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Jimènez-Barragan M, Falguera-Puig G, Curto-Garcia JJ, Monistrol O, Coll-Navarro E, Tarragó-Grima M, Ezquerro-Rodriguez O, Ruiz AC, Codina-Capella L, Urquizu X, Pino Gutierrez AD. Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study. BMC Pregnancy Childbirth 2024; 24:500. [PMID: 39054429 PMCID: PMC11270936 DOI: 10.1186/s12884-024-06695-6] [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: 08/29/2023] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE To assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems. DESIGN A prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks' gestation and followed at three different time points: at 12-14 weeks of pregnancy, at 29-30 weeks of pregnancy, and 4-6 weeks postpartum. All women completed a mental screening at week 12-14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS). SETTING Seven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain. PARTICIPANTS Pregnant women (N = 335, age 18-45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020. FINDINGS The most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12-14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner's income. In weeks 29-30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4-6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems. CONCLUSIONS Early screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.
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Affiliation(s)
- Marta Jimènez-Barragan
- Universitat de Barcelona, Fundació Assistencial Mútua Terrassa, (Terrassa), Research Group on Sexual and Reproductive Healthcare (GRASSIR), (2021-sgr-01489), Barcelona, 08221, Spain.
- ASSIR Fundació Assistencial Mútua Terrassa, Universitat de Barcelona, Plaça Dr. Robert 5, Barcelona, 08221, Spain.
| | - Gemma Falguera-Puig
- Atenció a la Salut Sexual i Reproductiva Metropolitana Nord, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- Research Group on Sexual and Reproductive Healthcare (GRASSIR), (2021-sgr-01489), Barcelona, 08007, Spain
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | | | - Olga Monistrol
- Faculty of Nursing and Physiotherapy, University of Lleida, Iguada, Spain
| | | | - Mercè Tarragó-Grima
- Midwife, Sexual and Reproductive Health Clinic (ASSIR) CAP Rambla Terrassa, Mollet, Spain
| | | | - Anna Carmona Ruiz
- Department of Obstetrics and Gynaecology, Fundació Sanitària Mollet, Mollet, Spain
| | - Laura Codina-Capella
- Department of Obstetrics and Gynaecology, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
| | - Xavier Urquizu
- Department of Obstetrics and Gynaecology, Fundació Sanitària Mollet, Mollet, Spain
| | - Amparo Del Pino Gutierrez
- Departament de Salut Pública, Facultat de Medicina i Ciències de la Salut, Salut Mental i Materno-infantil, Universitat de Barcelona, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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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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3
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Pacho M, Aymerich C, Pedruzo B, Salazar de Pablo G, Sesma E, Bordenave M, Dieguez R, Lopez-Zorroza I, Herrero J, Laborda M, Fernandez-Rivas A, Garcia-Rizo C, Gonzalez-Torres MA, Catalan A. Substance use during pregnancy and risk of postpartum depression: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1264998. [PMID: 38025481 PMCID: PMC10666188 DOI: 10.3389/fpsyt.2023.1264998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Postpartum depression (PPD) is a prevalent mental health condition affecting women globally within the first year following childbirth. Substance use during pregnancy has been associated with an increased risk of developing PPD, but the evidence remains inconclusive. This meta-analysis aims to comprehensively assess the effects of different substances on PPD risk, exploring potential modifiers and confounding factors. Objectives To examine the proportion of PPD among substance users during pregnancy, compared to non-users, and investigate the specific risk associated with different substances (tobacco, alcohol, and non-specified substance use/multiple substance use). Methods A systematic literature search was conducted from inception to November 2022 using the Web of Science database (Clarivate Analytics), incorporating Web of Science Core Collection, the BIOSIS Citation Index, the KCI-Korean Journal Database, MEDLINE®, the Russian Science Citation Index, the SciELO Citation Index, and the Cochrane Central Register of Reviews, and Ovid/PsycINFO databases. Inclusion criteria comprised original studies with pregnant women, using validated depression scales and substance use reporting. Results Among the 26 included studies, encompassing 514,441 women, the pooled prevalence of PPD among substance users during pregnancy was 29% (95% CI 25-33). Meta-analyzes revealed an overall odds ratio (OR) of 3.67 (95% CI 2.31-5.85, p < 0.01) indicating a significantly higher risk of PPD among substance users compared to non-users. Subgroup analyzes demonstrated a higher risk for women with non-specified or multiple substance use (OR 4.67, 95% CI 2.59-8.41; p < 0.01) and tobacco use (OR 4.01, 95% CI 2.23-7.20; p < 0.01). Alcohol use showed a trend toward higher risk that did not reach statistical significance (OR 1.88, 95% CI 1.00-3.55; p = 0.051). Conclusion This meta-analysis provides evidence of an increased risk of PPD among pregnant substance users, particularly those using multiple substances or tobacco. However, caution is needed in interpreting the association with alcohol use due to its non-significant result. Systematic review registration This study protocol was registered at PROSPERO (registration number: CCRD42022375500).
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Affiliation(s)
- Malein Pacho
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Claudia Aymerich
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Borja Pedruzo
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Eva Sesma
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Facultad de Medicina y Odontología, University of the Basque Country, UPV/EHU, Leioa, Spain
| | - Marta Bordenave
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Rodrigo Dieguez
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Itziar Lopez-Zorroza
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Jon Herrero
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Maria Laborda
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Aranzazu Fernandez-Rivas
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Facultad de Medicina y Odontología, University of the Basque Country, UPV/EHU, Leioa, Spain
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Department of Medicine, Institut de Neurociències, Universitat de Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Miguel Angel Gonzalez-Torres
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Facultad de Medicina y Odontología, University of the Basque Country, UPV/EHU, Leioa, Spain
| | - Ana Catalan
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- NIH Oxford Health Biomedical Research Centre, Oxford, United Kingdom
- Neuroscience Department, University of Basque Country (UPV/EHU), Leioa, Spain
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4
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Jimenez-Barragan M, del Pino Gutierrez A, Garcia JC, Monistrol-Ruano O, Coll-Navarro E, Porta-Roda O, Falguera-Puig G. Study protocol for improving mental health during pregnancy: a randomized controlled low-intensity m-health intervention by midwives at primary care centers. BMC Nurs 2023; 22:309. [PMID: 37674184 PMCID: PMC10483870 DOI: 10.1186/s12912-023-01440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Pregnancy-related anxiety and depression has received considerable attention worldwide. Mental health problems in pregnant women already since early weeks of gestation may have important consequences to the fetus. The necessity for more effective health care pathways, including some early interventions that reduce the overall burden of the childbearing situation appears a key factor for a successful birth and care of the baby. The few studies focalized in interventions, are focused on delivery and postpartum, without taking into account the whole maternity process. Current literature recommends the use of interventions based on new technologies for the treatment of mood disorders, already during the prenatal period. There have been scarce well-designed intervention studies that test technological low-intensity interventions by midwives to address pregnant women's mental health, diminishing anxiety and depression during pregnancy. METHODS/DESIGN Adult pregnant women (weeks 12-14 of gestation) will be recruited and screened from different primary care centers in Catalonia, Spain. Women who pass the initial mental screening will be randomly allocated to the relaxation virtual reality intervention or control group. The intervention aims to improve mental state of pregnant women during pregnancy, work through breathing, mindfulness and muscle relaxation techniques. Women in the control group will receive standard care offered by the public funded maternity services in Catalonia. The primary outcome measures will include the Edinburg Postnatal Depression (EPDS), State Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), and the Cambridge Worry Scale (CWS) instruments. Secondary outcome measures will include the Temperament and Character Inventory-Revised (TCI-R) and the Whooley and Generalized Anxiety Disorder-2 (GAD-2) questions. Routinary pregnancy monitoring measures will be also evaluated. DISCUSSION This study aims to test the efficacy of a low-intensity, midwife-led e-health intervention based on new technologies to work on women's anxiety and depression during pregnancy. We hypothesize that low-intensity mental health intervention during pregnancy, using an e-health (virtual reality) as a support tool, will be effective in reducing of anxiety, depressive symptoms, and improving satisfaction with pregnancy follow-up. TRIAL REGISTRATION Clinical Trials ID NCT05756205.
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Affiliation(s)
- Marta Jimenez-Barragan
- Fundació Assistencial Mútua Terrassa, (Terrassa), Universitat de Barcelona, Barcelona, Spain
- Research Group Atenció a La Salut Sexual I Reproductiva (GRASSIR), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Amparo del Pino Gutierrez
- Departament de Salut Pública, Salut Mental I Materno-Infantil, Facultat de Medicina I Ciències de La SalutUniversitat de Barcelona, Barcelona, Spain
- Ciber Fisiopatología Obesidad Y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Jorge Curto Garcia
- Departament de Salut Pública, Salut Mental I Materno-Infantil, Facultat de Medicina I Ciències de La SalutUniversitat de Barcelona, Barcelona, Spain
| | - Olga Monistrol-Ruano
- Patient Safety and Research Nurse, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
| | | | - Oriol Porta-Roda
- Obstetrics and Gynecology Department, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Falguera-Puig
- Research Group Atenció a La Salut Sexual I Reproductiva (GRASSIR), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Direcció d’Atenció Primària Metropolitana Nord, Atenció a La Salut Sexual I Reproductiva Metropolitana Nord, Institut Català de La Salut, Barcelona, Spain
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Madley-Dowd P, Kalkbrenner AE, Heuvelman H, Heron J, Zammit S, Rai D, Schendel D. Maternal smoking during pregnancy and offspring intellectual disability: sibling analysis in an intergenerational Danish cohort. Psychol Med 2022; 52:1847-1856. [PMID: 33050963 PMCID: PMC8044256 DOI: 10.1017/s0033291720003621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/19/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Maternal smoking has known adverse effects on fetal development. However, research on the association between maternal smoking during pregnancy and offspring intellectual disability (ID) is limited, and whether any associations are due to a causal effect or residual confounding is unknown. METHOD Cohort study of all Danish births between 1995 and 2012 (1 066 989 persons from 658 335 families after exclusions), with prospectively recorded data for cohort members, parents and siblings. We assessed the association between maternal smoking during pregnancy (18.6% exposed, collected during prenatal visits) and offspring ID (8051 cases, measured using ICD-10 diagnosis codes F70-F79) using logistic generalised estimating equation regression models. Models were adjusted for confounders including measures of socio-economic status and parental psychiatric diagnoses and were adjusted for family averaged exposure between full siblings. Adjustment for a family averaged exposure allows calculation of the within-family effect of smoking on child outcomes which is robust against confounders that are shared between siblings. RESULTS We found increased odds of ID among those exposed to maternal smoking in pregnancy after confounder adjustment (OR 1.35, 95% CI 1.28-1.42) which attenuated to a null effect following adjustment for family averaged exposure (OR 0.91, 95% CI 0.78-1.06). CONCLUSIONS Our findings are inconsistent with a causal effect of maternal smoking during pregnancy on offspring ID risk. By estimating a within-family effect, our results suggest that prior associations were the result of unmeasured genetic or environmental characteristics of families in which the mother smokes during pregnancy.
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Affiliation(s)
- Paul Madley-Dowd
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Amy E. Kalkbrenner
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Hein Heuvelman
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
- Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, UK
| | - Diana Schendel
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- National Centre for Register-based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Fletcher C, Hoon E, Gialamas A, Dekker G, Lynch J, Smithers L. Isolation, marginalisation and disempowerment - understanding how interactions with health providers can influence smoking cessation in pregnancy. BMC Pregnancy Childbirth 2022; 22:396. [PMID: 35538450 PMCID: PMC9086664 DOI: 10.1186/s12884-022-04720-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background Maternal smoking during pregnancy can lead to serious adverse health outcomes for both women and their infants. While smoking in pregnancy has declined over time, it remains consistently higher in women with lower socioeconomic circumstances. Furthermore, fewer women in this group will successfully quit during pregnancy. Aim This study explores the barriers to smoking cessation experienced by socially disadvantaged pregnant women and investigates how interactions with health providers can influence their smoking cessation journey. Methods Women (either pregnant or birthed in the previous 10 years, who smoked or quit smoking in pregnancy) were recruited from a metropolitan public hospital antenatal clinic in South Australia and community organisations in surrounding suburbs. Seventeen women participated in qualitative semi-structured small focus groups or interviews. The focus groups and interviews were recorded, transcribed and thematically analysed. Findings Four interconnected themes were identified: 1) smoking embedded in women’s challenging lives and pregnancies, 2) cyclic isolation and marginalisation, 3) feeling disempowered, and 4) autonomy and self-determination. Themes 3 and 4 are characterised as being two sides of a single coin in that they coexist simultaneously and are inseparable. A key finding is a strong unanimous desire for smoking cessation in pregnancy but women felt they did not have the necessary support from health providers or confidence and self-efficacy to be successful. Conclusion Women would like improvements to antenatal care that increase health practitioners’ understanding of the social and contextual healthcare barriers faced by women who smoke in pregnancy. They seek improved interventions from health providers to make informed choices about smoking cessation and would like women-centred care. Women feel that with greater support, more options for cessation strategies and consistency and encouragement from health providers they could be more successful at antenatal smoking cessation. If such changes were made, then South Australian practice could align more with best practice international guidelines for addressing smoking cessation in pregnancy, and potentially improve outcomes for women and their children. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04720-0.
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Affiliation(s)
- Cherise Fletcher
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia.,The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia
| | - Elizabeth Hoon
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia.,Discipline of General Practice, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Angela Gialamas
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia.,The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia
| | - Gustaaf Dekker
- The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia.,Obstetrics and Gynaecology Department, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - John Lynch
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia.,The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Lisa Smithers
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia. .,The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia. .,School of Health & Society, Faculty of Arts, Social Sciences & Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia. .,The Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia.
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McDaid L, Thomson R, Emery J, Coleman T, Cooper S, Phillips L, Naughton F. Agreement and Disparities between Women and Stop-Smoking Specialists about How to Promote Adherence to Nicotine Replacement Therapy in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094673. [PMID: 33924763 PMCID: PMC8125676 DOI: 10.3390/ijerph18094673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022]
Abstract
Evidence for the effectiveness of nicotine replacement therapy (NRT) for smoking-cessation in pregnancy is weak. This has been attributed to insufficient dosing and low adherence. This study investigated the acceptability of key messages and delivery modes for a behavioral intervention to increase NRT adherence in pregnancy. Semi-structured telephone interviews were carried out with pregnant or postpartum women aged ≥16 from across England, who had been offered NRT during pregnancy as part of a quit attempt and who struggled to quit (n = 10), and a focus group with stop-smoking specialists from across England (n = 6). The two data sources were coded separately using a thematic approach and then integrated to compare perspectives. Women and specialists agreed on message tone and delivery modes. However, views diverged on the most influential sources for certain messages and whether some information should be given proactively or reactively. There was also disagreement over which messages were novel and which were routinely delivered. This study demonstrates the value of capturing and integrating different perspectives and informational requirements when developing behavior-change interventions. The findings provide useful insights for designing a pregnancy-specific NRT adherence intervention that is acceptable to both those who will deliver and receive it.
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Affiliation(s)
- Lisa McDaid
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
- Correspondence:
| | - Ross Thomson
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Joanne Emery
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Lucy Phillips
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Felix Naughton
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
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Berveiller P, Rault E, Guerby P. [Physiological and Psychological Data influencing Pregnant Women Smoking Behavior - CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:551-558. [PMID: 32247097 DOI: 10.1016/j.gofs.2020.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Nicotine is the main addictive substance in tobacco and its addictive effects mainly involve dopamine. Nicotine is mainly metabolized (C-oxidation) in the liver to cotinine by the cytochrome P450 enzyme system. Nicotine half-life is short being about 2hours. Nicotine metabolism appears to be increased during pregnancy, mainly due to an increased cytochrome activity and maternal cardiac output. Thus, the smoking behavior of the pregnant woman is subsequently modified with an increase in withdrawal syndromes and an increased desire to smoke. These pharmacological elements should be taken into account when prescribing nicotine replacement therapy. Regarding the markers of tobacco intoxication, there is a good correlation between the importance of smoking and the measurement of expired air carbon monoxide. Although there is no evidence of decreased obstetrical complications related to its use, it is simple and non-invasive and therefore may be useful in routine practice. It gives an instantaneous value of tobacco intoxication, and represents a starting point for dialogue and management and can help to highlight the reality of withdrawal. Regarding the evaluation of tobacco addiction, the most commonly used questionnaires are the Fagerström tests (FTCD, HSI…), which are well correlated with cotinine concentration. However, there is insufficient evidence of their usefulness in reducing tobacco consumption during pregnancy to recommend them in current practice. DSM-V diagnostic criteria for addiction should be known as they can also be used to characterize the intensity of this addiction.
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Affiliation(s)
- P Berveiller
- Service de gynécologie-obstétrique, CHI de Poissy St-Germain, 78300 Poissy, France.
| | - E Rault
- Service d'obstétrique, hospices civils de Lyon, hôpital Femme-Mère-Enfant Lyon, 69500 Bron, France
| | - P Guerby
- Service de gynécologie-obstétrique, CHU de Toulouse, 31300 Toulouse, France
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9
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Bales M, Pambrun E, Melchior M, Glangeaud-Freudenthal NC, Charles MA, Verdoux H, Sutter-Dallay AL. Prenatal Psychological Distress and Access to Mental Health Care in the ELFE Cohort. Eur Psychiatry 2020; 30:322-8. [DOI: 10.1016/j.eurpsy.2014.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/08/2014] [Accepted: 11/17/2014] [Indexed: 11/28/2022] Open
Abstract
AbstractBackground:Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care.Methods:We used data from the French cohort Étude Longitudinale Française depuis l’Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses.Results:Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad.Limitations:Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics.Conclusions:Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.
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Gupta R, Brown HK, Barker LC, Dennis CL, Vigod SN. Rapid repeat pregnancy in women with schizophrenia. Schizophr Res 2019; 212:86-91. [PMID: 31420202 DOI: 10.1016/j.schres.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 01/14/2023]
Abstract
AIM Women with schizophrenia are vulnerable to adverse reproductive health outcomes. Short inter-pregnancy interval, or rapid repeat pregnancy, is associated with maternal and infant complications, and may be preventable. Whether women with schizophrenia are at disproportionate risk for rapid repeat pregnancy is unknown. METHODS This population-based cohort study in Ontario, Canada (2002-2013) compared women with and without schizophrenia on their risk of rapid repeat pregnancy, defined as pregnancy within 12 months of an index live birth. Among women with public drug coverage, those with and without schizophrenia were compared on their use of non-barrier contraception (hormonal and surgical) post-delivery. RESULTS Women with schizophrenia (n = 1565) were at higher risk for rapid repeat pregnancy than women without schizophrenia (n = 924,657) (6.3% vs. 3.9%, adjusted relative risk, aRR 1.31, 95% confidence interval, CI, 1.07-1.59). They had more rapid repeat pregnancies resulting in live births (aRR 1.85, 95% CI 1.26-2.72), but not pregnancy losses (aRR 1.50, 95% CI 0.99-2.29) or induced abortions (aRR 1.07, 95% CI 0.81-1.42). Post-delivery non-barrier contraception use was similar between groups (43.7% vs. 43.6%, aRR 1.06, 95% CI 0.93-1.20), although women with schizophrenia were more likely to use injectable contraception (14.1% vs. 10.1%, aRR 1.67, 95% CI 1.35-2.07). DISCUSSION Women with schizophrenia are at higher risk than their peers for rapid repeat pregnancy, but use non-barrier contraception at similar rates. The postnatal period is an opportune time to initiate targeted interventions designed to optimize planning for any future pregnancies, and contribute to improving maternal and child health in this vulnerable group.
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Affiliation(s)
- Renu Gupta
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hilary K Brown
- ICES, Toronto, Canada; Dalla Lana School of Public Health, Interdisciplinary Centre for Health & Society, University of Toronto, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Lucy C Barker
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Faculty of Nursing, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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11
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Ashford K, Fallin-Bennett A, McCubbin A, Wiggins A, Barnhart S, Lile J. Associations of first trimester co-use of tobacco and Cannabis with prenatal immune response and psychosocial well-being. Neurotoxicol Teratol 2019; 73:42-48. [PMID: 30936023 DOI: 10.1016/j.ntt.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aims to describe the association of first trimester co-use of tobacco and cannabis with maternal immune response and psychosocial well-being, relative to tobacco use only. METHODS A preliminary midpoint analysis included 138 pregnant women with biologically verified tobacco use, 38 of whom (28%) also tested positive for recent cannabis use. Maternal perceived stress (Perceived Stress Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and serum immune markers (IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα, CRP, MMP8), were collected, although cytokine data were only available for 122 women. RESULTS Participant average age was 29.1 years, approximately half had a high school education or less, and half were unemployed. Compared to tobacco only users, co-users were more likely to be non-White, younger and more economically disadvantaged. In the adjusted linear regression models, TNF-α levels were significantly lower among co-users relative to tobacco only users, after adjusting for age, race/ethnicity, body mass index and tobacco use group (tobacco cigarettes, electronic nicotine delivery devices [ENDS] or both). TNF-α was the only immune marker found to be significant in this analysis. Measured stress levels (M = 5.9, SD = 3.3; potential range 0-16) and depression scores (M = 7.8, SD = 5.8; potential range 0-30) were low across all participants and did not differ as a function of co-use. CONCLUSION Preliminary results suggest women co-using during the first trimester exhibit decreased pro-inflammatory immune responsivity on one out of eight markers. Further research is needed to determine the impact of this immune modulation on fetal health outcomes and the unique contribution of cannabis.
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Affiliation(s)
- Kristin Ashford
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA.
| | - Amanda Fallin-Bennett
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA
| | - Andrea McCubbin
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA
| | - Amanda Wiggins
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA
| | - Sheila Barnhart
- University of Kentucky College of Social Work, 653 Patterson Office Tower, Lexington, KY 40506, USA
| | - Josh Lile
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA; Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
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12
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Fillo J, Kamper-DeMarco KE, Brown WC, Stasiewicz PR, Bradizza CM. Emotion regulation difficulties and social control correlates of smoking among pregnant women trying to quit. Addict Behav 2019; 89:104-112. [PMID: 30286396 DOI: 10.1016/j.addbeh.2018.09.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/14/2018] [Accepted: 09/25/2018] [Indexed: 01/21/2023]
Abstract
Approximately 15% of US women currently smoke during pregnancy. An important step toward providing effective smoking cessation interventions during pregnancy is to identify individuals who are more likely to encounter difficulty quitting. Pregnant smokers frequently report smoking in response to intrapersonal factors (e.g., negative emotions), but successful cessation attempts can also be influenced by interpersonal factors (i.e., influence from close others). This study examined the association between emotion regulation difficulties, positive and negative social control (e.g., encouragement, criticism), and smoking cessation-related variables (i.e., smoking quantity, withdrawal symptoms) among pregnant smokers. Data were drawn from the pretreatment wave of a smoking cessation trial enrolling low-income pregnant women who self-reported smoking in response to negative affect (N = 73). Greater emotion regulation difficulties were related to greater smoking urges (b = 0.295, p = .042) and withdrawal symptoms (b = 0.085, p = .003). Additionally, more negative social control from close others was related to fewer smoking days (b = -0.614, p = .042) and higher smoking abstinence self-efficacy (b = 0.017, p = .002). More positive social control from close others interacted with negative affect smoking (b = -0.052, p = .043); the association between negative affect smoking and nicotine dependence (b = 0.812, p < .001) only occurred at low levels of positive social control. Findings suggest that emotion regulation difficulties may contribute to smoking during pregnancy by exacerbating women's negative experiences related to smoking cessation attempts. Negative social control was related to lower smoking frequency and greater confidence in quitting smoking, suggesting that it may assist pregnant smokers' cessation efforts. Positive social control buffered women from the effects of negative affect smoking on nicotine dependence. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01163864.
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13
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di Giacomo E, Colmegna F, Pescatore F, Aspesi F, Fotiadou M, Clerici M. The burden of personality disorders on the DSM 5 addiction to tobacco during pregnancy. Compr Psychiatry 2018; 84:101-105. [PMID: 29729554 DOI: 10.1016/j.comppsych.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Tobacco smoking is a major health concern. Many women smoke during their reproductive years, some of them during their pregnancy. Adverse outcomes for the newborns physical health are well recognized, while the influence on their mental health is still under investigation. We aim at demonstrating the contribution of maternal personality disorders in maintaining addiction to tobacco during pregnancy, to underline their role and the need of their detection as a preventive effort. METHOD 150 women, consecutively admitted to the Perinatal Psychiatric Outpatient Department were tested with the SCID II, CTQ, WHOQOL-BREF, EPDS, BDI and BAI. Tobacco use disorder was attested with the fulfillment of DSM 5 criteria. RESULTS 46% (n = 69) of the sample was affected by at least one personality disorder ("PD+"). "PD+" showed a significant higher rate of pregnant women addicted to tobacco (p = 0.021). The average number of cigarettes per day was notably distinct, since patients affected by "NPD" smokes twice the amount compared to "PD-" and "other PDs", while those affected by Borderline PD has a halfway consumption (7.20 ± 5.54 vs 3.37 ± 4.62 vs 3 ± 3.39 vs 5.50 ± 4.10). ANOVA and POST HOC showed a significance between "NPD" and "other PDs" (p = 0.035), and "other PDs" has significantly the highest rate of active smokers. CONCLUSION Personality disorders demonstrate to be a clear contributor in supporting addiction to tobacco during pregnancy. Short and long term health and mental consequences attested in the newborn, encourage awareness in detecting tobacco dependency during this sensitive period. The inclusion of personality evaluation and management in tobacco dependency treatment programs is strictly encouraged to boost their efficiency and increase tobacco abstinence.
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Affiliation(s)
- Ester di Giacomo
- PhD program in Neuroscience, Doctorate School of the University of Milano-Bicocca, Italy; School of Medicine and Surgery-University of Milano Bicocca, Italy; Psychiatric Department-ASST Monza, Italy.
| | | | | | | | - Maria Fotiadou
- Female Medium Secure Forensic Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Massimo Clerici
- School of Medicine and Surgery-University of Milano Bicocca, Italy; Psychiatric Department-ASST Monza, Italy
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14
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Bauld L, Graham H, Sinclair L, Flemming K, Naughton F, Ford A, McKell J, McCaughan D, Hopewell S, Angus K, Eadie D, Tappin D. Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study. Health Technol Assess 2018; 21:1-158. [PMID: 28661375 DOI: 10.3310/hta21360] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although many women stop smoking in pregnancy, others continue, causing harm to maternal and child health. Smoking behaviour is influenced by many factors, including the role of women's significant others (SOs) and support from health-care professionals (HPs). OBJECTIVES To enhance understanding of the barriers to, and facilitators of, smoking cessation and the feasibility and acceptability of interventions to reach and support pregnant women to stop smoking. DESIGN Four parts: (1) a description of interventions in the UK for smoking cessation in pregnancy; (2) three systematic reviews (syntheses) of qualitative research of women's, SOs' and HPs' views of smoking in pregnancy using meta-ethnography (interpretative approach for combining findings); (3) semistructured interviews with pregnant women, SOs and HPs, guided by the social-ecological framework (conceptualises behaviour as an outcome of individuals' interactions with environment); and (4) identification of new/improved interventions for future testing. SETTING Studies in reviews conducted in high-income countries. Qualitative research was conducted from October 2013 to December 2014 in two mixed urban/rural study sites: area A (Scotland) and area B (England). PARTICIPANTS Thirty-eight studies (1100 pregnant women) in 42 papers, nine studies (150 partners) in 14 papers and eight studies described in nine papers (190 HPs) included in reviews. Forty-one interviews with pregnant women, 32 interviews with pregnant women's SOs and 28 individual/group interviews with 48 HPs were conducted. MAIN OUTCOME MEASURES The perceived barriers to, and facilitators of, smoking cessation in pregnancy and the identification of potential new/modified interventions. RESULTS Syntheses identified smoking-related perceptions and experiences for pregnant women and SOs that were fluid and context dependent with the capacity to help or hinder smoking cessation. Themes were analysed in accordance with the social-ecological framework levels. From the analysis of the interviews, the themes that were central to cessation in pregnancy at an individual level, and that reflected the findings from the reviews, were perception of risk to baby, self-efficacy, influence of close relationships and smoking as a way of coping with stress. Overall, pregnant smokers were faced with more barriers than facilitators. At an interpersonal level, partners' emotional and practical support, willingness to change smoking behaviour and role of smoking within relationships were important. Across the review and interviews of HPs, education to enhance knowledge and confidence in delivering information about smoking in pregnancy and the centrality of the client relationship, protection of which could be a factor in downplaying risks, were important. HPs acknowledged that they could best assist by providing support and understanding, and access to effective interventions, including an opt-out referral pathway to Stop Smoking Services, routine carbon monoxide screening, behavioural support and access to pharmacotherapy. Additional themes at community, organisational and societal levels were also identified. LIMITATIONS Limitations include a design grounded in qualitative studies, difficulties recruiting SOs, and local service configurations and recruitment processes that potentially skewed the sample. CONCLUSIONS Perceptions and experiences of barriers to and facilitators of smoking cessation in pregnancy are fluid and context dependent. Effective interventions for smoking cessation in pregnancy should take account of the interplay between the individual, interpersonal and environmental aspects of women's lives. FUTURE WORK Research focus: removing barriers to support, improving HPs' capacity to offer accurate advice, and exploration of weight concerns and relapse prevention. Interventions focus: financial incentives, self-help and social network interventions. STUDY REGISTRATION This study is registered as PROSPERO CRD42013004170. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Linda Bauld
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Lesley Sinclair
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK.,Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - Allison Ford
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Jennifer McKell
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | | | - Sarah Hopewell
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - Kathryn Angus
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Douglas Eadie
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - David Tappin
- Child Health, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
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15
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Jankovic J, Stamenkovic Z, Stojanovski K, Goodwin RD, Janevic T. Predictors of prenatal smoking and attempted smoking cessation during pregnancy: a community-based study of Romani women in Southeastern Europe. J Public Health (Oxf) 2017; 39:e186-e193. [PMID: 27899475 DOI: 10.1093/pubmed/fdw123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The objective of this study was to examine predictors of prenatal smoking, and attempted smoking cessation during pregnancy among Romani women. Methods A community-based, cross-sectional study (November 2012 to February 2013) of 410 Romani women in Roma settlements in Serbia and Macedonia was conducted. Logistic regression was used to identify predictors of prenatal smoking and attempted smoking cessation during pregnancy. Results Romani women older than 30 years and those who were living with a man were over twice as likely (adjusted odds ratio (aOR) 2.48, 95% confidence interval (CI) 1.12-5.46; aOR 2.09, 95% CI 1.27-3.43) to smoke during pregnancy, compared to women <20 and married women, respectively. An inverse relationship between education and prenatal smoking was observed (for primary education versus no education, aOR 0.56, 95% CI 0.32-0.98; for secondary or higher education versus no education, aOR 0.38, 95% CI 0.16-0.90). Having a husband/partner who smokes was associated with significantly increased likelihood of prenatal smoking (aOR 3.71, 95% CI 2.20-6.25) and decreased likelihood of attempting to quit (aOR 0.51, 95% CI 0.24-1.06). Conclusions Culturally sensitive and comprehensive prevention strategies and intervention programs are needed to reduce smoking during pregnancy among Romani women, including interventions targeting male partners.
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Affiliation(s)
- Janko Jankovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia
| | - Zeljka Stamenkovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia
| | - Kristefer Stojanovski
- Center for Regional Policy Research and Cooperation, Studiorum, Nikola Parapunov br. 41, PO Box 24, 1020 Skopje, Macedonia
| | - Renee D Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), 65-30 Kissena Boulevard, Queens, NY 11367, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Teresa Janevic
- Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA
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Smoking during pregnancy in the United States, 2005-2014: The role of depression. Drug Alcohol Depend 2017; 179:159-166. [PMID: 28783546 PMCID: PMC5635833 DOI: 10.1016/j.drugalcdep.2017.06.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite success of public health-oriented tobacco control programs in lowering the smoking prevalence over the past several decades, it is unclear whether similar reductions in smoking have been experienced among pregnant women, especially in vulnerable groups such as those with major depression and/or lower socioeconomic status. OBJECTIVES The purpose of this study is to examine the relationship between major depressive episode (MDE) and smoking among pregnant women overall, and by demographics and to estimate changes in the prevalence of cigarette smoking among pregnant women with and without MDE from 2005 to 2014. STUDY DESIGN Cigarette use among pregnant women with and without MDE was examined using logistic regression models in the National Survey on Drug Use and Health. RESULTS Prenatal smoking is more common among pregnant women with, compared to without, MDE (32.5% vs. 13.0%; (adjusted OR=2.50 (1.85, 3.40)), and greater disparities were revealed when also considering income, education and race. Over time, smoking during pregnancy increased significantly among women with MDE (35.9% to 38.4%; p=0.02)) and showed a decreasing trend among women without MDE (12.5% to 9.1%; p=0.07) from 2005 to 2014. CONCLUSIONS Over the past decade, smoking during pregnancy has increased among women experiencing a major depressive episode and is over four times more common among pregnant women with, than without, MDE. Disparities in smoking during pregnancy by MDE status and socioeconomic subgroups appear substantial. Given the multitude of risks associated with both MDE and smoking during the prenatal period, more work targeting this vulnerable and high-risk group is needed.
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17
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Kolko RP, Emery RL, Cheng Y, Levine MD. Do Psychiatric Disorders or Measures of Distress Moderate Response to Postpartum Relapse Prevention Interventions? Nicotine Tob Res 2017; 19:615-622. [PMID: 28403471 DOI: 10.1093/ntr/ntw385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/15/2016] [Indexed: 11/13/2022]
Abstract
Introduction Most women who quit smoking during pregnancy will relapse postpartum. Interventions for sustained postpartum abstinence can benefit from understanding prenatal characteristics associated with treatment response. Given that individuals with psychiatric disorders or elevated depressive symptoms have difficulty quitting smoking and that increases in depressive symptoms prenatally are common, we examined the relevance of psychiatric diagnoses, prenatal depressive symptoms, and stress to postpartum relapse prevention intervention response. Methods Pregnant women (N = 300) who quit smoking during pregnancy received intervention (with specialized focus on mood, weight, and stress [STARTS] or a comparison [SUPPORT]) to prevent postpartum relapse. As previously published, nearly one-third and one-quarter of women achieved biochemically-confirmed sustained abstinence at 24- and 52-weeks postpartum, with no difference in abstinence rates between the interventions. Women completed psychiatric interviews and questionnaires during pregnancy. Smoking was assessed in pregnancy, and 24- and 52-weeks postpartum. Results Psychiatric disorders did not predict sustained abstinence or treatment response. However, treatment response was moderated by end-of-pregnancy depressive symptoms (χ2 = 9.98, p = .002) and stress (χ2 = 6.90, p = .01) at 24- and 52-weeks postpartum and remained significant after including covariates. Women with low distress achieved higher abstinence rates in SUPPORT than in STARTS (37% vs. 19% for depressive symptoms; 36% vs. 19% for stress), with no difference for women with high symptoms. Conclusions Prenatal depressive symptoms and stress predicted differential treatment efficacy in women with low symptoms, not in women with high symptoms. Diagnostic history did not predict treatment differences. Future research to address prenatal distress may help tailor postpartum relapse prevention interventions. Implications We examined prenatal history of psychiatric disorders and psychiatric distress as moderators of response to postpartum smoking relapse prevention intervention that either included or did not include added content on mood, stress, and weight concerns. For women with lower psychiatric distress, the added focus is not necessary, as these women achieved greater sustained abstinence in the less-intensive treatment. Understanding which women need which level of care to sustain abstinence can help allocate resources for all postpartum former smokers. These findings underscore the importance of perinatal symptom monitoring and promoting behavioral health more broadly in pregnant and postpartum women.
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Affiliation(s)
- Rachel P Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rebecca L Emery
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Yu Cheng
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Statistics, University of Pittsburgh, Pittsburgh, PA
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017; 31:519-552. [PMID: 28440103 DOI: 10.1177/0269881117699361] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
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Affiliation(s)
- R Hamish McAllister-Williams
- 1 Institute of Neuroscience, Newcastle University, Newcastle, UK.,2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David S Baldwin
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,4 University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Abby Easter
- 6 Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- 2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,7 Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Vivette Glover
- 8 Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lucian Green
- 9 Ealing, Hounslow, Hammersmith & Fulham Perinatal Mental Health Service, West London Mental Health Trust, London, UK
| | - Alain Gregoire
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,10 Hampshire Perinatal Mental Health Service, Winchester, UK
| | - Louise M Howard
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Jones
- 13 National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Hind Khalifeh
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Elizabeth McDonald
- 15 Royal College of Psychiatrists, London, UK.,16 East London Foundation Trust, London, UK.,17 Tavistock and Portman NHS Foundation Trust, London, UK
| | - Nadia Micali
- 18 Behavioural and Brain Sciences Unit, GOSH Institute of Child Health, University College London, London, UK
| | - Carmine M Pariante
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ann Roberts
- 20 St Martin's Healthcare Services CIC, Leeds, UK.,21 Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, UK.,22 Postgraduate School of Medicine, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Natalie C Smith
- 23 Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, County Durham, UK
| | - David Taylor
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,24 Institute of Pharmaceutical Science, King's College London, London, UK
| | - Angelika Wieck
- 25 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,26 University of Manchester, Manchester, UK
| | - Laura M Yates
- 27 UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,28 Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Allan H Young
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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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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20
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Tong VT, Farr SL, Bombard J, DʼAngelo D, Ko JY, England LJ. Smoking Before and During Pregnancy Among Women Reporting Depression or Anxiety. Obstet Gynecol 2016; 128:562-70. [PMID: 27500342 PMCID: PMC5013536 DOI: 10.1097/aog.0000000000001595] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe prepregnancy smoking, prenatal smoking, and prenatal cessation among women reporting and not reporting depression or anxiety. METHODS We analyzed cross-sectional data from the 2009-2011 Pregnancy Risk Assessment Monitoring System, a population-based survey of women with live births (N=34,633). Smoking status was defined as self-reported prepregnancy smoking (during the 3 months before pregnancy), prenatal smoking (during the last 3 months of pregnancy), and prenatal cessation (no smoking by the last 3 months among prepregnancy smokers). Depression and anxiety status was self-reported of having either condition or both during the 3 months before pregnancy. We compared smoking prevalence by self-reported depression and anxiety status using χ tests and adjusted prevalence ratios. RESULTS Overall, 16.9% of women in our sample reported depression, anxiety, or both during the 3 months before pregnancy. Compared with those who did not report, women who reported depression or anxiety had significantly higher prepregnancy (46.7% compared with 22.5%, P<.01) and prenatal smoking (27.5% compared with 10.5%, P<.01). A lower proportion of prepregnancy smokers who reported depression or anxiety quit smoking by the last 3 months of pregnancy than those who did not report (41.4% compared with 53.8%, P<.01). In adjusted analyses, women reporting depression or anxiety were 1.5 and 1.7 times more likely to smoke prepregnancy and prenatally, respectively, and less likely to quit smoking (adjusted prevalence ratio 0.86, 95% confidence interval 0.80-0.92). CONCLUSION Women who reported depression, anxiety, or both were more likely to smoke before and during pregnancy and less likely to quit smoking during the prenatal period. Screening recommendations for perinatal depression and anxiety provide an opportunity to identify a subpopulation of women who may have a higher prevalence of smoking and to provide effective tobacco cessation interventions and mental health care.
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Affiliation(s)
- Van T Tong
- Division of Reproductive Health and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and the National Center for Birth Defects and Developmental Disabilities, Atlanta, Georgia
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21
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Brown QL, Hasin DS, Keyes KM, Fink DS, Ravenell O, Martins SS. Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age. Drug Alcohol Depend 2016; 166:116-24. [PMID: 27422762 PMCID: PMC4983465 DOI: 10.1016/j.drugalcdep.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/22/2016] [Accepted: 07/02/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding the relationship between health insurance coverage and tobacco and alcohol use among reproductive age women can provide important insight into the role of access to care in preventing tobacco and alcohol use among pregnant women and women planning to become pregnant. METHODS We examined the association between health insurance coverage and both past month alcohol use and past month tobacco use in a nationally representative sample of women age 12-44 years old, by pregnancy status. The women (n=97,788) were participants in the National Survey of Drug Use and Health (NSDUH) in 2010-2013. Logistic regression models assessed the association between health insurance (insured versus uninsured), past month tobacco and alcohol use, and whether this was modified by pregnancy status. RESULTS Pregnancy status significantly moderated the relationship between health insurance and tobacco use (p-value≤0.01) and alcohol use (p-value≤0.01). Among pregnant women, being insured was associated with lower odds of alcohol use (adjusted odds ratio [AOR]=0.47; 95% confidence interval [CI]=0.27-0.82), but not associated with tobacco use (AOR=1.14; 95% CI=0.73-1.76). Among non-pregnant women, being insured was associated with lower odds of tobacco use (AOR=0.67; 95% CI=0.63-0.72), but higher odds of alcohol use (AOR=1.23; 95% CI=1.15-1.32). CONCLUSION Access to health care, via health insurance coverage is a promising method to help reduce alcohol use during pregnancy. However, despite health insurance coverage, tobacco use persists during pregnancy, suggesting missed opportunities for prevention during prenatal visits.
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Affiliation(s)
- Qiana L. Brown
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY,New York State Psychiatric Institute, New York, NY,Corresponding author at: Deborah S. Hasin, Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive #123, New York, NY 10032, US. Phone: 1 (646) 774-7909, Fax: 1 (646) 774-7920.
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - David S. Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Silvia S. Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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22
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Weng SC, Huang JP, Huang YL, Lee TSH, Chen YH. Effects of tobacco exposure on perinatal suicidal ideation, depression, and anxiety. BMC Public Health 2016; 16:623. [PMID: 27448804 PMCID: PMC4957348 DOI: 10.1186/s12889-016-3254-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/30/2016] [Indexed: 12/16/2022] Open
Abstract
Background Previous studies have stressed the importance of tobacco exposure for the mood disorders of depression and anxiety. Although a few studies have focused on perinatal women, none have specifically considered the effects of smoking and secondhand smoke exposure on perinatal suicidal ideation. Thus, this study aimed to investigate the relationships of smoking/secondhand smoke exposure status with suicidal ideation, depression, and anxiety from the first trimester to the first month post partum. Methods This cross-sectional study based on self-reported data was conducted at five hospitals in Taipei, Taiwan from July 2011 to June 2014. The questionnaire inquired about women’s pregnancy history, sociodemographic information, and pre-pregnancy smoking and secondhand smoke exposure status, and assessed their suicidal ideation, depression, and anxiety symptoms. Logistic regression models were used for analysis. Results In the 3867 women in the study, secondhand smoke exposure was positively associated with perinatal depression and suicidal ideation. Compared with women without perinatal secondhand smoke exposure, women exposed to secondhand smoke independently exhibited higher risks for suicidal ideation during the second trimester (odds ratio (OR) = 7.63; 95 % confidence interval (CI) = 3.25–17.93) and third trimester (OR = 4.03; 95 % CI = 1.76–9.23). Women exposed to secondhand smoke had an increased risk of depression, especially those aged 26–35 years (OR = 1.71; 95 % CI = 1.27–2.29). Conclusions Secondhand smoke exposure also considerably contributes to adverse mental health for women in perinatal periods, especially for the severe outcome of suicidal ideation. Our results strongly support the importance of propagating smoke-free environments to protect the health of perinatal women. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3254-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shu-Chuan Weng
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.,Mackay Memorial Hospital, New Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ya-Li Huang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Education, National Taiwan Normal University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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Dagklis T, Papazisis G, Tsakiridis I, Chouliara F, Mamopoulos A, Rousso D. Prevalence of antenatal depression and associated factors among pregnant women hospitalized in a high-risk pregnancy unit in Greece. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1025-31. [PMID: 27138949 DOI: 10.1007/s00127-016-1230-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/26/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Women who face pregnancy complications may require hospitalization in a high-risk pregnancy unit (HRPU), and this may have a negative impact on the pregnant woman's mental health. The purpose of this study was to screen for depressive symptoms in pregnant women admitted in a high-risk pregnancy unit and also to investigate associated risk factors. METHODS This was a cross-sectional study that enrolled pregnant women admitted at ≥24 gestational weeks in a university hospital HRPU, between September 2014 and November 2015. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms on admission. A cutoff score ≥13 was considered as indicative of depression. Test results were then correlated with the reasons that led to the women's admission as well as socio-demographic characteristics. RESULTS Overall, 157 of the women admitted in the HRPU during the study period were eligible for the study and agreed to complete the questionnaire. The mean age of the pregnant women was 30 ± 6 years, and the mean gestational week at admission was 32 ± 3 weeks. The prevalence of antenatal depression (score ≥13) was 28 % (44/157). In the multivariate analysis, antenatal depression was significantly correlated with smoking (OR = 2.681, 95 % CI 1.089-6.601) and the existence of thoughts for pregnancy termination (OR = 3.624, 95 % CI 1.149-11.427). CONCLUSIONS Approximately one quarter of pregnant women hospitalized in the HRPU may show signs of depression at the time of admission. Smoking and an unwanted pregnancy were found to be independently associated with antenatal depression, whereas no association was found with any obstetric parameters.
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Affiliation(s)
- Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynaecology, Hippokrateion Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynaecology, Hippokrateion Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Foteini Chouliara
- 3rd Department of Obstetrics and Gynaecology, Hippokrateion Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- 3rd Department of Obstetrics and Gynaecology, Hippokrateion Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - David Rousso
- 3rd Department of Obstetrics and Gynaecology, Hippokrateion Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Weinberger AH, Kashan RS, Shpigel DM, Esan H, Taha F, Lee CJ, Funk AP, Goodwin RD. Depression and cigarette smoking behavior: A critical review of population-based studies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:416-431. [DOI: 10.3109/00952990.2016.1171327] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rachel S. Kashan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | | | - Hannah Esan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Farah Taha
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY, USA
| | - Christine J. Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Allison P. Funk
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Renee D. Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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25
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Alibekova R, Huang JP, Lee TSH, Au HK, Chen YH. Effects of smoking on perinatal depression and anxiety in mothers and fathers: A prospective cohort study. J Affect Disord 2016; 193:18-26. [PMID: 26766030 DOI: 10.1016/j.jad.2015.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/14/2015] [Accepted: 12/19/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Considerable concern persists on tobacco use during perinatal periods. No study has simultaneously investigated the longitudinal association of paternal smoking with maternal and paternal depressive and anxiety symptoms during perinatal periods. METHODS In this prospective study, 533 couples (pregnant women and their husbands) completed 5 self-report instruments from early pregnancy until 6 months postpartum. Generalized estimating equations were used for the analyses. RESULTS We found that fathers who smoked in the mother's presence had higher depressive (regression coefficient=1.0, 95% confidence interval (CI) 0.3-1.8) and anxiety symptoms (3.0, 95% CI=1.2-4.7) during perinatal periods compared with nonsmoking fathers. Paternal smoking in the mother's presence also increased maternal disturbances, especially for depression during pregnancy (1.2, 95% CI=0.1-2.3) and anxiety during the postpartum period (3.4, 95% CI=0.6-6.3). No significant association was found between paternal smoking but not in the mother's presence and maternal emotional disturbances. Paternal smoking but not in the mother's presence affected only paternal anxiety, especially in the postpartum period (regression coefficient 2.7, 95% CI 0.7-4.7) compared with nonsmokers. LIMITATIONS Self-report measures were used. The effects of maternal smoking could not be estimated because of the small sample of pregnant women who disclosed their smoking status. CONCLUSIONS These findings imply a necessity to combine strategies for smoking cessation with interventions for affective disturbances in fathers. We also stress the importance of at least restricting the father's smoking in the presence of the pregnant wife during perinatal periods if smoking cessation is tentatively unattainable.
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Affiliation(s)
- Raushan Alibekova
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Education, National Taiwan Normal University, Taipei, Taiwan
| | - Heng-Kien Au
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
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26
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Abstract
This integrative review provides an overview of nicotine dependence measures used with perinatal women and an evaluation of their psychometric properties. Fifty-five articles that met inclusion and exclusion criteria were identified from five different databases. Most of the studies used the Fagerström Test for Nicotine Dependence (FTND). Other approaches included diagnostic tests, the Wisconsin Inventory of Smoking Dependence Motives (WISDM), the Tobacco Dependence Screener, and single-item measures. This review indicated that the FTND may not be the best option for measuring nicotine dependence in this population. The WISDM is a newer instrument that has excellent psychometric properties and captures nonnicotinic dimensions of nicotine dependence relevant to women. Future research is needed to assess its reliability in the perinatal population. Other recommendations from this review include the use of biomarker validation, thorough psychometric reporting on nicotine dependence instruments, and the use of multiple instruments to maximize comparability between nicotine dependence instruments.
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Hanson JD, Jensen JL, Campbell K, Chaudhary KR, Puumala SE. Epidemiology of substance-exposed pregnancies at one Great Lakes hospital that serves a large number of American Indians. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2016; 23:44-62. [PMID: 27536897 PMCID: PMC5011980 DOI: 10.5820/aian.2304.2016.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this research was to determine the prevalence of substance-exposed pregnancies at a hospital in the Great Lakes region of the U.S. METHOD Data were collected via retrospective chart abstractions of patients who were seen for delivery at one Great Lakes region hospital during a 1-year period who were given at least one of the International Classification of Diseases codes related to substance use. RESULTS A total of 342 medical records were included in the analysis, and, while much race/ethnicity data were missing, a large percentage of those in our analysis identified as American Indian. The prevalence of substance-exposed pregnancies at this hospital during a 1-year period was 34.5%. The majority (84.8%) were tobacco users, and many were found to have multiple substance exposures. Also, 48.5% were found to have a mental health diagnosis in addition to substance use. CONCLUSIONS Data from this project can be used in prevention efforts, including preconception care for women at risk for substance use and mental health issues.
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28
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Probert K, Miller S, Kheirallah AK, Hall IP. Developmental genetics of the COPD lung. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40749-015-0014-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Akkaş Yılmaz E, Gülümser Ç. The risk factors, consequences, treatment, and importance of gestational depression. Turk J Obstet Gynecol 2015; 12:102-113. [PMID: 28913052 PMCID: PMC5558373 DOI: 10.4274/tjod.42744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/07/2014] [Indexed: 12/01/2022] Open
Abstract
Nowadays, mental problems have become an important health issue, the most frequent of which in pregnancy is depression. Gestational depression is known to increase gestational complications and negatively affect maternal and fetal health. The frequency of gestational depression and depressive symptoms are 10-30%. Risk factors vary according to genetic, psychologic, environmental, social, and biologic factors. Maternal morbidity and mortality rates increase in pregnant women who do not receive treatment, obstetric complications and negative fetal consequences are seen, and the incidence of postpartum depression increases. Due to all these important consequences, healthcare providers who manage pregnant women should be informed about the frequency, symptoms, and screening methods of postpartum depression, the significance of the consequences of undiagnosed and untreated depression on the health of mother and baby, and the importance of early diagnosis. Pregnant women who are at risk should be screened and detected, and directed to related centers. In this review, we briefly review the definition of gestational depression, its frequency, risk factors, complications, screening, treatments, and the procedures that need to be performed the diagnostic process.
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Affiliation(s)
- Elif Akkaş Yılmaz
- Sami Ulus Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Çağrı Gülümser
- Başkent University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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30
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Maccani JZ, Maccani MA. Altered placental DNA methylation patterns associated with maternal smoking: current perspectives. ADVANCES IN GENOMICS AND GENETICS 2015; 2015:205-214. [PMID: 26203295 PMCID: PMC4507353 DOI: 10.2147/agg.s61518] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The developmental origins of health and disease hypothesis states that adverse early life exposures can have lasting, detrimental effects on lifelong health. Exposure to maternal cigarette smoking during pregnancy is associated with morbidity and mortality in offspring, including increased risks for miscarriage, stillbirth, low birth weight, preterm birth, asthma, obesity, altered neurobehavior, and other conditions. Maternal cigarette smoking during pregnancy interferes with placental growth and functioning, and it has been proposed that this may occur through the disruption of normal and necessary placental epigenetic patterns. Epigenome-wide association studies have identified a number of differentially methylated placental genes that are associated with maternal smoking during pregnancy, including RUNX3, PURA, GTF2H2, GCA, GPR135, and HKR1. The placental methylation status of RUNX3 and NR3C1 has also been linked to adverse infant outcomes, including preterm birth and low birth weight, respectively. Candidate gene analyses have also found maternal smoking-associated placental methylation differences in the NR3C1, CYP1A1, HTR2A, and HSD11B2 genes, as well as in the repetitive elements LINE-1 and AluYb8. The differential methylation patterns of several genes have been confirmed to also exhibit altered gene expression patterns, including CYP1A1, CYP19A1, NR3C1, and HTR2A. Placental methylation patterns associated with maternal smoking during pregnancy may be largely gene-specific and tissue-specific and, to a lesser degree, involve global changes. It is important for future research to investigate the mechanistic roles that these differentially methylated genes may play in mediating the association between maternal smoking during pregnancy and disease in later life, as well as to elucidate the potential influence of emerging tobacco product use during pregnancy, including the use of electronic cigarettes, on placental epigenetics.
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Affiliation(s)
- Jennifer Zj Maccani
- Penn State Tobacco Center of Regulatory Science, College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
| | - Matthew A Maccani
- Penn State Tobacco Center of Regulatory Science, College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
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Jarlenski MP, Chisolm MS, Kachur S, Neale DM, Bennett WL. Use of pharmacotherapies for smoking cessation: analysis of pregnant and postpartum Medicaid enrollees. Am J Prev Med 2015; 48:528-34. [PMID: 25891051 PMCID: PMC4405626 DOI: 10.1016/j.amepre.2014.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/15/2014] [Accepted: 10/21/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Affordable Care Act requires state Medicaid programs to cover pharmacotherapies for smoking cessation without cost sharing for pregnant women. Little is known about use of these pharmacotherapies among Medicaid-enrolled women. PURPOSE To describe the prevalence of prescription fills for smoking-cessation pharmacotherapies during pregnancy and postpartum among Medicaid-enrolled women and to examine whether certain pregnancy complications or copayments are associated with prescription fills. METHODS Insurance claims data for women enrolled in a Medicaid managed care plan in Maryland and who used tobacco during pregnancy from 2003 to 2010 were obtained (N=4,709) and analyzed in 2014. Descriptive statistics were used to calculate the prevalence of smoking-cessation pharmacotherapy use during pregnancy and postpartum. Generalized estimating equations were employed to examine the relationship of pregnancy complications and copayments with prescription fills of smoking-cessation pharmacotherapies during pregnancy and postpartum. RESULTS Few women filled any prescription for a smoking-cessation pharmacotherapy during pregnancy or postpartum (2.6% and 2.0%, respectively). Having any smoking-related pregnancy complication was positively associated with filling a smoking-cessation pharmacotherapy prescription during pregnancy (OR=1.69, 95% CI=1.08, 2.65) but not postpartum. Copayments were associated with significantly decreased odds of filling any prescription for smoking-cessation pharmacotherapies in the postpartum period (OR=0.38, 95% CI=0.22, 0.66). CONCLUSIONS Smoking-related pregnancy complications and substance use are predictive of filling a prescription for pharmacotherapies for smoking cessation during pregnancy. Low use of pharmacotherapies during pregnancy is consistent with clinical guidelines; however, low use postpartum suggests an unmet need for cessation aids in Medicaid populations.
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Affiliation(s)
- Marian P Jarlenski
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
| | - Margaret S Chisolm
- Department of Psychiatry and Behavioral Sciences, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Columbia, Maryland
| | - Sarah Kachur
- Johns Hopkins HealthCare, LLC, Baltimore, Columbia, Maryland
| | - Donna M Neale
- Department of Gynecology and Obstetrics, Center for Maternal and Fetal Medicine, Johns Hopkins Hospital, Columbia, Maryland
| | - Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Columbia, Maryland; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Columbia, Maryland
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Strengell P, Väisänen I, Joukamaa M, Luukkaala T, Seppä K. Psychiatric comorbidity among substance misusing mothers. Nord J Psychiatry 2015; 69:315-21. [PMID: 25426622 DOI: 10.3109/08039488.2014.978892] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Approximately half of patients suffering from a significant drug or alcohol related disorder also match the criteria of some other psychiatric disorder. Yet, little is known about comorbidity among substance misusing pregnant women. AIMS To estimate the prevalence of psychiatric diseases among mothers with substance misuse severe enough to end up in an assessment at a specialized addiction clinic and to compare their backgrounds to the controls. METHODS Between 1 June 2003 and 31 December 2005, the maternity clinics in Pirkanmaa health district were asked to refer mothers with possible substance misuse to Tampere University Addiction Psychiatric Clinic, where 119/217 patients were considered misusers. Of these, 49/119 (41.2%) participated in the whole study. At baseline, the assessment was made using the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and at the end of the study, 6-12 months after delivery, with the Structured Clinical Interview for DSM-IV (SCID). The comparison group (n = 74) filled a postal survey concerning their background and substance use. RESULTS 57% of substance misusing pregnant women had psychiatric illnesses; 6-12 months after delivery the number of substance use-related diagnoses was 40%. However, the number, spectrum and severity of psychiatric diagnoses were high in this group. CONCLUSIONS Psychiatric comorbidity is common among substance misusing mothers. Their social situation is often very difficult and support needs vary a lot. In order to offer them best possible treatment, diagnosing these disorders should be a routine part of evaluation during pregnancy.
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Affiliation(s)
- Paula Strengell
- Paula Strengell, Medical School, University of Tampere; Department of Psychiatry, Tampere University Hospital , Tampere , Finland
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Maternal nicotine exposure leads to impaired disulfide bond formation and augmented endoplasmic reticulum stress in the rat placenta. PLoS One 2015; 10:e0122295. [PMID: 25811377 PMCID: PMC4374683 DOI: 10.1371/journal.pone.0122295] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/17/2015] [Indexed: 12/16/2022] Open
Abstract
Maternal nicotine exposure has been associated with many adverse fetal and placental outcomes. Although underlying mechanisms remain elusive, recent studies have identified that augmented endoplasmic reticulum (ER) stress is linked to placental insufficiency. Moreover, ER function depends on proper disulfide bond formation—a partially oxygen-dependent process mediated by protein disulfide isomerase (PDI) and ER oxidoreductases. Given that nicotine compromised placental development in the rat, and placental insufficiency has been associated with poor disulfide bond formation and ER stress, we hypothesized that maternal nicotine exposure leads to both placental ER stress and impaired disulfide bond formation. To test this hypothesis, female Wistar rats received daily subcutaneous injections of either saline (vehicle) or nicotine bitartrate (1 mg/kg) for 14 days prior to mating and during pregnancy. Placentas were harvested on embryonic day 15 for analysis. Protein and mRNA expression of markers involved in ER stress (e.g., phosphorylated eIF2α, Grp78, Atf4, and CHOP), disulfide bond formation (e.g., PDI, QSOX1, VKORC1), hypoxia (Hif1α), and amino acid deprivation (GCN2) were quantified via Western blot and/or Real-time PCR. Maternal nicotine exposure led to increased expression of Grp78, phosphorylated eIF2α, Atf4, and CHOP (p<0.05) in the rat placenta, demonstrating the presence of augmented ER stress. Decreased expression of PDI and QSOX1 (p<0.05) reveal an impaired disulfide bond formation pathway, which may underlie nicotine-induced ER stress. Finally, elevated expression of Hif1α and GCN2 (p<0.05) indicate hypoxia and amino acid deprivation in nicotine-exposed placentas, respectively, which may also cause impaired disulfide bond formation and augmented ER stress. This study is the first to link maternal nicotine exposure with both placental ER stress and disulfide bond impairment in vivo, providing novel insight into the mechanisms underlying nicotine exposure during pregnancy on placental health.
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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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Flemming K, McCaughan D, Angus K, Graham H. Qualitative systematic review: barriers and facilitators to smoking cessation experienced by women in pregnancy and following childbirth. J Adv Nurs 2014; 71:1210-26. [PMID: 25430626 DOI: 10.1111/jan.12580] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
Abstract
AIM To explore barriers and facilitators to smoking cessation experienced by women during pregnancy and postpartum by undertaking a synthesis of qualitative studies. BACKGROUND The majority of pregnant women are aware that smoking in pregnancy compromises maternal and infant health. Despite this knowledge, quit rates among pregnant women remain low, particularly among women in disadvantaged circumstances; disadvantage also increases the chances of living with a partner who smokes and returning to smoking after birth. A deeper understanding of what hinders and what helps pregnant smokers to quit and remain ex-smokers postpartum is needed. DESIGN A synthesis of qualitative research using meta-ethnography. DATA SOURCES Five electronic databases (January 1990-May 2013) were searched comprehensively, updating and extending the search for an earlier review to identify qualitative research related to the review's aims. REVIEW METHODS Following appraisal, 38 studies reported in 42 papers were included and synthesized following the principles of meta-ethnography. Over 1100 pregnant women were represented, the majority drawn from disadvantaged groups. RESULTS Four factors were identified that acted both as barriers and facilitators to women's ability to quit smoking in pregnancy and postpartum: psychological well-being, relationships with significant others, changing connections with her baby through and after pregnancy; appraisal of the risk of smoking. CONCLUSION The synthesis indicates that barriers and facilitators are not fixed and mutually exclusive categories; instead, they are factors with a latent capacity to help or hinder smoking cessation. For disadvantaged smokers, these factors are more often experienced as barriers than facilitators to quitting.
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Affiliation(s)
- Kate Flemming
- Department of Health Sciences, University of York, UK
| | | | - Kathryn Angus
- Institute for Social Marketing, University of Stirling, UK
| | - Hilary Graham
- Department of Health Sciences, University of York, UK
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Dupré F, Perriot J, Defay I, Lavessière C, Defay F, Guillon C, Mathern G, Berland M. Dépression chez la femme enceinte fumeuse : impact sur la motivation à l’arrêt du tabac. ACTA ACUST UNITED AC 2014; 43:691-7. [PMID: 24135016 DOI: 10.1016/j.jgyn.2013.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/09/2013] [Accepted: 09/13/2013] [Indexed: 02/08/2023]
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Windsor R, Clark J, Cleary S, Davis A, Thorn S, Abroms L, Wedeles J. Effectiveness of the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) dissemination project: a science to prenatal care practice partnership. Matern Child Health J 2014; 18:180-190. [PMID: 23483412 DOI: 10.1007/s10995-013-1252-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study evaluated the effectiveness of the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program selected by the West Virginia-Right From The Start Project for state-wide dissemination. A process evaluation documented the fidelity of SCRIPT delivery by Designated Care Coordinators (DCC), licensed nurses and social workers who provide home-based case management to Medicaid-eligible clients in all 55 counties. We implemented a quasi-experimental, non-randomized, matched Comparison (C) Group design. The SCRIPT Experimental E Group (N = 259) were all clients in 2009-2010 that wanted to quit, provided a screening carbon monoxide (CO), and received a SCRIPT home visit. The (C) Group was derived from all clients in 2006-2007 who had the same CO assessments as E Group clients and reported receiving cessation counseling. We stratified the baseline CO of E Group clients into 10 strata, and randomly selected the same number of (C) Group clients (N = 259) from each matched strata to evaluate the effectiveness of the SCRIPT Program. There were no significant baseline differences in the E and (C) Group. A Process Evaluation documented a significant increase in the fidelity of DCC delivery of SCRIPT Program procedures: from 63 % in 2006 to 74 % in 2010. Significant increases were documented in the E Group cessation rate (+9.3 %) and significant reduction rate (+4.5 %), a ≥50 % reduction from a baseline CO. Perinatal health case management staff can deliver the SCRIPT Program, and Medicaid-supported clients can change smoking behavior, even very late in pregnancy. When multiple biases were analyzed, we concluded the SCRIPT Dissemination Project was the most plausible reason for the significant changes in behavior.
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Affiliation(s)
- Richard Windsor
- Department of Prevention and Community Health, The George Washington University School of Public Health and Health Services, 2175 K Street, Suite #701, Washington, DC, 20037, USA.
| | - Jeannie Clark
- West Virginia Department of Health and Human Resources, Department of Perinatal Services, Charleston, WV, USA
| | - Sean Cleary
- Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC, USA
| | - Amanda Davis
- Department of Prevention and Community Health, The George Washington University School of Public Health and Health Services, 2175 K Street, Suite #701, Washington, DC, 20037, USA
| | - Stephanie Thorn
- West Virginia Department of Health and Human Resources, Department of Perinatal Services, Charleston, WV, USA
| | - Lorien Abroms
- Department of Prevention and Community Health, The George Washington University School of Public Health and Health Services, 2175 K Street, Suite #701, Washington, DC, 20037, USA
| | - John Wedeles
- Department of Prevention and Community Health, The George Washington University School of Public Health and Health Services, 2175 K Street, Suite #701, Washington, DC, 20037, USA
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Goodman JH, Guarino A, Chenausky K, Klein L, Prager J, Petersen R, Forget A, Freeman M. CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Womens Ment Health 2014; 17:373-87. [PMID: 24449191 PMCID: PMC4107206 DOI: 10.1007/s00737-013-0402-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/26/2013] [Indexed: 01/06/2023]
Abstract
Many women experience anxiety during pregnancy with potential negative effects on maternal, birth, and child outcomes. Because of potential risks of fetal exposure to psychotropic medications, efficacious non-pharmacologic approaches are urgently needed. However, no published studies of psychotherapeutic treatments for anxiety in pregnancy exist. Mindfulness-based cognitive therapy (MBCT) may substantially reduce anxiety and co-morbid symptoms in people with anxiety disorders. Coping with Anxiety through Living Mindfully (CALM) Pregnancy is an adaptation of MBCT designed to address anxiety in pregnant women. This study examined the feasibility, acceptability, and clinical outcomes of the CALM Pregnancy intervention in pregnant women anxiety. Twenty-four pregnant women with generalized anxiety disorder (GAD) or prominent symptoms of generalized anxiety participated in an open treatment trial of the CALM Pregnancy group intervention. Psychiatric diagnoses were determined by structured clinical interview, and self-report measures of anxiety, worry, depression, self-compassion, and mindfulness were completed at baseline and post-intervention. Qualitative feedback was elicited via questionnaire. Twenty-three participants completed the intervention with high attendance and good compliance with home practice. Completers showed statistically and clinically significant improvements in anxiety, worry, and depression, and significant increases in self-compassion and mindfulness. Of the 17 participants who met GAD criteria at baseline, only one continued to meet criteria post-intervention. Participants regarded their experience in the intervention to be overwhelmingly positive. MBCT in the form of the CALM Pregnancy intervention holds potential to provide effective, non-pharmacological treatment for pregnant women with anxiety. These promising findings warrant further testing of the intervention with a randomized controlled trial.
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Affiliation(s)
- Janice H Goodman
- MGH Institute of Health Professions, School of Nursing, 36 1st Ave, Boston, MA, 02129, USA,
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Kawashima A, Koide K, Ventura W, Hori K, Takenaka S, Maruyama D, Matsuoka R, Ichizuka K, Sekizawa A. Effects of maternal smoking on the placental expression of genes related to angiogenesis and apoptosis during the first trimester. PLoS One 2014; 9:e106140. [PMID: 25165809 PMCID: PMC4148425 DOI: 10.1371/journal.pone.0106140] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Maternal cigarette smoking is reportedly associated with miscarriage, fetal growth restriction and placental abruption, and is paradoxically associated with a decreased risk of developing preeclampsia. In the present study, we investigated the gene expression levels of villous tissues in early gestation. We compared the expression levels of the genes related to angiogenesis and apoptosis in the villous tissues obtained from smoking and non-smoking pregnant women. MATERIALS AND METHODS We collected villous tissue samples from 57 women requesting surgical termination due to non-medical reasons at 6-8 weeks of gestation. The maternal cigarette smoking status was evaluated by the level of serum cotinine and patients were divided into active smokers and non-smokers by the serum cotinine level. The placental levels of VEGFA, PGF, FLT1, HIF1A, TP53, BAX and BCL2 mRNA were quantified by real time PCR. RESULTS The gene expression level of PGF and HIF1A in the active smoker group was significantly higher than that in the non-smoker group. We did not observe any significant differences in the VEGFA or FLT1 expression between the groups. In active smoker group, the gene expression levels of TP53 and BAX were significantly higher than those in the non-smoker group. The ratio of BAX/BCL2 mRNA in the active smoker group was significantly higher than that in the non-smoker group. CONCLUSIONS Our findings revealed that smoking might affect the placenta during early pregnancy. Maternal cigarette smoking in early pregnancy may be associated with villus hypoxia, which may influence angiogenesis and apoptosis.
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Affiliation(s)
- Akihiro Kawashima
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
- * E-mail:
| | - Keiko Koide
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Walter Ventura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Kyoko Hori
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Shin Takenaka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Daisuke Maruyama
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
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Dornelas E, Oncken C, Greene J, Sankey HZ, Kranzler HR. Major depression and PTSD in pregnant smokers enrolled in nicotine gum treatment trial. Am J Addict 2014; 22:54-9. [PMID: 23398227 DOI: 10.1111/j.1521-0391.2013.12029.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/14/2012] [Accepted: 07/27/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pregnant women face considerable barriers to smoking cessation. The purpose of this study was to determine the prevalence of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) and response to smoking cessation treatment in pregnant smokers participating in a randomized, placebo-controlled trial of nicotine gum. METHODS Participants were 194 low-income, ethnically diverse pregnant smokers. RESULTS Utilizing a structured interview, 45% and 18% of the subjects met criteria for a lifetime diagnosis of MDD and PTSD, respectively. There was no difference in response to treatment, based on the presence of either of these psychiatric disorders. CONCLUSIONS Cumulatively, these findings provide evidence of the high degree of unmet mental health needs in pregnant smokers. SCIENTIFIC SIGNIFICANCE Pregnant women with a history of MDD and PTSD appear to be as likely to benefit from smoking cessation treatment as those without such a history.
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Affiliation(s)
- Ellen Dornelas
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
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A comparison of maternal and neonatal outcomes of pregnancy with mental disorders: results of an analysis using propensity score-based weighting. Arch Gynecol Obstet 2014; 290:883-9. [DOI: 10.1007/s00404-014-3304-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
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Irner TB, Teasdale TW, Nielsen T, Vedal S, Olofsson M. Cognitive, emotional and social development in adolescents born to substance using women. Scand J Psychol 2014; 55:319-25. [PMID: 24828950 DOI: 10.1111/sjop.12134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 03/11/2014] [Indexed: 11/27/2022]
Abstract
The aim of this article is to investigate the long-term developmental consequences of being born to a substance-using mother, focusing on cognitive functions, attention, emotional and social development. The longitudinal sample comprised 48 adolescents aged 12-16 at the time of follow-up assessments, which included the Wechsler Intelligence Scale for Children-III, the Test of Everyday Attention for Children, The Tower of London test and the Strengths and Difficulties Questionnaire. The adolescents scored significantly lower than the norms on Wechsler's subtests and Full-Scale IQ, and on The Everyday Attention test. There were few differences on the Strengths and Difficulties Questionnaire. The girls reported significantly more hyperactivity than the British norms, and the teachers reported higher impact scores in boys, compared to the British norms. Thus, the results on cognitive consequences of maternal substance use appear to be very substantial while the emotional and social consequences do not. The results suggest serious negative effects of substance exposure in utero on attention and cognitive functioning in general.
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Affiliation(s)
- Tina Birk Irner
- Department of Psychology, Copenhagen University Hospital, Copenhagen, Denmark
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Forray A, Gotman N, Kershaw T, Yonkers KA. Perinatal smoking and depression in women with concurrent substance use. Addict Behav 2014; 39:749-56. [PMID: 24447885 DOI: 10.1016/j.addbeh.2013.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 11/21/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this report was to examine the course of smoking among pregnant women with concurrent substance use, and to assess the impact of depression on smoking. METHODS Data were gathered as part of a randomized controlled trial assessing the efficacy of substance abuse treatment in pregnant women. Women (n=176) were recruited before 28 completed weeks of pregnancy, and followed until 3months postpartum. Depression was assessed using the Inventory of Depressive Symptomatology and the MINI Neuropsychiatric Interview. Our outcome was the average number of cigarettes smoked per day. Linear mixed effects regression was used to measure differential changes in smoking. RESULTS 66% of women smoked in the three months before pregnancy, 42% of pre-pregnancy smokers achieved abstinence before delivery and 60% of the baseline cohort smoked postpartum. Smoking did not differ significantly between depressed and non-depressed groups. After delivery both groups increased smoking at similar rates. CONCLUSION Smoking was common among our cohort of pregnant women with a history of substance use. Women were able to discontinue or decrease smoking during pregnancy, but were likely to resume or increase smoking postpartum. Having clinically significant depressive symptoms or a diagnosis of depression did not have an obvious effect on smoking behaviors.
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Bourke CH, Stowe ZN, Owens MJ. Prenatal antidepressant exposure: clinical and preclinical findings. Pharmacol Rev 2014; 66:435-65. [PMID: 24567054 DOI: 10.1124/pr.111.005207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Pharmacological treatment of any maternal illness during pregnancy warrants consideration of the consequences of the illness and/or medication for both the mother and unborn child. In the case of major depressive disorder, which affects up to 10-20% of pregnant women, the deleterious effects of untreated depression on the offspring can be profound and long lasting. Progress has been made in our understanding of the mechanism(s) of action of antidepressants, fetal exposure to these medications, and serotonin's role in development. New technologies and careful study designs have enabled the accurate sampling of maternal serum, breast milk, umbilical cord serum, and infant serum psychotropic medication concentrations to characterize the magnitude of placental transfer and exposure through human breast milk. Despite this progress, the extant clinical literature is largely composed of case series, population-based patient registry data that are reliant on nonobjective means and retrospective recall to determine both medication and maternal depression exposure, and limited inclusion of suitable control groups for maternal depression. Conclusions drawn from such studies often fail to incorporate embryology/neurotransmitter ontogeny, appropriate gestational windows, or a critical discussion of statistically versus clinically significant. Similarly, preclinical studies have predominantly relied on dosing models, leading to exposures that may not be clinically relevant. The elucidation of a defined teratological effect or mechanism, if any, has yet to be conclusively demonstrated. The extant literature indicates that, in many cases, the benefits of antidepressant use during pregnancy for a depressed pregnant woman may outweigh potential risks.
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Sieminska A, Jassem E. The many faces of tobacco use among women. Med Sci Monit 2014; 20:153-62. [PMID: 24487778 PMCID: PMC3915001 DOI: 10.12659/msm.889796] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/21/2013] [Indexed: 12/14/2022] Open
Abstract
Smoking is still considered to be mainly a male problem. However, it is estimated that there are approximately 250 million women worldwide who smoke cigarettes and millions more women who use smokeless tobacco products. This article addresses the many facets of tobacco use among women. The aim of the paper is to increase recognition among clinicians and researchers of the specific characteristics of female tobacco use. Together with providing epidemiological data on the distribution of tobacco use among women and data from population-based analyses on sociocultural factors that influence it, the article presents tobacco use during pregnancy as a particularly important public health problem. Further, the article points out sex-related differences (ie, physiological, psychological, or behavioral) between male and female tobacco use. A special focus is on the important role of ovarian hormones. Adverse effects of tobacco use to women and their children as well as tobacco-related morbidities and comorbidities are presented, and women's greater susceptibility to tobacco constituents as compared to men is stressed. Awareness of these differences can contribute to improvement of the effectiveness of smoking cessation programs addressed both to the specific female population and to an individual smoking woman.
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Blalock JA, Minnix JA, Mathew AR, Wetter DW, McCullough JP, Cinciripini PM. Relationship of childhood trauma to depression and smoking outcomes in pregnant smokers. J Consult Clin Psychol 2013; 81:821-30. [PMID: 23750463 PMCID: PMC3905676 DOI: 10.1037/a0033381] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We evaluated whether childhood trauma moderated the treatment effect on depression and smoking outcomes in pregnant smokers. METHOD The sample included pregnant smokers participating in a randomized trial evaluating the efficacy of a 10-session interpersonally focused therapy-cognitive behavioral analysis system of psychotherapy (CBASP)-versus a time-matched health and wellness control (HW) for smoking cessation and depression reduction. Women (N = 248) who completed the Childhood Trauma Questionnaire (CTQ) were included. On average, women were 25 years old (SD = 5.91) and smoked 10 (SD = 6.9) cigarettes per day. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale (CES-D), and women had an average score of 21 (SD = 11.03). Seventy-six percent of women had experienced some form of moderate to severe childhood trauma as assessed by the CTQ. RESULTS In women with a history of moderate to severe childhood trauma, there was a dose-response association of treatment on depression outcome through 6 months postpartum; those with increasing amounts of childhood trauma benefitted more from CBASP, whereas those in the HW condition did not. Childhood trauma did not moderate the treatment effect on abstinence, although increasing amounts of trauma were associated with reduced likelihood of abstinence at 6 months posttreatment. CONCLUSIONS An interpersonally focused therapy may be beneficial for the treatment of depression during the prenatal period in pregnant smokers with childhood trauma histories, and such treatment becomes increasingly more important with cumulative trauma experience. Childhood trauma increases risk for cessation failure in pregnant smokers. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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Affiliation(s)
- Janice A Blalock
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center
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Piñeiro B, Fernández del Río E, López-Durán A, Martínez Ú, Becoña E. The association between probable personality disorders and smoking cessation and maintenance. Addict Behav 2013; 38:2369-73. [PMID: 23628430 DOI: 10.1016/j.addbeh.2013.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/18/2013] [Accepted: 03/27/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although it has been suggested that persons with psychopathological disorders experience greater difficulty in quitting smoking, the few studies that have analyzed personality disorders in smokers have failed to produce conclusive results. The aim of this study was to examine whether the presence of probable personality disorders was associated with the achievement of abstinence at the end of a smoking cessation treatment, as well as the maintenance of abstinence at 6 and 12 months of follow-up. METHODS The sample comprised 290 smokers (41% men and 59% women) who participated in a psychological smoking cessation treatment and who were followed for a year. Abstinence was tested by measuring carbon monoxide in exhaled air. RESULTS Participants with a probable borderline, antisocial or avoidant personality disorder were less likely to quit smoking at the end of the treatment, whereas probable schizoid personality disorder predicted better maintenance of abstinence at 6 and 12 months. In addition, smoking 25 or more cigarettes before starting the treatment decreased the likelihood of maintaining abstinence at 6 and 12 months of follow-up. CONCLUSIONS This study revealed differential (and opposing) relationships between specific personality disorders and smoking cessation outcomes, illustrating the need to consider Axis II disorders separately when predicting treatment outcomes.
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Becoña E, Fernández del Río E, López-Durán A, Piñeiro B, Martínez Ú. Axis II disorders and cigarette smoking among adults from the general population. J Pers Disord 2013; 27:411-24. [PMID: 22928853 DOI: 10.1521/pedi_2012_26_051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study examined whether personality disorders (PDs) are associated with cigarette smoking, and the possible influence of nicotine dependence, sociodemographic variables, and the presence of any lifetime Axis I mental disorder in these relationships. The sample was made up of 1,081 adult participants from the Spanish general population and was stratified by smoking status (519 smokers and 562 nonsmokers). PDs were assessed by means of the International Personality Disorder Examination Questionnaire, Module DSM-IV. Results indicated that participants with a paranoid, a narcissistic, a borderline, an antisocial, or an obsessive-compulsive PD had a higher probability for being smokers and for being nicotine-dependent. The only exception was the schizoid PD, because participants with this Axis II disorder had a lower probability for being nicotine-dependent smokers. The association between PDs and smoking was maintained even after adjusting for all covariates. Findings are discussed in relation to the influence of Axis II disorders on smoking cessation interventions.
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Affiliation(s)
- Elisardo Becoña
- Smoking Cessation Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain.
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Exploring the adequacy of smoking cessation support for pregnant and postpartum women. BMC Public Health 2013; 13:472. [PMID: 23672201 PMCID: PMC3658958 DOI: 10.1186/1471-2458-13-472] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/10/2013] [Indexed: 11/23/2022] Open
Abstract
Background Smoking in pregnancy exemplifies the relationship between tobacco use and health inequalities. While difficulty reaching and engaging this population in cessation support is often highlighted in the literature, there is limited research that explores the factors that shape the provision and use of support by this subpopulation. Using Ontario, Canada, as a case study, this study examines how the use of cessation support by women is encouraged or discouraged by cessation policy, programming and practice; how geographical and sociocultural factors influence provision and uptake of support; and how barriers and challenges can be addressed through a comprehensive approach. Methods Semi-structured, in-depth interviews with key informants (31) and pregnant or postpartum women (29) were conducted to examine the cessation needs of this subpopulation, barriers to the provision and uptake of cessation support and directions for policy, service provision and programming. Results Key barriers included: the absence of a provincial cessation strategy and funding, capacity and engagement/accessibility issues. Geographical features presented additional challenges to provision/uptake, as did the absence of resources tailored to Aboriginal women and adolescents. Key informants recommended a comprehensive cessation strategy to facilitate coordination of cessation resources provincially and locally and elucidated the need for capacity building within tobacco control and within reproductive, child and maternal health. Participants also highlighted the need to further develop tobacco control policies and target the social determinants of health through poverty reduction, housing and education support. The provision of incentives, transportation, childcare and meals/snacks; adoption of woman-centred, harm-reduction and stigma reduction approaches; and promotion of programs through a variety of local venues were recommended by participants to address engagement and accessibility issues. Conclusions The current cessation system in Ontario is not equipped to adequately reduce smoking among pregnant and postpartum women. A comprehensive, multi-sector strategy designed to provide tailored and sustainable support through different system entry points is needed. A cultural shift in practice is also necessary to eliminate mixed messaging, strengthen practice and encourage open channels of communication about smoking between women and their providers. The study highlights the need to address smoking among women in a more holistic manner and for capacity building strategies that focus on strengthening providers’ competency and confidence in practice. Future research should explore: capacity building strategies, especially among rural and remote communities; the smoking and cessation experiences of different subpopulations of pregnant and postpartum women; the effectiveness of tailored strategies; and interventions that address smoking among partners and other family members.
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Ostergaard SD, Waltoft BL, Mortensen PB, Mors O. Environmental and familial risk factors for psychotic and non-psychotic severe depression. J Affect Disord 2013; 147:232-40. [PMID: 23228568 DOI: 10.1016/j.jad.2012.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/05/2012] [Accepted: 11/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Severe unipolar depression can be classified as either psychotic depression (PD) or non-psychotic depression (non-PD). A number of biological and clinical differences have been detected between PD and non-PD, but it remains unknown whether risk factors for the two subtypes also differ. The aim of the present study was therefore to investigate whether a number of potential risk factors influenced the risk of developing PD and non-PD to different extents. METHODS This is a register-based historical prospective cohort study following all 2.4 million individuals born in Denmark between 1955 and 1990. During follow-up 2183 and 9101 individuals were registered in the Danish Psychiatric Central Research Register with PD and non-PD respectively. The association between risk factors and the development of PD and non-PD was estimated by survival analysis (Poisson regression) and expressed as incidence rate ratios (IRR). RESULTS The most consistent finding of the study was that of a general overlap in familial and environmental risk factors for PD and non-PD. However, a parental history of bipolar disorder was a risk factor for PD (mother, IRR=1.66, p=0.003. Father, IRR=1.56, p=0.040) and not for non-PD (mother, IRR=0.92, p=0.430. Father, IRR=1.08, p=0.552). Conversely, a positive family history of schizophrenia was associated with neither PD nor non-PD LIMITATIONS: Diagnoses were assigned as part of routine clinical practice. CONCLUSION Our findings justify the distinction between PD and non-PD in the current diagnostic manuals. Furthermore, the fact that parental bipolar disorder and not schizophrenia was a risk factor for PD supports the Kraepelinian dichotomy.
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Affiliation(s)
- Søren Dinesen Ostergaard
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark.
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