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Level RA, Zhang Y, Tiemeier H, Estabrook R, Shaw DS, Leve LD, Wakschlag LS, Reiss D, Neiderhiser JM, Massey SH. Unique influences of pregnancy and anticipated parenting on cigarette smoking: results and implications of a within-person, between-pregnancy study. Arch Womens Ment Health 2024; 27:301-308. [PMID: 37994923 PMCID: PMC11302987 DOI: 10.1007/s00737-023-01396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023]
Abstract
Not all pregnant individuals want to become parents and "parenting intention" can also vary within individuals during different pregnancies. Nevertheless, the potential impact of parenting intention on health-related behavior during pregnancy has been heavily underexplored. In this study, we employed a within-person between pregnancy design to estimate the effect of parenting-specific influences on smoking, separate from pregnancy-specific and individual-level influences. We quantified within-mother differences in smoking during pregnancies of infants they reared (n = 84) versus pregnancies of infants they placed for adoption at birth (n = 65) using multivariate mixed-effects Poisson regression models. Mean cigarettes/day declined as the pregnancy progressed regardless of whether infants were reared or placed. However, participants smoked fewer cigarettes/day during reared pregnancies. Relative to "adopted" pregnancies, smoking during "reared" pregnancies was lower by 24%, 41%, and 54% in first (95% CI 0.64-0.90; p = 0.001), second (95% CI 0.48-0.72; p < 0.001), and third trimesters (95% CI 0.36-0.59; p < 0.001), respectively, independent of between-pregnancy differences in maternal age, fetal sex, parity, and pregnancy complications. Female sex and nulliparity were protective. Parenting intention was associated with a protective effect on pregnancy smoking independent of pregnancy-specific influences and individual characteristics. Failure to consider the impact of parenting intention on health-related behavior during pregnancy could perpetuate an unrealistic expectation to "do what's best for the baby" and stigmatize women with unintended or unwanted pregnancies.
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Affiliation(s)
- Rachel A Level
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Yingzhe Zhang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, MA, USA
| | - Ryne Estabrook
- Department of Psychology, University of Illinois Chicago, Chicago, IL, USA
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leslie D Leve
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - David Reiss
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Jenae M Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Suena H Massey
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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David AT, Sharma V, Bittencourt L, Gurka KK, Perez-Carreño JG, Lopez-Quintero C. Exploring the associations between serious psychological distress and the quantity or frequency of tobacco, alcohol, and cannabis use among pregnant women in the United States. Prev Med 2023; 177:107770. [PMID: 37951544 PMCID: PMC11099898 DOI: 10.1016/j.ypmed.2023.107770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
Serious Psychological Distress (SPD) and prenatal exposure to substances are associated with adverse outcomes for pregnant individuals and their developing offspring. This study aims to examine the relationship between SPD and quantity, or frequency of substance use among pregnant women in the United States (US). Descriptive and negative binomial regression analyses of the 2015-2019 National Survey on Drug Use and Health (NSDUH) were conducted among 3373 pregnant women (18 to 44 years old) to examine the association between SPD and (1) average number of cigarettes smoked in the past 30 days, (2) number of days of binge drinking in the past 30 days, and (3) number of days of cannabis use in the past 30 days. About 6% of the study population experienced SPD in the past 30 days. Compared to pregnant women who did not report SPD, pregnant women experiencing SPD showed greater rates in the number of cigarettes smoked during the past 30 days (IRR = 2.1, 95%CI = 1.1, 4.5), the number of days of binge drinking in the past 30 days (IRR = 5.1, 95%CI = 1.7, 15.4), and the number of days of cannabis use in the past 30 days (IRR = 2.9, 95%CI = 1.3, 6.5). Our results extend findings from prior research by documenting an association between SPD and the quantity and frequency of substance use among pregnant women in the US. Individual and structural interventions addressing SPD and/or substance might help reduce the impact of these comorbid conditions on expectant parents and their offspring.
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Affiliation(s)
- Ayomide T David
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Vinita Sharma
- Boise State University, School of Public and Population Health, Boise, ID 83725-1835, United States of America.
| | - Lorna Bittencourt
- University of Minnesota, Division of Environmental Health Sciences, Minneapolis, MN 55455, United States of America
| | - Kelly K Gurka
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Juan Guillermo Perez-Carreño
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Catalina Lopez-Quintero
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
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Massey SH, Pool LR, Estabrook R, Level RA, Shisler S, Stacks AM, Neiderhiser JM, Espy KA, Wakschlag LS, Eiden RD, Allen NB. Within-person decline in pregnancy smoking is observable prior to pregnancy awareness: Evidence across two independent observational cohorts. Addict Biol 2022; 27:e13245. [PMID: 36301213 PMCID: PMC9939010 DOI: 10.1111/adb.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
Decreased consumption of nicotine and other drugs during pregnancy appears to be a cross-species phenomenon from which mechanism(s) capable of interrupting addictive processes could be elucidated. Whether pregnancy influences smoking behaviour independent of women's knowledge of the pregnancy, however, has not been considered. Using repeated measures analysis of variance (ANOVA), we estimated within-person change in mean cigarettes/day smoked across the estimated date of conception but prior to individually reported dates of pregnancy recognition using longitudinal smoking data from two independent observational cohorts, the Growing Up Healthy (GUH, n = 271) and Midwest Infant Development Studies (MIDS, n = 145). Participants smoked an average of half a pack/day in the month immediately before conception (M (SD) = 12(8.1) and 9.5(6.7) cigarettes/day in GUH and MIDS, respectively). We observed within-person declines in smoking after conception, both before (MGUH = -0.9; 95% CI -1.6, -0.2; p = 0.01; MMIDS = -1.1; 95% CI -1.9, -0.3; p = 0.01) and after (MGUH = -4.8; 95% CI -5.5, -4.1; p < 0.001; MMIDS = -3.3; 95% CI -4.4, -2.5; p < 0.001) women were aware of having conceived, even when women who had quit and women who were planning to conceive were excluded from analyses. Pregnancy may interrupt smoking-related processes via mechanisms not previously considered. Plausible candidates and directions for future research are discussed.
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Affiliation(s)
- Suena H. Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Deparment of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsay R. Pool
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Deparment of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryne Estabrook
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rachel A. Level
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shannon Shisler
- Research Institute on Addictions, University at Buffalo, Buffalo, New York, USA
| | - Ann M. Stacks
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan, USA
| | - Jenae M. Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly A. Espy
- Department of Neuroscience, Developmental and Regenerative Biology; Department of Psychiatry and Behavioral Science, Long School of Medicine, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Lauren S. Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rina D. Eiden
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Norrina B. Allen
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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4
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Massey SH, Allen NB, Pool LR, Miller ES, Pouppirt NR, Barch DM, Luby J, Perlman SB, Rogers CE, Smyser CD, Wakschlag LS. Impact of prenatal exposure characterization on early risk detection: Methodologic insights for the HEALthy Brain and Child Development (HBCD) study. Neurotoxicol Teratol 2021; 88:107035. [PMID: 34606910 PMCID: PMC8578417 DOI: 10.1016/j.ntt.2021.107035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A major challenge in prenatal drug exposure research concerns the balance of measurement quality with sample sizes necessary to address confounders. To inform the selection of optimal exposure measures for the HEALthy Brain and Child Development (HBCD) Study, we employed integrated analysis to determine how different methods used to characterize prenatal tobacco exposure influence the detection of exposure-related risk, as reflected in normal variations in birth weight. METHODS Participants were N = 2323 mother-infant dyads derived from 7 independent developmental cohorts harmonized on measures of exposure, outcome (birthweight), and covariates. We compared estimates of PTE-related effects on birthweight derived from linear regression models when PTE was categorized dichotomously based on any fetal exposure (30% exposed; 69% not exposed); versus categorically, based on common patterns of maternal smoking during pregnancy (never smoked 69%; quit smoking 16%; smoked intermittently 2%; smoked persistently 13%). We secondarily explored sex differences in PTE-birthweight associations across these categorization methods. RESULTS When PTE was categorized dichotomously, exposure was associated with a - 125-g difference in birthweight (95% C.I. -173.7 - -76.6, p < .0001). When PTE was characterized categorically based on maternal smoking patterns, however, exposure was associated with either no difference in birthweight if mothers quit smoking by the end of the first trimester (B = -30.6, 95% C.I. -88.7-27.4, p = .30); or a - 221.8 g difference in birthweight if mothers did not [95% C.I. (-161.7 to -282.0); p < .001]. Qualitative sex differences were also detected though PTE x sex interactions did not reach statistical significance. Maternal smoking cessation during pregnancy was associated with a 239.3 g increase in birthweight for male infants, and a 114.0 g increase in birthweight for females infants (p = .07). CONCLUSIONS Categorization of PTE based on patterns of maternal smoking rather than the presence or absence of exposure alone revealed striking nuances in estimates of exposure-related risk. The described method that captures both between-individual and within-individual variability in prenatal drug exposure is optimal and recommended for future developmental investigations such as the HBCD Study.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 1000, Chicago, IL 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Avenue, Suite 2100, Chicago, IL 60611, USA; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA.
| | - Norrina B Allen
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lakeshore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Lindsay R Pool
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lakeshore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Emily S Miller
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA; Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Room 05-2175, Chicago, IL 60611, USA.
| | - Nicole R Pouppirt
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA; Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 45, Chicago, IL 60611, USA.
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, Box 1125, One Brookings Drive, St. Louis, MO 63130, USA.
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 660 S. Euclid Box 8511, St. Louis, MO 63110, USA.
| | - Susan B Perlman
- Department of Child and Adolescent Psychiatry, Washington University School of Medicine in St. Louis, 4444 Forest Park Ave, St. Louis, MO 63110, United States of America.
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 660 S. Euclid Box 8511, St. Louis, MO 63110, USA.
| | - Chris D Smyser
- Departments of Neurology, Pediatrics, and Radiology, Washington University School of Medicine in St. Louis, 4525 Scott Avenue, St. Louis, MO 63110, USA.
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Avenue, Suite 2100, Chicago, IL 60611, USA; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA.
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Nagpal N, Ramos AM, Hajal N, Massey SH, Leve LD, Shaw DS, Ganiban JM, Reiss D, Neiderhiser JM. Psychopathology Symptoms are Associated with Prenatal Health Practices in Pregnant Women with Heavy Smoking Levels. Matern Child Health J 2021; 25:330-337. [PMID: 33417106 DOI: 10.1007/s10995-020-03048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Smoking during pregnancy may be linked to other problematic prenatal health behaviors in women. We examined interrelationships among prenatal smoking, prenatal health behaviors and mental health. The objective of this study was to examine factors that may contribute to variations in prenatal health practices among women who smoke during pregnancy. METHODS Birth mothers from an adoption study (N = 912) were interviewed about prenatal smoking, health behaviors, and mental health symptoms at 5 months postpartum. RESULTS One-quarter of participants (N = 222) reported smoking 6 or more cigarettes daily for at least 1 trimester. For mothers who smoked more than 6 cigarettes daily, higher levels of antisocial behaviors (β = - .14, p = .03) and depressive symptoms (β = - .17, p = .03) were associated with less frequent prenatal folate use; antisocial behaviors and depressive symptoms were not associated for prenatal folate use among women who did not smoke more than 6 cigarettes daily. For mothers who did not smoke more than 6 cigarettes daily, more depressive symptoms were associated with fewer prenatal care visits (β = .12, p = .01). Antisocial behaviors and anxiety symptoms were not associated with prenatal care visits in either group of mothers. CONCLUSIONS FOR PRACTICE: Maternal antisocial behaviors and depressive symptoms during pregnancy may be markers for poorer adherence to recommendations for folate supplementation among women who smoke 6 or more cigarettes daily during pregnancy, independent of adequacy of prenatal care.
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Affiliation(s)
- Nikita Nagpal
- Department of Pediatrics, NYU Grossman School of Medicine/Bellevue Hospital Center, 462 First Avenue, Administration Building Rm A314, New York, NY, 10016, USA.
| | - Amanda M Ramos
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | - Nastassia Hajal
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Suena H Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Leslie D Leve
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Jody M Ganiban
- Department of Psychology, George Washington University, Washington, USA
| | - David Reiss
- Yale Child Study Center, Yale University, New Haven, USA
| | - Jenae M Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, USA
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Jussila H, Pelto J, Korja R, Ekholm E, Pajulo M, Karlsson L, Karlsson H. The association of maternal-fetal attachment with smoking and smoking cessation during pregnancy in The FinnBrain Birth Cohort Study. BMC Pregnancy Childbirth 2020; 20:741. [PMID: 33256653 PMCID: PMC7708161 DOI: 10.1186/s12884-020-03393-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background Smoking in pregnancy constitutes a preventable risk factor for fetal/child development and maternal-fetal attachment (MFA) seems to contain a momentum that can break the chain of adverse outcomes by promoting maternal prenatal health practices. This study aimed to explore the association of MFA with smoking at any time during pregnancy and smoking cessation in early pregnancy, and the modifying role of MFA on the expected effects of education and prenatal psychological distress (PPD) on prenatal smoking behavior. Methods The pregnant women (n = 3766) participated in the The FinnBrain Birth Cohort Study in Finland between December 2011 and April 2015. The binary outcomes, smoking at any time during pregnancy and smoking cessation in early pregnancy, were obtained from self-reports at gestational weeks (gwks) 14 and 34 and The Finnish Medical Birth Register. MFA was assessed with the Maternal-Fetal Attachment Scale (MFAS) at gwks 24 and 34. Logistic regression analyses were used to determine the association between MFA and maternal prenatal smoking behavior. Findings The prevalence of smoking was 16.5%, and 58.1% of the smokers quit smoking during pregnancy. The independent associations of total MFA scores with prenatal smoking behavior were not established (aOR = 1.00-1.02, multiplicity adjusted p > 0.05). A higher score in the altruistic subscale of MFA, Giving of self, associated with a higher probability of smoking cessation (24 gwks: aOR = 1.13, 95% CI [1.04, 1.24], p = 0.007, multiplicity adjusted p = 0.062; 34 gwks: aOR = 1.17, 95% CI [1.07, 1.29], p < 0.001, multiplicity adjusted p = 0.008). The modifying effect of MFA on the observed associations between PPD and smoking in pregnancy and between maternal education and smoking in pregnancy / smoking cessation in early pregnancy was not demonstrated. Conclusions The altruistic dimension of maternal-fetal attachment associates with an increased probability of smoking cessation during pregnancy and therefore strengthening altruistic maternal-fetal attachment may constitute a promising novel approach for interventions aiming at promoting smoking cessation during pregnancy.
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Affiliation(s)
- Heidi Jussila
- Doctoral Programme of Clinical Investigation, Department of Child Psychiatry, University of Turku, Turku, Finland. .,FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.
| | - Juho Pelto
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Department of Psychology , University of Turku , Turku, Finland
| | - Eeva Ekholm
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Department of Obstetrics and Gynecology , Turku University Hospital , Turku, Finland
| | - Marjukka Pajulo
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Department of Child Psychiatry , University of Turku , Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Centre for Population Health Research , University of Turku and Turku University Hospital , Turku, Finland.,Department of Child Psychiatry , Turku University Hospital and University of Turku , Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Department of Psychiatry , Turku University Hospital and University of Turku , Turku, Finland
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Míguez MC, Pereira B, Pinto TM, Figueiredo B. Continued tobacco consumption during pregnancy and women's depression and anxiety symptoms. Int J Public Health 2019; 64:1355-1365. [PMID: 31628523 DOI: 10.1007/s00038-019-01308-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/31/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study aimed to analyse depression and anxiety symptoms changes from the first to the third trimester of pregnancy in non-smokers versus quitters versus continuous smokers, and the contribution of depression and anxiety symptoms to continued tobacco consumption during pregnancy. METHODS The sample comprises 850 Spanish pregnant women (595 non-smokers, 123 quitters, and 132 continuous smokers), assessed at the first and the third trimester of pregnancy with a questionnaire concerning socio-demographic, obstetric, and tobacco consumption information, and measures of depression and anxiety. RESULTS Continuous smokers during pregnancy showed more depression and anxiety symptoms than both non-smokers and quitters and no changes from the first trimester to the third trimester of pregnancy, while both non-smokers and quitters revealed a decrease in depression and anxiety symptoms. More anxiety symptoms at the first trimester (OR 1.03) and depression symptoms at the third trimester (OR 1.14) were associated with continued smoking during pregnancy. CONCLUSIONS Anxiety and depression symptoms need to be considered to screening for women at risk of smoking during pregnancy. Future prenatal smoking cessation interventions must take into account these variables.
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Affiliation(s)
- M Carmen Míguez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Campus Vida, 15782, Santiago de Compostela, Spain.
| | - Beatriz Pereira
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Campus Vida, 15782, Santiago de Compostela, Spain
| | - Tiago Miguel Pinto
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Bárbara Figueiredo
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
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Does Current General Mental Health Status Relate to Current Smoking Status in Pregnant Women? J Pregnancy 2019; 2019:7801465. [PMID: 31186961 PMCID: PMC6521577 DOI: 10.1155/2019/7801465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Research shows that smoking during pregnancy is related to mental health diagnoses. The purpose of this study was to assess whether current general mental health status is related to current smoking status in pregnant women after controlling for other factors related to both mental health and tobacco use during pregnancy. Methods This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance Survey (BRFSS) data for 621 pregnant women aged 18-38 from Florida (N=136), Kansas (N=116), Minnesota (N=105), Nebraska (N=90), New York (N=78), and Utah (N=96). Multiple logistic regression analysis was used to assess the relationship between current mental health status and current tobacco use, while controlling for state, depression diagnosis, routine checkup, healthcare plan, age, marital status, ethnicity/race, education level, income level, and employment status. Results Overall, very few participants reported current smoking (6%) and about one-third reported low or moderate mental health status in the past 30 days. Adjusted results indicated that those who reported high mental health status were about 3 times less likely (OR=0.29, 95% CI=0.09, 0.88) to report current smoking status compared to those who reported low mental health status. Conclusions Overall, current mental health status was highly related to current smoking status in pregnant women. Clinicians in obstetrics may expect a very low proportion of pregnant women to report smoking and up to one-third to report low or moderate current general mental health status. Given that current mental health issues and current tobacco use may harm both mother and child, be highly related in pregnant women, and change throughout the pregnancy, pregnant women should be screened automatically for both at each visit.
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Godleski SA, Shisler S, Eiden RD, Huestis MA. Co-use of tobacco and marijuana during pregnancy: Pathways to externalizing behavior problems in early childhood. Neurotoxicol Teratol 2018; 69:39-48. [PMID: 30081085 PMCID: PMC6396313 DOI: 10.1016/j.ntt.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022]
Abstract
Use and co-use of tobacco and marijuana during pregnancy are associated with the development of social, cognitive, and behavioral problems for infants and children. However, less is known about the potential developmental impact of the use of tobacco and marijuana in tandem. The present study examined an etiological model for the development of externalizing behavior problems (EBP) in early childhood in a high risk sample (N = 247) of mother-infant dyads with prospective data from pregnancy to 36 months of child age. Co-use during pregnancy and continued maternal tobacco and marijuana use from infancy through early childhood were investigated. Although direct pathways from exposure during pregnancy to EBP were not significant, there was a significant indirect pathway from prenatal tobacco use to EBP via lower breastfeeding duration to lower maternal warmth/sensitivity to EBP, and a pathway from higher maternal affective dysregulation to higher EBP. These results highlight the importance of considering cascading effects of substance use during pregnancy on parental processes within the context of developmental risk and protection.
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Affiliation(s)
- Stephanie A Godleski
- College of Liberal Arts, Rochester Institute of Technology, 18 Lomb Memorial Drive, Rochester, NY 14623, USA.
| | - Shannon Shisler
- Research Institute on Addictions, University at Buffalo, The State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
| | - Rina D Eiden
- Department of Psychology, University at Buffalo, The State University of New York, 204 Park Hall, Buffalo, NY 14260, USA
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA 19107, USA
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Mahabee-Gittens EM, Ammerman RT, Khoury JC, Stone L, Meyers GT, Witry JK, Merianos AL, Mancuso TF, Stackpole KMW, Bennett BL, Akers L, Gordon JS. Healthy families: study protocol for a randomized controlled trial of a screening, brief intervention, and referral to treatment intervention for caregivers to reduce secondhand smoke exposure among pediatric emergency patients. BMC Public Health 2017; 17:374. [PMID: 28464887 PMCID: PMC5414142 DOI: 10.1186/s12889-017-4278-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/21/2017] [Indexed: 11/15/2022] Open
Abstract
Background Involuntary exposure to secondhand smoke (SHSe) is an important cause of morbidity in children who present to the pediatric emergency department (PED) and urgent care (UC). SHSe interventions delivered in the PED and UC would benefit both the smoker and child, but there have been no large trials testing the efficacy of such interventions. The Healthy Families program is the first randomized controlled trial to test whether a screening, brief intervention, and referral to treatment (SBIRT) intervention delivered in the PED and UC will be effective in decreasing SHSe in children and increasing cessation in smokers. Methods/design This trial uses a randomized, two-group design in which caregiver-smokers of children 0–17 years old are recruited from the PED and UC. Eligible caregiver-smokers are randomized to either the: 1) SBIRT Condition with face-to-face, tailored counseling that focuses on the child’s illness, the importance of reducing child SHSe, caregiver smoking cessation, and the option to receive nicotine replacement therapy; or 2) Healthy Habits Control Condition which includes face-to-face, tailored attention control “5–2–1-0” counseling that focuses on improving the child’s health. Dyadic assessments are conducted in-person at baseline, and via email, phone, or in-person at 6-weeks and 6-months. The primary outcomes are biochemically-verified, 7-day point prevalence and prolonged smoking abstinence. Secondary outcomes are cigarettes smoked per week, 24 h quit attempts, and biochemically validated child SHSe at each time point. The costs of this intervention will also be analyzed. Discussion This study will test an innovative, multilevel intervention designed to reduce child SHSe and increase smoking cessation in caregivers. If effective and routinely used, this SBIRT model could reach at least one million smokers a year in the U.S., resulting in significant reductions in caregivers’ tobacco use, SHSe-related pediatric illness, and healthcare costs in this population of children. Trial registration ClinicalTrials.gov Identifier: NCT02531594. Date of registration: August 4, 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4278-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA. .,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA.
| | - Robert T Ammerman
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio, USA
| | - Jane C Khoury
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Biostatistics and Epidemiology, Cincinnati, Ohio, USA
| | - Lara Stone
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA
| | - Gabe T Meyers
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA
| | - John K Witry
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, PO Box 210002, Cincinnati, OH, 45221, USA
| | - Tierney F Mancuso
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Pediatric Residency Training Program, Cincinnati, Ohio, USA
| | - Kristin M W Stackpole
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Center for Better Health and Nutrition (HealthWorks!), Cincinnati, Ohio, USA
| | - Berkeley L Bennett
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA
| | - Laura Akers
- Oregon Research Institute, 1776 Millrace Drive, Eugene, Oregon, 97403, USA
| | - Judith S Gordon
- College of Nursing University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, USA
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Goodwin RD, Cheslack-Postava K, Nelson DB, Smith PH, Hasin DS, Janevic T, Bakoyiannis N, Wall MM. Serious Psychological Distress and Smoking During Pregnancy in the United States: 2008-2014. Nicotine Tob Res 2017; 19:605-614. [PMID: 28403468 PMCID: PMC5441894 DOI: 10.1093/ntr/ntw323] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The current study examined the relationship between acute (past 30 day) and recent (past year but not past 30 day) serious psychological distress (SPD) and smoking during pregnancy among women in the United States overall, stratified by demographic characteristics, and described the change in the prevalence of prenatal smoking among women with and without SPD, from 2008 to 2014. METHODS Data were drawn from the National Survey on Drug Use and Health (NSDUH), an annual cross-sectional study of US persons aged 12 and over. SPD and smoking in the past 30 days among pregnant women, aged 18 and older, were examined using logistic regression models. Heterogeneity in this association by demographic characteristics, trends over time, and level of cigarette consumption was also examined. RESULTS Prenatal smoking was common. Almost 40% of pregnant women with acute SPD reported smoking, 23% of pregnant women with recent SPD smoked, and 11.7% of pregnant women without recent SPD smoked. No significant change was found in the prevalence of prenatal smoking from 2008 to 2014 in any of these groups. Robust relationships were found between acute (OR = 5.05 [3.64-6.99]) and recent SPD (OR = 2.37 [1.74-3.24]) and smoking; these findings remained after adjusting for demographics. CONCLUSIONS SPD and smoking during pregnancy are strongly associated; this relationship is present across all sociodemographic groups and the prevalence of smoking in pregnancy has remained relatively unchanged over the past decade both in the presence and absence of SPD. IMPLICATIONS SPD and smoking in pregnancy are robustly linked; the prevalence of smoking in pregnancy is extremely high in women with SPD. Screening women with mental health problems for prenatal smoking, as well as screening pregnant smokers for mental health problems, seems warranted and may assist more women in seeking and utilizing treatment options. Efforts to reduce the prevalence of smoking during pregnancy might specifically target women with SPD, where the potential for impact is substantial.
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Affiliation(s)
- Renee D Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Keely Cheslack-Postava
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Deborah B Nelson
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
- Department of Obstetrics and Gynecology, Temple University School of Medicine, Philadelphia, PA
| | - Philip H Smith
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY School of Medicine, New York, NY
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Teresa Janevic
- Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Nina Bakoyiannis
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY
| | - Melanie M Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
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12
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Chamberlain C, O'Mara‐Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2017; 2:CD001055. [PMID: 28196405 PMCID: PMC6472671 DOI: 10.1002/14651858.cd001055.pub5] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. MAIN RESULTS The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.
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Affiliation(s)
- Catherine Chamberlain
- La Trobe UniversityJudith Lumley Centre251 Faraday StreetMelbourneVicAustralia3000
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - Alison O'Mara‐Eves
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jessie Porter
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
| | - Tim Coleman
- University of NottinghamDivision of Primary CareD1411, Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | - Susan M Perlen
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
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13
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Ondersma SJ, McGoron L, Beatty JR. An Ecodevelopmental Exploration of Mediators Between Maltreatment in Childhood and Drug use During Pregnancy. MERRILL-PALMER QUARTERLY (WAYNE STATE UNIVERSITY. PRESS) 2017; 63:135-154. [PMID: 29681674 PMCID: PMC5909984 DOI: 10.13110/merrpalmquar1982.63.1.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Child maltreatment is associated with increased risk of substance abuse in adulthood. However, prior investigations have not examined substance use specifically in pregnancy, and have relied on self-report of substance use. The present study addresses these gaps via secondary analysis of 295 primarily low-income, Black postpartum women who agreed to complete a brief questionnaire and subsequently provided urine and hair samples. A clear relationship emerged between self-reported maltreatment and positive toxicology (with drug use present in 37.2% of maltreated participants and 17.1% of non-maltreated participants; p < .001). Depression and violence exposure were positively associated with maltreatment and with drug use. The combined effect of violence exposure and depression mediated the association between maltreatment and drug use during pregnancy (the bootstrapped 95% confidence interval of total indirect effect ranged from .17-.86). This investigation is the first to show an association between childhood maltreatment and toxicological evidence of drug use in pregnancy.
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Affiliation(s)
- Steven J Ondersma
- Merrill-Palmer Skillman Institute, Departments of Psychiatry & Behavioral Neurosciences and Obstetrics & Gynecology, Wayne State University
| | - Lucy McGoron
- Merrill-Palmer Skillman Institute, Departments of Psychiatry & Behavioral Neurosciences and Obstetrics & Gynecology, Wayne State University
| | - Jessica R Beatty
- Merrill-Palmer Skillman Institute, Departments of Psychiatry & Behavioral Neurosciences and Obstetrics & Gynecology, Wayne State University
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Míguez MC, Pereira B, Figueiredo B. Tobacco consumption and spontaneous quitting at the first trimester of pregnancy. Addict Behav 2017; 64:111-117. [PMID: 27608322 DOI: 10.1016/j.addbeh.2016.08.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/22/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The purpose of this study was to examine the association between pregnant women's socio-demographic characteristics, smoking-related variables and psychological symptoms (anxiety and depression) and both tobacco consumption and spontaneous quitting at the first trimester of pregnancy. In particular, we wished to examine the contribution of depressive symptoms to tobacco consumption and spontaneous quitting, while controlling for anxiety symptoms, socio-demographic and smoking-related variables. METHODS The sample was comprised of 901 Spanish pregnant women. Assessment included an ad hoc questionnaire with socio-demographic and tobacco consumption information, the Edinburg Postnatal Depression Scale (EPDS), and The State-Anxiety Inventory (STAI-S). Two multiple logistic regression analyses were performed, respectively to predict tobacco consumption and to predict spontaneous quitting. RESULTS Having a partner who smokes (OR=5.578), not having a college education (OR=2.803), higher scores on the EPDS (OR=1.073) and higher scores on the STAI-S (OR=1.027) increase the probability of continuing smoking. Being primiparous (OR=2.463), having a college education (OR=2.141), smoking fewer cigarettes before pregnancy (OR=1.175), and lower scores on the STAI-S (OR=1.045) increase the probability of spontaneously quitting smoking at the first trimester of pregnancy. CONCLUSIONS Depressive symptoms were a predictor of tobacco consumption but not of spontaneous quitting; spontaneous quitting was better predicted by anxiety symptoms. These findings support recommendations that women with depressive symptoms are at risk for smoking during pregnancy and highlight that anxious symptoms should be targeted in interventions for smoking cessation during pregnancy.
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Riaz M, Lewis S, Coleman T, Aveyard P, West R, Naughton F, Ussher M. Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomized controlled trial. Addiction 2016; 111:1656-65. [PMID: 26997495 PMCID: PMC5084769 DOI: 10.1111/add.13395] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/26/2015] [Accepted: 03/14/2016] [Indexed: 11/27/2022]
Abstract
AIMS To examine the ability of different common measures of cigarette dependence to predict smoking cessation during pregnancy. DESIGN Secondary analysis of data from a parallel-group randomized controlled trial of physical activity for smoking cessation. The outcomes were biochemically validated smoking abstinence at 4 weeks post-quit and end-of-pregnancy. SETTING Women identified as smokers in antenatal clinics in 13 hospital trusts predominantly in southern England, who were recruited to a smoking cessation trial. PARTICIPANTS Of 789 pregnant smokers recruited, 784 were included in the analysis. MEASUREMENTS Using random-effect logistic regression models, we analysed the effects of baseline measures of cigarette dependence, including numbers of cigarettes smoked daily, Fagerström Test of Cigarette Dependence (FTCD) score, the two FTCD subscales of Heaviness of Smoking Index (HSI) and non-Heaviness of Smoking Index (non-HSI), expired carbon monoxide (CO) level and urges to smoke (strength and frequency) on smoking cessation. Associations were adjusted for significant socio-demographic/health behaviour predictors and trial variables, and area under the receiver operating characteristic (ROC) curve was used to determine the predictive ability of the model for each measure of dependence. FINDINGS All the dependence variables predicted abstinence at 4 weeks and end-of-pregnancy. At 4 weeks, the adjusted odds ratio (OR) (95% confidence interval) for a unit standard deviation increase in FTCD was 0.59 (0.47-0.74), expired CO = 0.54 (0.41-0.71), number of cigarettes smoked per day 0.65 (0.51-0.84) and frequency of urges to smoke 0.79 (0.63-0.98); at end-of-pregnancy they were: 0.60 (0.45-0.81), 0.55 (0.37-0.80), 0.70 (0.49-0.98) and 0.69 (0.51-0.94), respectively. HSI and non-HSI exhibited similar results to the full FTCD. CONCLUSIONS Four common measures of dependence, including number of cigarettes smoked per day, scores for Fagerström Test of Cigarette Dependence and frequency of urges and level of expired CO, all predicted smoking abstinence in the short term during pregnancy and at end-of-pregnancy with very similar predictive validity.
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Affiliation(s)
- Muhammad Riaz
- Population Health Research Institute, St George's University of LondonLondonUK
| | - Sarah Lewis
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Tim Coleman
- Division of Primary Care and UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCLLondonUK
| | - Felix Naughton
- Behavioural Science Group, Institute of Public HealthUniversity of CambridgeCambridgeUK
| | - Michael Ussher
- Population Health Research Institute, St George's University of LondonLondonUK
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16
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Godleski SA, Eiden RD, Schuetze P, Colder CR, Huestis MA. Tobacco exposure and maternal psychopathology: Impact on toddler problem behavior. Neurotoxicol Teratol 2016; 57:87-94. [PMID: 27498223 PMCID: PMC6059373 DOI: 10.1016/j.ntt.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/03/2016] [Accepted: 07/29/2016] [Indexed: 02/07/2023]
Abstract
Prenatal exposure to tobacco has consistently predicted later problem behavior for children. However, little is known about developmental mechanisms underlying this association. We examined a conceptual model for the association between prenatal tobacco exposure and child problem behavior in toddlerhood via indirect paths through fetal growth, maternal depression, and maternal aggressive disposition in early infancy and via maternal warmth and sensitivity and infant negative affect in later infancy. The sample consisted of 258 mother-child dyads recruited during pregnancy and assessed periodically at 2, 9, and 16months of child age. Pathways via maternal depression and infant negative affect to toddler problem behavior were significant. Further, combined tobacco and marijuana exposure during pregnancy and reduced fetal growth also demonstrated important associations with infant negative affect and subsequent problem behavior. These results highlight the importance of considering the role of maternal negative affect and poor fetal growth as risk factors in the context of prenatal exposure.
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Affiliation(s)
| | - Rina D Eiden
- Research Institute of Addictions, University at Buffalo, State University of New York, United States
| | - Pamela Schuetze
- Psychology Department, Buffalo State College, State University of New York, United States
| | - Craig R Colder
- Psychology Department, University at Buffalo, State University of New York, United States
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Coleman-Cowger VH, Koszowski B, Rosenberry ZR, Terplan M. Factors Associated with Early Pregnancy Smoking Status Among Low-Income Smokers. Matern Child Health J 2016; 20:1054-60. [PMID: 26649884 PMCID: PMC4826823 DOI: 10.1007/s10995-015-1891-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare pregnant women who are current smokers at their first prenatal visit with those who recently quit smoking in the 90 days prior to their first prenatal visit (i.e., spontaneous quitters) to identify differences between them and factors that predict their intake smoking status. METHODS One hundred and thirty participants were enrolled in this cross-sectional research study. The sample was drawn from a population of pregnant women attending their first prenatal visit at a low-income obstetrics clinic in Baltimore, Maryland; the large majority of which have characteristics that previous research has identified as putting them at high-risk of continued smoking during pregnancy. Participants were recruited through referrals from clinical staff. Intake data collection occurred between March and December, 2013. RESULTS Of the 130 pregnant women enrolled in the study, 126 had complete intake data. The sample included 86 current smokers and 40 recent quitters. The large majority of participants were African American with an average age of 26. Current smokers were significantly more likely than recent quitters to have: more depression symptoms; self-perceived stress; internalizing and externalizing disorder symptoms; substance use disorders; and tobacco dependence. The most significant predictors of smoking status at first prenatal visit were depressive symptoms, readiness to quit, and number of children. CONCLUSIONS for Practice Differences were identified at intake among this sample of pregnant women already considered to be at high-risk for continued smoking throughout their pregnancy. This study identified relevant factors associated with whether or not a woman had recently quit smoking in early pregnancy or was continuing to smoke at her first prenatal visit. Knowledge of these factors may benefit physicians in understanding and promoting smoking cessation throughout the perinatal period and specifically intervening to decrease depressive symptoms and increasing readiness to quit may improve outcomes.
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Affiliation(s)
- Victoria H Coleman-Cowger
- The Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, 6115 Falls Road, Suite 200, Baltimore, MD, 21209, USA.
| | - Bartosz Koszowski
- The Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, 6115 Falls Road, Suite 200, Baltimore, MD, 21209, USA
| | - Zachary R Rosenberry
- The Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, 6115 Falls Road, Suite 200, Baltimore, MD, 21209, USA
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Berlin I, Singleton EG, Heishman SJ. Craving and Withdrawal Symptoms During Smoking Cessation: Comparison of Pregnant and Non-Pregnant Smokers. J Subst Abuse Treat 2016; 63:18-24. [PMID: 26806411 DOI: 10.1016/j.jsat.2015.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/26/2022]
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Elevated risk of nicotine dependence among sib-pairs discordant for maternal smoking during pregnancy: evidence from a 40-year longitudinal study. Epidemiology 2016; 26:441-7. [PMID: 25767988 DOI: 10.1097/ede.0000000000000270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Compelling evidence links maternal smoking during pregnancy with elevated risk of nicotine dependence among the offspring. However, no study to date has examined the maternal smoking during pregnancy-nicotine dependence link among sibling-pairs discordant for maternal smoking during pregnancy. We tested two hypotheses that, if supported, suggest that the maternal smoking during pregnancy-nicotine dependence link may be physiologically mediated. METHODS Study participants were adult offspring of women enrolled in the Providence and Boston sites of the Collaborative Perinatal Project (1959-1966). Approximately 10% of these adult offspring (average age: 39.6 years) were enrolled in the New England Family Study (n = 1,783), a follow-up study that oversampled families with multiple siblings. Logistic regression models predicting maternal smoking during pregnancy risk on various prospectively collected smoking and marijuana use outcomes, including nicotine dependence, were fit using models that allowed between-mother effects of maternal smoking during pregnancy exposure to differ from within-mother effects. In the absence of significant effect heterogeneity, we calculated a combined estimate. RESULTS Maternal smoking during pregnancy predicted progression from weekly smoking to nicotine dependence (odds ratio = 1.4 [95% confidence interval = 1.2, 1.8]), but not weekly smoking or progression to marijuana dependence. CONCLUSIONS Current evidence from sibling-pairs discordant for maternal smoking during pregnancy is consistent with previous reports of a dose-response association between maternal smoking during pregnancy and nicotine dependence, as well as of up-regulation of nicotine receptors among animals exposed to maternal smoking during pregnancy. Together, they provide support for the existence of a physiologically mediated link between maternal smoking during pregnancy and nicotine dependence.
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Massey SH, Reiss D, Neiderhiser JM, Leve LD, Shaw DS, Ganiban JM. Maternal personality traits associated with patterns of prenatal smoking and exposure: Implications for etiologic and prevention research. Neurotoxicol Teratol 2016; 53:48-54. [PMID: 26655208 PMCID: PMC4703540 DOI: 10.1016/j.ntt.2015.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/27/2015] [Accepted: 11/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the characteristics of women who smoke during pregnancy beyond demographic factors. We examined the relationship between novelty seeking, harm avoidance, and self-directedness and (a) abstinence from smoking during pregnancy and (b) average daily cigarette consumption during pregnancy. METHODS Participants were 826 birth mothers who made adoption placements in the Early Growth and Development Study and completed the Temperament and Character Inventory - Short Form, and interview-based smoking assessments 3-6 months postpartum. Never smokers (n=199), pregnancy abstainers (n=277), pregnancy light smokers (n=184), and pregnancy heavy smokers (n=166) were compared on personality dimensions and smoking-related processes. Using regression analyses we examined relationships between personality and (a) abstinence versus smoking during pregnancy; and (b) average daily cigarette consumption among lifetime smokers, controlling for nicotine dependence, birth father substance dependence, maternal antisocial behavior, and depressive symptoms during pregnancy. RESULTS Smokers with higher self-directedness and lower harm avoidance were more likely to abstain during pregnancy [O.R. 1.380; 95% C.I. (1.065-1.787); B(SE)=.322(.132); p=.015] and [O.R. .713; 95% C.I. (.543-.935); B(SE)=-.339(.138); p=.014], respectively. Novelty seeking differentiated never smokers from lifetime smokers (t=-3.487; p=.001), but was not significant in multivariate models. Lifetime smokers who abstained during pregnancy reported fewer depressive symptoms relative to never smokers. CONCLUSIONS Personality dimensions associated with abstinence from smoking and cigarettes per day during pregnancy may be important to consider in etiologic and intervention research.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 1000, Chicago, IL 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19th Floor, Chicago, IL 60611, USA.
| | - David Reiss
- Yale Child Study Center, Yale University, 230 South Frontage Rd., New Haven, CT 06519, USA.
| | - Jenae M Neiderhiser
- Department of Psychology, The Pennsylvania State University, 141 Moore Building, University Park, PA 16802, USA.
| | - Leslie D Leve
- Department of Counseling Psychology and Human Services, College of Education 6217, University of Oregon, Eugene, OR 97403, USA.
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, 4101 Sennott Square, 3rd Floor, Pittsburgh, PA 15260, USA.
| | - Jody M Ganiban
- Department of Psychology, George Washington University Columbian College of Arts and Sciences, 2125 G Street, NW, Room 308, Washington, DC 20052, USA.
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De Genna NM, Goldschmidt L, Day NL, Cornelius MD. Prenatal and Postnatal Maternal Trajectories of Cigarette Use Predict Adolescent Cigarette Use. Nicotine Tob Res 2015; 18:988-92. [PMID: 26712844 DOI: 10.1093/ntr/ntv269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 12/04/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The goal of this study was to identify maternal patterns of prenatal and postnatal cigarette smoking associated with adolescent smoking. We hypothesized that maternal use at multiple time points, especially at later assessments when the offspring were adolescents, would predict offspring use. METHODS Pregnant women (N = 456: ages 13-42) were recruited from a prenatal clinic and interviewed during pregnancy and at delivery, providing data on cigarette use (any/none) for the first and third trimesters. Mothers were re-assessed at 6, 10, 14, and 16 years postpartum. Offspring reported cigarette use at age 16. Covariates included maternal race, age, education, family income, child age, parenting behavior, and other maternal and child substance use. RESULTS A growth mixture model revealed five patterns of tobacco use: infrequent/nonuse (39%), postpartum quitters (5%), later quitters (7%), increasing likelihood of being smokers (17%), and chronic users (32%). Offspring of postpartum quitters and the increasing likelihood of being smokers groups were more likely to use cigarettes, compared to adolescents of mothers from the infrequent/nonuse group, controlling for significant covariates. CONCLUSIONS This is the first study to examine trajectories of maternal cigarette use from pregnancy to 16 years postpartum, linking prenatal and postnatal patterns of maternal use to use in adolescent offspring. Our findings highlight the risk associated with prenatal exposure, because mothers who used during pregnancy but quit by 6 years postpartum still had offspring who were 3.5 times more likely to smoke than non/infrequent users. IMPLICATIONS This is the first study to examine trajectories of maternal cigarette use from the prenatal period to 16 years postpartum, and to link prenatal and postnatal patterns of use to use in adolescent offspring. We identified two long-term patterns of maternal cigarette use that were associated with offspring smoking at age 16, including one where offspring were exposed prenatally, but much less likely to be exposed to maternal cigarette use postpartum. Our findings highlight the risk associated with prenatal exposures for cigarette use in offspring, even if mothers quit in the postpartum.
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Affiliation(s)
- Natacha M De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA;
| | - Lidush Goldschmidt
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nancy L Day
- Departments of Psychiatry, Epidemiology, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Marie D Cornelius
- Departments of Psychiatry and Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Melchior M, Chollet A, Glangeaud-Freudenthal N, Saurel-Cubizolles MJ, Dufourg MN, van der Waerden J, Sutter-Dallay AL. Tobacco and alcohol use in pregnancy in France: the role of migrant status: the nationally representative ELFE study. Addict Behav 2015; 51:65-71. [PMID: 26233939 DOI: 10.1016/j.addbeh.2015.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 07/06/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Tobacco and alcohol use in pregnancy are modifiable yet frequent risk factors of poor perinatal outcomes. We examined whether characteristics associated with substance use in pregnancy vary between native and migrant women, who often differ in terms of socio-demographic characteristics. METHODS Data come from a nationally representative sample of children born in France in 2011 (ELFE study, n=18,014). Maternal substance use in pregnancy (tobacco: ≥1 cigarette/day, alcohol: ≥1 time, binge drinking: ≥3 units of alcohol on one occasion) was assessed using survey methodology by a) trained interviewers and b) self-reports. Migration status was determined based on country of birth (native-born vs. migrant). The sample included 2330 migrant women, predominantly from North Africa (35.4% - primarily Algeria and Morocco), Sub-Saharan Africa (27.3% - primarily Senegal, Ivory Coast, the Congo and Cameroun), Europe (20.2% - primarily Portugal and Germany) and Asia (10.2% - primarily Turkey). Characteristics potentially associated with substance use included socio-demographics (maternal age, number of children, relationship status, educational attainment, employment status), health (psychological difficulties, incomplete prenatal care) and partner's characteristics (migration status, employment). RESULTS Compared to the native-born, migrant women had lower levels of tobacco smoking (8.8 vs. 21.9%) and alcohol use (23.4 vs. 40.7%), but not binge drinking (2.9 vs. 3.3%). Unfavorable socioeconomic circumstances were associated with tobacco smoking in native-born women only. Single parenthood was associated with alcohol use only in migrant women. In migrant women, co-occurring use of another substance and psychological difficulties were more strongly associated with use of tobacco, alcohol or binge drinking than in native-born women. CONCLUSIONS Migrant women have less favorable socioeconomic characteristics than native women but are generally less likely to use tobacco and alcohol in pregnancy. However those who experience single-parenthood need special attention, as they are disproportionately likely to use psychoactive substances which put them and their children at risk of poor health outcomes.
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How to support patients with severe mental illness in their parenting role with children aged over 1 year? A systematic review of interventions. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1765-83. [PMID: 26091723 DOI: 10.1007/s00127-015-1069-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/13/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE There are well-established risks for parents with severe mental illness (i.e. psychotic and bipolar disorders), both for their children and themselves. Interventions to help parents fulfil their role should therefore be a public health objective, but their implementation needs to be underpinned by research evidence. This systematic review determines what is known about the nature and effectiveness of interventions for parents with severe mental illness. METHODS We conducted a narrative synthesis of controlled and uncontrolled studies reporting interventions for this patient group after the post-natal period (i.e. after the child has turned 1 year old). RESULTS Eighteen publications reported data from 15 studies. All but two studies were rated as low quality studies. Interventions included home visiting programmes, complex community programmes, residential treatments, and online interventions. Interventions targeted diverse areas, with parenting skills and understanding the impact of mental illness on parenting most frequently addressed. Both parent and child-related outcomes improved, but children were only assessed via observers and follow-up times were short. CONCLUSIONS Interventions were diverse with respect to their nature and effectiveness. Future interventions should combine different intervention strategies to target multiple areas in a flexible manner. The addition of positively focussed and resource-oriented components should be investigated. Trials should include direct assessments of both parents and children, outcomes that are relevant from a public health perspective, and establish the long-term effects ideally until children have reached 18 years of age.
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Estabrook R, Massey SH, Clark CAC, Burns JL, Mustanski BS, Cook EH, O'Brien TC, Makowski B, Espy KA, Wakschlag LS. Separating Family-Level and Direct Exposure Effects of Smoking During Pregnancy on Offspring Externalizing Symptoms: Bridging the Behavior Genetic and Behavior Teratologic Divide. Behav Genet 2015; 46:389-402. [PMID: 26581695 DOI: 10.1007/s10519-015-9762-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/16/2015] [Indexed: 01/18/2023]
Abstract
Maternal smoking during pregnancy (MSDP) has been robustly associated with externalizing problems and their developmental precursors in offspring in studies using behavioral teratologic designs (Wakschlag et al., Am J Public Health 92(6):966-974, 2002; Espy et al., Dev Psychol 47(1):153-169, 2011). In contrast, the use of behavior genetic approaches has shown that the effects commonly attributed to MSDP can be explained by family-level variables (D'Onofrio et al., Dev Psychopathol 20(01):139-164, 2008). Reconciling these conflicting findings requires integration of these study designs. We utilize longitudinal data on a preschool proband and his/her sibling from the Midwest Infant Development Study-Preschool (MIDS-P) to test for teratologic and family level effects of MSDP. We find considerable variation in prenatal smoking patterns both within and across pregnancies within families, indicating that binary smoking measures are not sufficiently capturing exposure. Structural equation models indicate that both conduct disorder and oppositional defiant disorder symptoms showed unique effects of MSDP over and above family level effects. Blending high quality exposure measurement with a within-family design suggests that it is premature to foreclose the possibility of a teratologic effect of MSDP on externalizing problems. Implications and recommendations for future studies are discussed.
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Affiliation(s)
- Ryne Estabrook
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA.
| | - Suena H Massey
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caron A C Clark
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - James L Burns
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
| | - Brian S Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
| | - Edwin H Cook
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Beth Makowski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
| | - Kimberly A Espy
- Departments of Psychology and Psychiatry, University of Arizona, Tucson, AZ, USA
- Office for Research & Economic Development, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
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Massey SH, Bublitz MH, Magee SR, Salisbury A, Niaura RS, Wakschlag LS, Stroud LR. Maternal-fetal attachment differentiates patterns of prenatal smoking and exposure. Addict Behav 2015; 45:51-6. [PMID: 25644587 DOI: 10.1016/j.addbeh.2015.01.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/14/2014] [Accepted: 01/14/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Smoking cessation during pregnancy may reflect altruistic motives on behalf of the unborn baby. We test the hypothesis that pregnancy quitters have higher maternal-fetal attachment than persistent smokers, and secondarily explore how maternal-fetal attachment differs among non-smokers, pregnancy quitters, and persistent smokers. METHODS Participants were 156 women in the Behavior and Mood in Babies and Mothers study who provided report of smoking throughout pregnancy via timeline follow back interviews, with salivary cotinine confirmation of reported cessation at 30 and 35 week gestation, and postpartum day one. Maternal Fetal Attachment Scale total and subscale scores (role-taking, differentiation of self from fetus, interaction with fetus, attributing characteristics to fetus, giving of self) were examined among non-smokers, pregnancy quitters, and persistent smokers. RESULTS At 30 weeks, pregnancy quitters scored higher on the 'giving of self' subscale compared to persistent smokers (21.6±2.4 versus 19.9±2.9; p=.004). Maternal 'giving of self' also differentiated pregnancies exposed to cigarette smoking from those without exposure from 30 weeks through delivery (19.9±2.9 versus 21.2±2.2; p=.002). Controlling for age, income, unemployment, gravida, and father's smoking status, 'giving of self' differentiated pregnancy quitters from persistent smokers [OR=5.144; 95% C.I. 1.509 - 17.538; B (SE)=1.638 (.626); p=.009]. CONCLUSIONS Women who reported a greater desire to maintain their personal health for the health of their fetus were more likely to quit smoking during pregnancy. Implications of findings for interventions and understanding mechanisms of risk are discussed.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 1000, Chicago, IL 60611, USA,; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19th Floor, Chicago, IL 60611, USA.
| | - Margaret H Bublitz
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02906, USA; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, 164 Summit Ave, Suite 309, Providence, RI 02906, USA.
| | - Susanna R Magee
- Department of Family Medicine, Alpert Medical School of Brown University, Box G-A1, Providence, RI 02912, USA.
| | - Amy Salisbury
- Department of Pediatrics, Alpert Medical School of Brown University, Box G-A1, Providence, RI 02912, USA.
| | - Raymond S Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, USA.
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19th Floor, Chicago, IL 60611, USA; Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL 60208, USA.
| | - Laura R Stroud
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02906, USA; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, 164 Summit Ave, Suite 309, Providence, RI 02906, USA.
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Melchior M, Hersi R, van der Waerden J, Larroque B, Saurel-Cubizolles MJ, Chollet A, Galéra C. Maternal tobacco smoking in pregnancy and children's socio-emotional development at age 5: The EDEN mother-child birth cohort study. Eur Psychiatry 2015; 30:562-8. [PMID: 25843027 DOI: 10.1016/j.eurpsy.2015.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/06/2015] [Accepted: 03/07/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is debate as to whether maternal tobacco use in pregnancy is related to offspring behaviour later on. We tested this association examining multiple aspects of children's behaviour at age 5 and accounting for parental smoking outside of pregnancy, as well as child and family characteristics. METHODS Data come from a prospective community based birth cohort study (EDEN; n=1113 families in France followed since pregnancy in 2003-2005 until the child's 5th birthday). Maternal tobacco use in pregnancy was self-reported. Children's socio-emotional development (emotional symptoms, conduct problems, symptoms of hyperactivity/inattention, peer relationship problems, prosocial behaviour) was assessed by mothers using the Strengths and Difficulties Questionnaire (SDQ) at age 5 years. Logistic regression analyses controlled for Inverse Probability Weights (IPW) of maternal tobacco use calculated based on study center, children's characteristics (sex, premature birth, low birth weight, breastfeeding), maternal characteristics (age at the child's birth, psychological difficulties and alcohol use in pregnancy, post-pregnancy depression, and smoking), paternal smoking in and post-pregnancy, parental educational attainment, family income, parental separation, and maternal negative life events. RESULTS Maternal smoking in pregnancy only predicted children's high symptoms of hyperactivity/inattention (sex and study center-adjusted ORs: maternal smoking in the 1st trimester: 1.95, 95%CI: 1.13-3.38; maternal smoking throughout pregnancy: OR=2.11, 95%CI: 1.36-3.27). In IPW-controlled regression models, only children of mothers who smoked throughout pregnancy had significantly elevated levels of hyperactivity/inattention (OR=2.20, 95%CI: 1.21-4.00). CONCLUSIONS Maternal tobacco smoking in pregnancy may contribute directly or through epigenetic mechanisms to children's symptoms of hyperactivity/inattention.
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Affiliation(s)
- M Melchior
- INSERM, UMR-S 1136, Department of Social Epidemiology, Pierre-Louis Institute of Epidemiology and Public Health, 75013 Paris, France; UMR-S 1136, Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC - Université Paris 06, 75013 Paris, France.
| | - R Hersi
- INSERM, UMR-S 1136, Department of Social Epidemiology, Pierre-Louis Institute of Epidemiology and Public Health, 75013 Paris, France; UMR-S 1136, Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC - Université Paris 06, 75013 Paris, France
| | - J van der Waerden
- INSERM, UMR-S 1136, Department of Social Epidemiology, Pierre-Louis Institute of Epidemiology and Public Health, 75013 Paris, France; UMR-S 1136, Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC - Université Paris 06, 75013 Paris, France
| | - B Larroque
- INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, 75020 Paris, France; UMR-S 953, UPMC - Université Paris 06, 75020 Paris, France
| | - M-J Saurel-Cubizolles
- INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, 75020 Paris, France; UMR-S 953, UPMC - Université Paris 06, 75020 Paris, France
| | - A Chollet
- INSERM, UMR-S 1136, Department of Social Epidemiology, Pierre-Louis Institute of Epidemiology and Public Health, 75013 Paris, France; UMR-S 1136, Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC - Université Paris 06, 75013 Paris, France
| | - C Galéra
- Department of Child and Adolescent Psychiatry, Charles-Perrens Hospital, University of Bordeaux, 33076 Bordeaux, France; INSERM U897, Center for Research in Epidemiology and Biostatistics, prévention et prise en charge des traumatismes, Bordeaux, France
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Parrott CE, Rathnayaka N, Blalock JA, Minnix JA, Cinciripini PM, Vincent JP, Wetter DW, Green C. Examination of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) Factor Structure in a Sample of Pregnant Smokers. Nicotine Tob Res 2014; 17:653-60. [PMID: 25475086 DOI: 10.1093/ntr/ntu238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/27/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking during pregnancy poses known risks to fetal and infant development. Women who continue to smoke during pregnancy exhibit higher levels of nicotine dependence than women who quit. Increased understanding of the construct of nicotine dependence in pregnant smokers may aid in the development of effective treatments. Research has suggested that nicotine dependence is a multifaceted construct, driven not only by withdrawal and tolerance processes, but also by reinforcement, sensory, and contextual processes. The Wisconsin inventory of smoking dependence motives (WISDM-68) assesses 13 varied smoking motives in order to assess processes that may lead to nicotine dependence. METHODS The factor structure of the WISDM-68 was explored using an ethnically diverse sample of 294 pregnant women who had been screened and/or enrolled in a smoking cessation treatment study. Confirmatory analyses were conducted with previously published models. An exploratory factor analysis and exploratory structural equation modeling (ESEM) were conducted to develop and validate a measurement model for the WISDM-68 in this sample. RESULTS Previously established models were not a good fit for the present data. Using ESEM, a 9-factor model exhibiting both predictive and concurrent validity emerged. Two factors predicted abstinence 6 months posttreatment. Several factors were associated with smoking heaviness, the Fagerström test for cigarette dependence and time to first cigarette. CONCLUSIONS In contrast to previously published studies, a 9-factor model best characterizes the WISDM in the present sample. These findings may reflect smoking motivations unique to young, pregnant women who continue to smoke during pregnancy.
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Affiliation(s)
| | - Nuvan Rathnayaka
- Department of Psychiatry, Center for Neurobehavioral Research on Addictions, University of Texas Health Science Center at Houston, Houston, TX
| | - Janice A Blalock
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX;
| | - Jennifer A Minnix
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John P Vincent
- Department of Psychology, University of Houston, Houston, TX
| | - David W Wetter
- Department of Health Disparities and Population Sciences Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles Green
- Department of Psychiatry, Center for Neurobehavioral Research on Addictions, University of Texas Health Science Center at Houston, Houston, TX
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Preliminary evidence for the interaction of the oxytocin receptor gene (oxtr) and face processing in differentiating prenatal smoking patterns. Neurosci Lett 2014; 584:259-64. [PMID: 25450139 DOI: 10.1016/j.neulet.2014.10.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 10/23/2014] [Accepted: 10/29/2014] [Indexed: 12/30/2022]
Abstract
Prenatal smoking cessation has been described as an empathic action "for the baby," but this has not been empirically demonstrated. We capitalized on a genetically-characterized extant dataset with outstanding measurement of prenatal smoking patterns and maternal face processing data (as an indicator of empathy) to test this hypothesis, and explore how empathy and smoking patterns may be moderated by a genetic substrate of empathy, the oxytocin receptor gene (OXTR). Participants were 143 Caucasian women from the East Boston family study with repeated prospective reports of smoking level, adjusted based on repeated cotinine bioassays. Salivary DNA and face processing (Diagnostic Analysis of Nonverbal Accuracy-2) were assessed 14 years later at an adolescent follow-up of offspring. Two-thirds of participants reported smoking prior to pregnancy recognition. Of these, 21% quit during pregnancy; 56% reduced smoking, and 22% smoked persistently at the same level. A significant interaction between face processing and OXTR variants previously associated with increased sensitivity to social context, rs53576GG and rs2254298A, was found (β = -.181; p = .015); greater ability to identify distress in others was associated with lower levels of smoking during pregnancy for rs53576(GG)/rs2254298(A) individuals (p = .013), but not for other genotypes (p = .892). Testing this "empathy hypothesis of prenatal smoking cessation" in larger studies designed to examine this question can elucidate whether interventions to enhance empathy can improve prenatal smoking cessation rates.
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Martel MM, Roberts BA. Prenatal testosterone increases sensitivity to prenatal stressors in males with disruptive behavior disorders. Neurotoxicol Teratol 2014; 44:11-7. [PMID: 24819590 PMCID: PMC4295486 DOI: 10.1016/j.ntt.2014.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 12/24/2022]
Abstract
Disruptive Behavior Disorders (DBD) exhibit a sex-biased prevalence rate favoring boys, and prenatal testosterone exposure appears to be part of the complex etiology of these disorders. The current study examines whether high prenatal testosterone exposure may heighten the risk for DBD symptoms in males by increasing susceptibility to negative environmental conditions such as maternal nicotine and alcohol use during pregnancy. Participants were 109 three- to six-year-olds (64% male; 72% with DBD) and their 109 primary caregivers and 55 daycare providers/teachers who completed a multi-informant diagnostic procedure. A proxy of prenatal testosterone exposure, finger-length ratios, interacted with maternal report of prenatal nicotine use to predict teacher-rated hyperactivity-impulsivity during preschool, for boys, but not girls, although the three-way interaction was not significant. Prenatal testosterone interacted with prenatal alcohol exposure to predict teacher-rated hyperactivity-impulsivity and ODD symptoms differentially based on child sex (significant three-way interaction). Boys with higher levels of prenatal testosterone who were also exposed to higher levels of nicotine and alcohol during pregnancy exhibited increased hyperactivity-impulsivity during early childhood, but girls did not exhibit this same pattern. Thus, high prenatal testosterone exposure seems to increase risk for DBD symptoms particularly in males by increasing susceptibility to prenatal environmental stressors.
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Varescon I, Leignel S, Gérard C, Aubourg F, Detilleux M. Self-esteem, psychological distress, and coping styles in pregnant smokers and non-smokers. Psychol Rep 2014; 113:935-47. [PMID: 24693823 DOI: 10.2466/13.20.pr0.113x31z1] [Citation(s) in RCA: 17] [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
The literature underscores that psychological factors could play an important role in smoking behavior, which is considered a coping mechanism. To study relations among measures of self-esteem, psychological distress, anxiety, depressive symptoms, and coping styles in pregnant smokers, a cross-sectional study was conducted. These factors were assessed in two groups of pregnant women (Smokers, n = 40; Non-smokers, n = 40) contacted at one University Hospital in Paris. All participants filled out the Fagerström Test for Nicotine Dependence, the Rosenberg Self-esteem Scale, the General Health Questionnaire, the Hospital Anxiety Depression Scale, and the Brief Cope Scale. Comparisons, correlations, and regression models were used to analyze the data. The results showed that the group of pregnant women who smoked had significantly lower mean self-esteem, elevated psychological distress and anxiety scores, and reported using more emotion-focused coping than the group of pregnant non-smokers. Self-esteem significantly predicted problem-focused coping. This study confirms the importance of assessing these psychological variables to offer women more specific support to quit smoking.
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Beijers C, Ormel J, Meijer JL, Verbeek T, Bockting CLH, Burger H. Stressful events and continued smoking and continued alcohol consumption during mid-pregnancy. PLoS One 2014; 9:e86359. [PMID: 24466052 PMCID: PMC3896477 DOI: 10.1371/journal.pone.0086359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 12/09/2013] [Indexed: 11/19/2022] Open
Abstract
Aim to examine whether the severity of different categories of stressful events is associated with continued smoking and alcohol consumption during mid-pregnancy. Also, we explored the explanation of these associations by anxiety and depressive symptoms during pregnancy. Finally, we studied whether the severity of stressful events was associated with the amount of cigarettes and alcohol used by continued users. Method we conducted a cross-sectional analysis using data from a population-based prospective cohort study. Pregnant women were recruited via midwifery practices throughout The Netherlands. We analyzed women who continued smoking (n = 113) or quit (n = 290), and women who continued alcohol consumption (n = 124) or quit (n = 1403) during pregnancy. Smoking, alcohol consumption, and perceived severity of stressful events were measured at 19 weeks of gestation. The State Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale were filled out at 14 weeks of gestation. Odds ratios were calculated as association measures and indicated the relative increase for the odds of continuation of smoking and alcohol consumption for the maximum severity score compared to the minimum score. Findings severity of the following stressful event categories was associated with continued alcohol consumption: ‘conflict with loved ones’ (OR = 10.4, p<0.01), ‘crime related’ (OR = 35.7, p<0.05), ‘pregnancy-specific’ (OR = 13.4, p<0.05), and the total including all events (OR = 17.2, p<0.05). Adjustment for potential confounders (age, parity and educational level) did not notably change the estimates. There was no association of anxiety and depressive symptoms with continued smoking or alcohol consumption. No associations emerged for continued smoking and severity of stressful events. The amount of cigarettes and alcohol consumption among continued users was not associated with severity of stressful events. Conclusions Our findings may be relevant for health care providers, in particular midwives and general practitioners. The impact of stressful events may be considered when advising pregnant women on smoking and alcohol consumption.
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Affiliation(s)
- Chantal Beijers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion regulation, Groningen, The Netherlands
- * E-mail:
| | - Johan Ormel
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Judith L. Meijer
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Tjitte Verbeek
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Claudi L. H. Bockting
- University of Groningen, Department of Clinical Psychology, Groningen, The Netherlands
| | - Huibert Burger
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion regulation, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
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Chamberlain C, O’Mara-Eves A, Oliver S, Caird JR, Perlen SM, Eades SJ, Thomas J. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2013; 10:CD001055. [PMID: 24154953 PMCID: PMC4022453 DOI: 10.1002/14651858.cd001055.pub4] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this fifth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, randomised cross-over trials, and quasi-randomised controlled trials (with allocation by maternal birth date or hospital record number) of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, and subgroup analyses and sensitivity analysis were conducted in SPSS. MAIN RESULTS Eighty-six trials were included in this updated review, with 77 trials (involving over 29,000 women) providing data on smoking abstinence in late pregnancy.In separate comparisons, counselling interventions demonstrated a significant effect compared with usual care (27 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.75), and a borderline effect compared with less intensive interventions (16 studies; average RR 1.35, 95% CI 1.00 to 1.82). However, a significant effect was only seen in subsets where counselling was provided in conjunction with other strategies. It was unclear whether any type of counselling strategy is more effective than others (one study; RR 1.15, 95% CI 0.86 to 1.53). In studies comparing counselling and usual care (the largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy (eight studies; average RR 1.06, 95% CI 0.93 to 1.21). However, a clear effect was seen in smoking abstinence at zero to five months postpartum (10 studies; average RR 1.76, 95% CI 1.05 to 2.95), a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77), and a significant effect at 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), but not in the longer term. In other comparisons, the effect was not significantly different from the null effect for most secondary outcomes, but sample sizes were small.Incentive-based interventions had the largest effect size compared with a less intensive intervention (one study; RR 3.64, 95% CI 1.84 to 7.23) and an alternative intervention (one study; RR 4.05, 95% CI 1.48 to 11.11).Feedback interventions demonstrated a significant effect only when compared with usual care and provided in conjunction with other strategies, such as counselling (two studies; average RR 4.39, 95% CI 1.89 to 10.21), but the effect was unclear when compared with a less intensive intervention (two studies; average RR 1.19, 95% CI 0.45 to 3.12).The effect of health education was unclear when compared with usual care (three studies; average RR 1.51, 95% CI 0.64 to 3.59) or less intensive interventions (two studies; average RR 1.50, 95% CI 0.97 to 2.31).Social support interventions appeared effective when provided by peers (five studies; average RR 1.49, 95% CI 1.01 to 2.19), but the effect was unclear in a single trial of support provided by partners.The effects were mixed where the smoking interventions were provided as part of broader interventions to improve maternal health, rather than targeted smoking cessation interventions.Subgroup analyses on primary outcome for all studies showed the intensity of interventions and comparisons has increased over time, with higher intensity interventions more likely to have higher intensity comparisons. While there was no significant difference, trials where the comparison group received usual care had the largest pooled effect size (37 studies; average RR 1.34, 95% CI 1.25 to 1.44), with lower effect sizes when the comparison group received less intensive interventions (30 studies; average RR 1.20, 95% CI 1.08 to 1.31), or alternative interventions (two studies; average RR 1.26, 95% CI 0.98 to 1.53). More recent studies included in this update had a lower effect size (20 studies; average RR 1.26, 95% CI 1.00 to 1.59), I(2)= 3%, compared to those in the previous version of the review (50 studies; average RR 1.50, 95% CI 1.30 to 1.73). There were similar effect sizes in trials with biochemically validated smoking abstinence (49 studies; average RR 1.43, 95% CI 1.22 to 1.67) and those with self-reported abstinence (20 studies; average RR 1.48, 95% CI 1.17 to 1.87). There was no significant difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however the effect was unclear in three dissemination trials of counselling interventions where the focus on the intervention was at an organisational level (average RR 0.96, 95% CI 0.37 to 2.50). The pooled effects were similar in interventions provided for women with predominantly low socio-economic status (44 studies; average RR 1.41, 95% CI 1.19 to 1.66), compared to other women (26 studies; average RR 1.47, 95% CI 1.21 to 1.79); though the effect was unclear in interventions among women from ethnic minority groups (five studies; average RR 1.08, 95% CI 0.83 to 1.40) and aboriginal women (two studies; average RR 0.40, 95% CI 0.06 to 2.67). Importantly, pooled results demonstrated that women who received psychosocial interventions had an 18% reduction in preterm births (14 studies; average RR 0.82, 95% CI 0.70 to 0.96), and infants born with low birthweight (14 studies; average RR 0.82, 95% CI 0.71 to 0.94). There did not appear to be any adverse effects from the psychosocial interventions, and three studies measured an improvement in women's psychological wellbeing. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy, and reduce low birthweight and preterm births.
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Affiliation(s)
- Catherine Chamberlain
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alison O’Mara-Eves
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Jenny R Caird
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Susan M Perlen
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Sandra J Eades
- School of Public Health, Sydney School of Medicine, University of Sydney, Sydney, Australia
| | - James Thomas
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
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