Karolinska Institutet; Stockholm Sweden
| | - Sven Cnattingius
- Clinical Pharmacology Unit; Department of Medicine Solna; Karolinska Institutet; Stockholm Sweden
| | - Anna-Karin Edstedt Bonamy
- Clinical Pharmacology Unit; Department of Medicine Solna; Karolinska Institutet; Stockholm Sweden
- Neonatal Research Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Ronny Wickström
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
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9
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Factors affecting perceived change in physical activity in pregnancy. Midwifery 2017; 51:16-23. [DOI: 10.1016/j.midw.2017.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 02/06/2023]
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Hulman A, Lutsiv O, Park CK, Krebs L, Beyene J, McDonald SD. Are women who quit smoking at high risk of excess weight gain throughout pregnancy? BMC Pregnancy Childbirth 2016; 16:263. [PMID: 27595584 PMCID: PMC5011923 DOI: 10.1186/s12884-016-1056-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/25/2016] [Indexed: 11/23/2022] Open
Abstract
Background Smoking cessation has been reported to be associated with high total gestational weight gain (GWG), which itself is a risk factor for adverse maternal-infant outcomes. Recent studies have criticized conventional single measures of GWG, since they may lead to biased results. Therefore, we aimed to compare patterns of GWG based on serial antenatal weight measurements between women who: never smoked, quit during pregnancy, continued to smoke. Methods Participants (N = 509) of our longitudinal study were recruited from seven antenatal clinics in Southwestern Ontario. Serial GWG measurements were abstracted from medical charts, while information on smoking status was obtained from a self-administered questionnaire at a median gestational age of 32 (27–37) weeks. GWG patterns were assessed by fitting piecewise mixed-effects models. First trimester weight gains and weekly rates for the last two trimesters were compared by smoking status. Results During the first trimester, women who never smoked and those who quit during pregnancy gained on average 1.7 kg (95 % CI: 1.4–2.1) and 1.2 kg (0.3–2.1), respectively, whereas women who continued smoking gained more than twice as much (3.5 kg, 2.4–4.6). Weekly rate of gain in the second and third trimesters was highest in women who quit smoking (0.60 kg/week, 0.54–0.65), approximately 20 and 50 % higher than in women who never smoked and those who smoked during pregnancy, respectively. Conclusions In this longitudinal study to examine GWG by smoking status based on serial GWG measurements, we found that women who quit smoking experienced a rapid rate of gain during the last two trimesters, suggesting that this high-risk group may benefit from targeted interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1056-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam Hulman
- Department of Obstetrics & Gynecology, McMaster University, 1280 Main Street West, Room 3N52, Hamilton, ON, L8S 4K1, Canada. .,Department of Medical Physics & Informatics, University of Szeged, Szeged, Hungary.
| | - Olha Lutsiv
- Department of Obstetrics & Gynecology, McMaster University, 1280 Main Street West, Room 3N52, Hamilton, ON, L8S 4K1, Canada
| | - Christina K Park
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Lynette Krebs
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sarah D McDonald
- Departments of Obstetrics & Gynecology, Radiology, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
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Kharkova OA, Krettek A, Grjibovski AM, Nieboer E, Odland JØ. Prevalence of smoking before and during pregnancy and changes in this habit during pregnancy in Northwest Russia: a Murmansk county birth registry study. Reprod Health 2016; 13:18. [PMID: 26952100 PMCID: PMC4782289 DOI: 10.1186/s12978-016-0144-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/25/2016] [Indexed: 12/21/2022] Open
Abstract
Background Smoking during pregnancy leads to adverse maternal and birth outcomes. However, the prevalence of smoking among women in Russia has increased from < 5 % in the 1980s to > 20 % in the 2000s. We conducted a registry-based study in Murmansk County, Northwest Russia. Our aims were twofold: (i) assess the prevalence of smoking before and during pregnancy; and (ii) examine the socio-demographic factors associated with giving up smoking or reducing the number of cigarettes smoked once pregnancy was established. Methods This study employs data from the population-based Murmansk County Birth Registry (MCBR) collected during 2006–2011. We used logistic regression to investigate associations between women’s socio-demographic characteristics and changes in smoking habit during pregnancy. To avoid departure from uniform risk within specific delivery departments, we employed clustered robust standard errors. Results Of all births registered in the MCBR, 25.2 % of the mothers were smokers before pregnancy and 18.9 % continued smoking during pregnancy. Cessation of smoking during pregnancy was associated with education, marital status and parity but not with maternal age, place of residence, and ethnicity. Women aged ≤ 20–24 years had higher odds of reducing the absolute numbers of cigarettes smoked per day during pregnancy than those aged ≥ 30–34 years. Moreover, smoking nulliparae and pregnant women who had one child were more likely to reduce the absolute numbers of cigarettes smoked per day compared to women having ≥ 2 children. Conclusions About 25.0 % of smoking women in the Murmansk County in Northwest Russia quit smoking after awareness of the pregnancy, and one-third of them reduced the number cigarettes smoked during pregnancy. Our study demonstrates that women who have a higher education, husband, and are primiparous are more likely to quit smoking during pregnancy. Maternal age and number of children are indicators that influence reduction in smoking during pregnancy. Our findings are useful in identifying target groups for smoking intervention campaigns.
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Affiliation(s)
- Olga A Kharkova
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway. .,International School of Public Health, Northern State Medical University, office 1252, Troitsky avenue 51, Arkhangelsk, 163000, Russia.
| | - Alexandra Krettek
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway. .,Department of Biomedicine and Public Health, School of Health and Education, University of Skövde, Skövde, Sweden. .,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Andrej M Grjibovski
- International School of Public Health, Northern State Medical University, office 1252, Troitsky avenue 51, Arkhangelsk, 163000, Russia. .,Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway. .,Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan. .,North-Easten Federal University, Yakutsk, Russia.
| | - Evert Nieboer
- Department of Biochemistry and Biomedical Sciences, Hamilton, ON, Canada.
| | - Jon Øyvind Odland
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway. .,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
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Muraro AP, Gonçalves-Silva RMV, Ferreira MG, Silva GAE, Sichieri R. Effect of the exposure to maternal smoking during pregnancy and childhood on the body mass index until adolescence. Rev Saude Publica 2015; 49:41. [PMID: 26247384 PMCID: PMC4544362 DOI: 10.1590/s0034-8910.2015049005423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 10/27/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Investigate the effect of exposure to smoking during pregnancy and early childhood on changes in the body mass index (BMI) from birth to adolescence. METHODS A population-based cohort of children (0-5 years old) from Cuiabá, Midwest Brazil, was assessed in 1999-2000 (n = 2,405). Between 2009 and 2011, the cohort was re-evaluated. Information about birth weight was obtained from medical records, and exposure to smoking during pregnancy and childhood was assessed at the first interview. Linear mixed effects models were used to estimate the association between exposure to maternal smoking during pregnancy and preschool age, and the body mass index of children at birth, childhood and adolescence. RESULTS Only 11.3% of the mothers reported smoking during pregnancy, but most of them (78.2%) also smoked during early childhood. Among mothers who smoked only during pregnancy (n = 59), 97.7% had smoked only in the first trimester. The changes in body mass index at birth and in childhood were similar for children exposed and those not exposed to maternal smoking. However, from childhood to adolescence the rate of change in the body mass index was higher among those exposed only during pregnancy than among those who were not exposed. CONCLUSIONS Exposure to smoking only during pregnancy, especially in the first trimester, seems to affect changes in the body mass index until adolescence, supporting guidelines that recommend women of childbearing age to stop smoking.
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Affiliation(s)
- Ana Paula Muraro
- Instituto de Saúde Coletiva, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | | | | | - Gulnar Azevedo E Silva
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Rosely Sichieri
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Slane JD, Levine MD. Association of Restraint and Disinhibition to Gestational Weight Gain among Pregnant Former Smokers. Womens Health Issues 2015; 25:390-5. [PMID: 26048757 DOI: 10.1016/j.whi.2015.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 03/01/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gaining excessive weight during pregnancy is associated with immediate maternal and fetal complications as well as longer term obesity. Prepregnancy body mass index, age, and smoking cessation have been related to gestational weight gain (GWG); however, less is known about how eating behaviors, that may be amenable to modification and have been related to weight gain outside of pregnancy, affect GWG. METHODS The present study evaluated the relationship of dietary restraint and disinhibition to GWG in a sample of women (n=248) who quit smoking before or early in pregnancy. Women self-reported height and prepregnancy weight during their third trimester. GWG was calculated by subtracting prepregnancy weight from third trimester weight. The Three-Factor Eating Questionnaire assessed restraint and disinhibition. RESULTS Average GWG was 14.60 (±7.64) kg and 47% of women had a GWG greater than the Institute of Medicine recommendations. Linear regression models were used to examine restraint and disinhibition as correlates of GWG, and multinomial logistic regressions were utilized to determine whether eating behaviors were associated with inadequate or excessive GWG. Restraint was associated positively with total GWG, but disinhibition was not associated with GWG. Thus, conscious attempts to restrict intake were associated with GWG beyond the influence of covariates. CONCLUSION These findings highlight the potential influence of modifiable eating behaviors on GWG and demonstrate the need for additional research to determine how these behaviors relate to GWG over the course of pregnancy.
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Affiliation(s)
- Jennifer D Slane
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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14
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Levine MD, Cheng Y, Marcus MD, Emery RL. Psychiatric disorders and gestational weight gain among women who quit smoking during pregnancy. J Psychosom Res 2015; 78:504-508. [PMID: 25433975 PMCID: PMC4380755 DOI: 10.1016/j.jpsychores.2014.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pregnancy is a common time for women to quit using cigarettes and other substances. Such changes in substance use as well as other psychiatric and psychosocial changes during pregnancy can affect gestational weight gain (GWG). Thus, we evaluated the relationship between psychiatric disorders and GWG among pregnant women who had quit smoking. METHODS Pregnant former smokers (n = 281) enrolled in a larger trial for postpartum relapse prevention completed semi-structured psychiatric interviews and measures of prepregnancy nicotine dependence and smoking behavior, and were weighed to estimate gestational weight gain. Using linear regression and mixed-effect models, the relationship between a lifetime prevalence of each psychiatric disorder and total GWG was evaluated, controlling for variables previously related to GWG. RESULTS Average GWG was 15.6 (± 8.5) kg, and 56% (n = 157) of women exceeded the GWG recommended by the Institute of Medicine (IOM) according to prepregnancy BMI. Over one-third (34.3%) of pregnant former smokers had a history of at least one diagnosable psychiatric disorder. History of psychiatric disorder was unrelated to GWG, with one exception; lifetime history of alcohol use disorder was associated with significantly larger GWG. CONCLUSION Women who quit smoking during pregnancy gain a considerable amount of gestational weight, and a previous history of alcohol use disorder is related to GWG. However, the benefits of smoking cessation to maternal and fetal health likely outweigh the disadvantage of weight gain, and other psychiatric disorders are not linked to GWG.
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Affiliation(s)
- Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Department of Statistics, University of Pittsburgh, Pittsburgh, PA, United States; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Yu Cheng
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Department of Statistics, University of Pittsburgh, Pittsburgh, PA, United States; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Marsha D Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Department of Statistics, University of Pittsburgh, Pittsburgh, PA, United States; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rebecca L Emery
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Department of Statistics, University of Pittsburgh, Pittsburgh, PA, United States; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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Weight gain in healthy pregnant women in relation to pre-pregnancy BMI, diet and physical activity. Midwifery 2015; 31:693-701. [PMID: 25981808 DOI: 10.1016/j.midw.2015.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/23/2015] [Accepted: 04/14/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE to explore gestational weight gain in healthy women in relation to pre-pregnancy Body Mass Index, diet and physical activity. DESIGN a cross-sectional survey was conducted among 455 healthy pregnant women of all gestational ages receiving antenatal care from an independent midwife in the Netherlands. Weight gain was assessed using the Institute of Medicine (IOM) guidelines and classified as below, within, or above the guidelines. A multinomial regression analysis was performed with weight gain classifications as the dependent variable (within IOM-guidelines as reference). Independent variables were pre-pregnancy Body Mass Index, diet (broken down into consumption of vegetables, fruit and fish) and physical activity (motivation to engage in physical activity, pre-pregnancy physical activity and decline in physical activity during pregnancy). Covariates were age, gestational age, parity, ethnicity, family income, education, perceived sleep deprivation, satisfaction with pre-pregnancy weight, estimated prepregnancy body mass index, smoking, having a weight gain goal and having received weight gain advice from the midwife. FINDINGS forty-two per cent of the women surveyed gained weight within the guidelines. Fourteen per cent of the women gained weight below the guidelines and 44 per cent gained weight above the guidelines. Weight gain within the guidelines, compared to both above and below the guidelines, was not associated with pre-pregnancy Body Mass Index nor with diet. A decline in physical activity was associated with weight gain above the guidelines (OR 0.54, 95 per cent CI 0.33-0.89). Weight gain below the guidelines was seen more often in women who perceived a greater sleep deprivation (OR 1.20, 95 per cent CI 1.02-1.41). Weight gain above the guidelines was seen less often in Caucasian women in comparison to non-Caucasian women (OR 0.22, 95 per cent CI 0.08-0.56) and with women who did not stop smoking during pregnancy (OR 0.49, 95 per cent CI 0.25-0.95). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE a decline in physical activity was the only modifiable factor in our population associated with weight gain above the gain recommended by the guidelines. Prevention of reduced physical activity during pregnancy seems a promising approach to promoting healthy weight gain. Interventions to promote healthy weight gain should focus on all women, regardless of pre-pregnancy body mass index.
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Mattsson K, Källén K, Rignell-Hydbom A, Lindh CH, Jönsson BAG, Gustafsson P, Olofsson P, Ivarsson SA, Rylander L. Cotinine Validation of Self-Reported Smoking During Pregnancy in the Swedish Medical Birth Register. Nicotine Tob Res 2015; 18:79-83. [PMID: 25895950 DOI: 10.1093/ntr/ntv087] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 04/10/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Self-reported data on smoking during pregnancy from the Medical Birth Register of Sweden (MBR) are widely used. However, underreporting of such behavior may occur, leading to biases. It is of importance to validate the smoking data in the MBR. The main objective was to investigate the agreement between self-reported smoking data from the MBR and cotinine levels in maternal serum among women from the general population in the region of Skåne, Sweden. We also estimated the transfer of cotinine from mother to fetus. METHODS From a cohort used previously to investigate the relationship between intrauterine environmental exposures and offspring neuropsychiatric outcomes, there were 204 control children retrieved from the MBR with data on maternal smoking in early pregnancy registered. Data on maternal and umbilical cord cotinine at delivery were available for these children from a regional biobank. RESULTS There was a high agreement between cotinine levels and MBR smoking data (κ = 0.82) and a high correlation between cotinine levels in maternal and umbilical cord serum (r s = 0.90, P < .001). Of the self-reported nonsmokers, 95% (95% confidence interval: 89% to 97%) were classified as nonsmokers after cotinine measurements. CONCLUSION In these data, we found that the agreement between mothers' self-reported smoking habits during pregnancy and their levels of serum cotinine was high, as was the transfer of cotinine from mother to fetus. This indicates that birth register data on pregnancy smoking in Sweden could be considered a valid measure.
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Affiliation(s)
- Kristina Mattsson
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden;
| | - Karin Källén
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anna Rignell-Hydbom
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Bo A G Jönsson
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Peik Gustafsson
- Department of Child and Adolescent Psychiatry, Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Per Olofsson
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Sten A Ivarsson
- Department of Clinical Sciences, Unit of Pediatric Endocrinology, Lund University/Clinical Research Centre, Malmö, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden
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Effect of smoking cessation on gestational and postpartum weight gain and neonatal birth weight. Obstet Gynecol 2013; 122:618-25. [PMID: 23921874 DOI: 10.1097/aog.0b013e3182a10836] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association among smoking cessation, gestational and postpartum weight gain, and neonatal birth weight. METHODS We analyzed prospectively collected data from 1,774 women with term singleton pregnancies. Smoking status during pregnancy was categorized as nonsmokers, smokers, and quitters; and smoking status 1 year postpartum as nonsmokers, smokers, relapsed quitters, and sustained quitters. The association between smoking status and gestational weight gain, weight gain 1 year postpartum, and neonatal birth weight was tested by linear regression analysis, and the association between smoking status and neonatal birth weight less than the 10th percentile for gestational age and sex was tested by multivariable logistic regression analysis. RESULTS Gestational weight gain at 16 weeks of gestation was comparable for nonsmokers, smokers, and quitters. The adjusted mean gestational weight gain at 37 weeks of gestation was 2.0 kg (95% confidence interval [CI] 1.5-2.6) higher in quitters compared with nonsmokers. The rate of neonatal birth weight less than the 10th percentile was 21.7% among smokers, 8.0% among quitters, and 7.4% among nonsmokers. The adjusted odds ratio (OR) for birth weight less than 10th percentile was 3.6 (95% CI 2.5-5.2) in neonates born to smokers; the risk was similar for quitters (OR 1.0, 95% CI 0.6-1.6). One year after delivery, sustained quitters had a 2.4-kg (95% CI 1.6-3.1) higher adjusted postpartum weight gain than nonsmokers. CONCLUSION Smoking cessation is associated with gestational as well as postpartum weight gain. However, smoking cessation is associated with a substantially lower rate of neonatal birth weight less than the 10th percentile. LEVEL OF EVIDENCE II.
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Levine MD, Cheng Y, Cluss PA, Marcus MD, Kalarchian MA. Prenatal smoking cessation intervention and gestational weight gain. Womens Health Issues 2013; 23:e389-93. [PMID: 24183413 PMCID: PMC3864656 DOI: 10.1016/j.whi.2013.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/04/2013] [Accepted: 07/31/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Quitting smoking is often associated with weight gain and prenatal cessation may lead to increased gestational weight gain (GWG). Although previous reports have suggested a link between prenatal smoking cessation and GWG, no studies have examined the relationship between cessation and guideline-recommended GWG, and there is little information about the relationship between the timing of prenatal cessation and GWG. Thus, we examine GWG among women in a community prenatal smoking cessation program and assess the relationship between the timing of prenatal cessation GWG. METHODS Pregnant women from care clinics serving economically disadvantaged women who participated in a smoking cessation intervention offered free of charge, self-reported weight, and provided biochemical verification of smoking. Relationships between duration of cessation and GWG were evaluated in t-tests and regression models. GWG was calculated from self-reported weight before pregnancy and self-reported weight at the last visit before delivery. FINDINGS Women who quit earlier during pregnancy had greater GWG (16.9 ± 7.5 kg) than did those who never quit (13.6 ± 8.9). After adjusting for timing of weight assessment and prepregnancy body mass index, however, GWG was not different between women who did and did not quit. CONCLUSION Quitting earlier in pregnancy is associated with greater GWG, but women who do and do not quit do not differ on total GWG. Despite increased GWG with early cessation, the maternal and fetal health benefits of prenatal smoking cessation outweigh risks of potential risks of excessive GWG.
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Affiliation(s)
- Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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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.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences Washington, DC 20037, USA.
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Washio Y, Higgins ST, Heil SH, Badger GJ, Skelly J, Bernstein IM, Solomon LJ, Higgins TM, Lynch ME, Hanson JD. Examining maternal weight gain during contingency-management treatment for smoking cessation among pregnant women. Drug Alcohol Depend 2011; 114:73-6. [PMID: 20870365 PMCID: PMC3027838 DOI: 10.1016/j.drugalcdep.2010.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 08/23/2010] [Accepted: 08/24/2010] [Indexed: 11/19/2022]
Abstract
Excessive maternal weight gain during pregnancy can result in serious adverse maternal and neonatal health consequences making it an important outcome to monitor in developing smoking-cessation interventions for pregnant women. Maternal weight gain was investigated in the present study with 154 pregnant participants in controlled trials investigating the efficacy of contingency management (CM) for smoking cessation. Women were assigned to either an abstinence-contingent condition wherein they earned vouchers exchangeable for retail items by abstaining from smoking or to a control condition where they received comparable vouchers independent of smoking status. Mean percent of negative smoking-status tests throughout antepartum was greater in the incentive than control condition (45.2±4.6 vs. 15.5±2.4, p<.001) as was late-pregnancy point-prevalence abstinence (36% vs. 8%, p<.001) but maternal weight gain did not differ significantly between treatment conditions (15.0±0.8kg vs. 15.0±0.9 kg, p=.97). In a comparison of women classified by smoking status rather than treatment condition, a greater percent of negative smoking-status tests predicted significantly more weight gain (0.34 kg per 10% increase in negative tests), an effect that appeared to be attributable to women with greater abstinence having larger infants. This study shows no evidence of excessive maternal weight gain among pregnant women receiving a CM intervention for smoking cessation.
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Affiliation(s)
- Yukiko Washio
- Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA.
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