1
|
Kobus M, Sitek A, Antoszewski B, Rożniecki JJ, Pełka J, Żądzińska E. The impact of exposure to tobacco smoking and maternal trauma in fetal life on risk of migraine. Front Neurosci 2023; 17:1191091. [PMID: 37456999 PMCID: PMC10338879 DOI: 10.3389/fnins.2023.1191091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/29/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Prenatal period is the key time in human development. Many prenatal factors are well-known and increase the risk of developing diseases' after birth. Few studies indicated the link between the prenatal period and the prevalence of migraine in childhood and adolescence so far. We decided to broaden current knowledge and investigate whether the prenatal factors influence the prevalence of migraine in adulthood. The objective of this study is to provide evidence of relationship between in utero environment and risk of migraine. Methods In total 266 females (136 in the migraine group, 130 in the control group) and 80 males (35 in the migraine group, 45 in the control group), aged 18-65 participated in the study. The quality of prenatal environment was characterized on the basis of mother's and father's education, tobacco smoke exposure, alcohol consumption, and traumatic event during pregnancy, which are considered as prenatal factors and affect on fetal development. Results Migraine occurrence in adulthood was significantly associated with maternal tobacco smoking during pregnancy (OR 3.42, 95% CI 1.54-7.61, p = 0.036) and traumatic event during pregnancy (OR 2.27, 95% CI 1.24-4.13, p = 0.020). Discussion Our study suggests that the fetal programming effect of tobacco smoking exposure and maternal trauma is not limited to prenatal life and is suggested as having a role in adulthood. Our findings support evidence that migraine adulthood can be partly influenced by early life conditions.
Collapse
Affiliation(s)
- Magdalena Kobus
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Aneta Sitek
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Esthetic Surgery, Institute of Surgery, Medical University of Lodz, Łódź, Poland
| | - Jacek J. Rożniecki
- Department of Neurology, Stroke and Neurorehabilitation, Medical University of Lodz, Lodz, Poland
| | - Jacek Pełka
- Department of Neurology, Norbert Barlicki Memory University Teaching Hospital, Lodz, Poland
| | - Elżbieta Żądzińska
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
- Biological Anthropology and Comparative Anatomy Research Unit, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
2
|
Harriett LE, Eary RL, Prickett SA, Romero J, Maddrell RG, Keenan-Devlin LS, Borders AEB. Adaptation of Screening Tools for Social Determinants of Health in Pregnancy: A Pilot Project. Matern Child Health J 2023:10.1007/s10995-023-03732-2. [PMID: 37316688 DOI: 10.1007/s10995-023-03732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Social determinants of health (SDOH) and stress during pregnancy may contribute to adverse pregnancy outcomes. The objective of this in the field pilot project was to develop a comprehensive screening tool by combining existing validated screeners. Additionally, implement use of this tool within routine prenatal visits and assess feasibility. METHODS Pregnant patients accessing prenatal care at a single site of an urban Federally Qualified Health Center were recruited during prenatal visits to complete a Social Determinants of Health in Pregnancy Tool (SIPT). SIPT combines a series of questions from existing and well-validated tools and consists of five domains: (1) perceived stress, (2) relationship and family stress, (3) domestic violence, (4) substance abuse, and (5) financial stress. RESULTS Between April 2018 and March 2019, 135 pregnant participants completed SIPT. Ninety-one percent of patients scored positive on at least one screener, 54% to three or more screeners. CONCLUSIONS Despite guidelines to screen for SDOH during pregnancy there is no universal tool. Our pilot project demonstrated the concurrent use of adapted screening tools where participants reported at least one area of potential stress, and that linking to resources at the time of a visit is plausible. Future work should examine if screening and point of care linkages of services improves maternal child outcomes.
Collapse
Affiliation(s)
- Lauren E Harriett
- PCC Community Wellness Center, 115 North Parkside Avenue, Chicago, IL, 60644, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., K Building, 2nd Floor, Suite 400F, Dallas, TX, 75390, USA.
| | - Sarah A Prickett
- Department of Family and Community Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., K Building, 2nd Floor, Suite 400F, Dallas, TX, 75390, USA
| | - Janedelie Romero
- Department of Obstetrics and Gynecology, NorthShore University Health System, Chicago, IL, USA
| | - Rebecca G Maddrell
- A.L. Burdick Family Medicine Center, 3 Erie Court Suite 6160, Oak Park, IL, 60302, USA
| | - Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University Health System and Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University Health System and Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|
3
|
Identification of the Obstetric Factors Increasing Tendency to Smoking Cessation During Pregnancy. J Addict Nurs 2023; 34:E28-E38. [PMID: 34519688 DOI: 10.1097/jan.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cigarette, one of the various forms of tobacco, is the most commonly used tobacco product in Turkey and in the world. Cigarette has several negative effects on general health and is a major problem in the pregnancy period. This study aims to identify pregnancy-related factors that affect the tendency to smoking cessation and their effect levels in pregnant women who continue to smoke during pregnancy. METHOD The sample of this descriptive and cross-sectional study was 430 pregnant women who smoked. Data were collected through an original interview form and face-to-face interviews. Data analysis was performed using chi-square, independent t test, and multiple logistic regression model in terms of demographic, obstetric, maternal, and fetal features. RESULTS The average number of cigarettes smoked before pregnancy was 13.28 ± 8.62, whereas the average number of cigarettes smoked during pregnancy was 6.60 ± 7.64. The tendency to decrease smoking increases 2.8 times ( OR = 2.825, 95% CI [1.631, 4.895]) with the number of pregnancies and approximately 2 times in case of a planned pregnancy ( OR = 1.946, 95% CI [1.076, 3.520]). The frequency of having prenatal visits showed a weak but significant relationship with the number of abortuses and the number of living children. CONCLUSIONS Developing a risk map in line with the findings of the study and considering the obstetric features of smoking women could enable to hypothesize about the types of behaviors in smoking in the following processes of pregnancy. With the precautions to be taken, the negative effects of smoking on maternal and fetal health could be prevented or minimized.
Collapse
|
4
|
Petersen AB, Ogunrinu T, Wallace S, Yun J, Belliard JC, Singh PN. Implementation and Outcomes of a Maternal Smoking Cessation Program for a Multi-ethnic Cohort in California, USA, 2012-2019. J Community Health 2022; 47:257-265. [PMID: 34739686 PMCID: PMC8569845 DOI: 10.1007/s10900-021-01042-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
Smoking during pregnancy remains one of the most significant risk factors for poor birth outcomes. During 2012-2019, the Loma Linda University Health Comprehensive Tobacco Treatment Program (CTTP) used a multicomponent behavioral intervention for tobacco cessation for 1402 pregnant smokers with components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). The CTTP cohort includes a multi-ethnic sample of pregnant women with a mean age of 27 years referred by collaborating community-based healthcare providers in San Bernardino county. Evaluation of program outcomes from 7 years of follow-up (2012-2019) creates a rich cohort dataset for implementation science research to examine the real-world effectiveness of the program. In this report, we provide a cohort profile, and 8-week prolonged abstinence (8-week PA) and relapse findings from the first year of follow-up (n = 233). We found: (1) 28.4% achieved 8-week PA, (2) At a median of 6.2 months of follow-up after achieving 8-week PA, 23.2% of enrolled subjects reported tobacco cessation, and (3) a high rate of loss to follow-up (44%). In addition, our modeling indicated that the odds of relapse/smoking after enrollment was significantly higher in young mothers, non-Hispanic mothers (White, Black/African-American), mothers in the first and third trimester, and rural mothers. Formative quantitative and qualitative research on the CTTP cohort will consider the effects of a range of implementation science (number of intervention sessions, addition of a mHealth component, distance to care) and individual (partner/household smoking, birth outcomes, NICU) outcome measures for the purpose of scaling up the CTTP model.
Collapse
Affiliation(s)
- Anne Berit Petersen
- Loma Linda University School of Nursing, 11262 Campus Street, Loma Linda, CA, 92350, USA.
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA, 92354, USA.
| | - Temidayo Ogunrinu
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Shane Wallace
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Jane Yun
- Loma Linda University Health SACHS Clinic, 250 S G St, San Bernardino, CA, 92410, USA
| | - Juan Carlos Belliard
- Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
- Institute for Community Partnerships, Loma Linda University, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Pramil N Singh
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
- Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA, 92354, USA
| |
Collapse
|
5
|
Christopher D, Markese A, Tonick S, Carpenter L, Harrison MS. Evaluating adherence to American College of Obstetricians and Gynecologists guidelines at the first obstetric visit. WOMEN'S HEALTH 2022; 18:17455057221122590. [PMID: 36173253 PMCID: PMC9527982 DOI: 10.1177/17455057221122590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This is a prospective observational cohort study with the objective of assessing adherence to the American College of Obstetricians and Gynecologists guidelines regarding the first prenatal visit and determining what patient and provider factors are associated with high adherence in a faculty obstetric clinic at an academic medical center. Methods: The American College of Obstetricians and Gynecologists guidelines recommend addressing 72 topics early in prenatal care. A research assistant observed the first prenatal encounter and noted which topics were discussed during the visit. Patient and clinic characteristics were also collected. The primary outcome was the percentage of topics covered at each visit. After analyzing all encounters, patient encounters that scored above the median score were compared with encounters scoring below the median using bivariate comparisons with respect to patient and clinic characteristics. A multivariable Poisson regression model with robust error variance was performed on characteristics with a p value of ⩽0.2. Results: Fifty-one patient encounters met inclusion criteria and the median score for topics covered was 74%. Patients with chronic disease were more likely to have a higher percentage of topics covered (odds ratio 1.67, 95% confidence interval: 0.91–3.09). Patients who completed a prenatal questionnaire were also more likely to have a higher percentage (odds ratio 2.28, 95% confidence interval: 1.00–5.15) as well as patients who had nurse-led education integrated into their visit during (odds ratio 1.82, 95% confidence interval: 1.19–2.78). Patient satisfaction had no correlation with the number of topics covered. Conclusion: The number of topics to cover at the first prenatal visit has expanded creating challenges for patients and providers. Integration of prenatal questionnaires and nurse-led education has the potential to address gaps in antenatal care.
Collapse
Affiliation(s)
- Diane Christopher
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amy Markese
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shawna Tonick
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Carpenter
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Margo S Harrison
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
6
|
Ashford K, McCubbin A, Barnett J, Blair LM, Lei F, Bush H, Breland A. Longitudinal Examination of Prenatal Tobacco Switching Behaviors and Birth Outcomes, Including Electronic Nicotine Delivery System (ENDS) and Dual Use. Matern Child Health J 2021; 25:1175-1181. [PMID: 33973130 PMCID: PMC8314381 DOI: 10.1007/s10995-021-03161-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In the US, approximately 8% of pregnant women smoke, and 5-11.9% currently use ENDS products. The health effects of ENDS use are debated; however, most contain nicotine which is known to cause adverse perinatal outcomes. Studies have shown adult ENDS users significantly alter use behaviors over time (switch to conventional cigarettes-only or dual use) thus complicating efforts to examine health effects of ENDS use. The purpose of this study was to describe switching behaviors and associated birth outcomes among infants of women using conventional cigarettes only, ENDS-only, or both. METHODS This was a multisite, longitudinal study of biologically confirmed perinatal tobacco users, with nicotine product use assessed each trimester. For the purpose of analysis, participants were defined as switchers, no-switchers, or quitters. Birth outcomes were abstracted from electronic medical records. Analysis included descriptive statistics, linear and multivariate logistic regression adjusted for age, preterm birth, smoking behavior in the first trimester, and an interaction between smoking switching behavior and smoking behavior in the first trimester. Analysis was conducted using SAS v9.4 with significance determined as p < 0.05. RESULTS At enrollment, 48.6% of participants used only conventional cigarettes, 41.7% were dual users, and 10% used ENDS-only. While almost two-thirds of participants used the same tobacco product throughout pregnancy, 26% reported switching behaviors that were complex and not easily clustered. No differences were found in birth outcomes between switchers and no-switchers; however, a difference emerged in birth weight between no-switchers and quitters. DISCUSSION Given the limited data on health effects of ENDS use, and the known harmful consequences of perinatal nicotine use, capturing and classifying product switching behaviors is imperative to inform public health, and remains a challenge requiring further research.
Collapse
Affiliation(s)
- Kristin Ashford
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA
| | - Andrea McCubbin
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA.
| | - Janine Barnett
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA
| | - Lisa M Blair
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA
| | - Feitong Lei
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Heather Bush
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Alison Breland
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
7
|
Perak AM, Lancki N, Kuang A, Labarthe DR, Allen NB, Shah SH, Lowe LP, Grobman WA, Lawrence JM, Lloyd-Jones DM, Lowe WL, Scholtens DM. Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence. JAMA 2021; 325:658-668. [PMID: 33591345 PMCID: PMC7887661 DOI: 10.1001/jama.2021.0247] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Pregnancy may be a key window to optimize cardiovascular health (CVH) for the mother and influence lifelong CVH for her child. OBJECTIVE To examine associations between maternal gestational CVH and offspring CVH. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study (examinations: July 2000-April 2006) and HAPO Follow-Up Study (examinations: February 2013-December 2016). The analyses included 2302 mother-child dyads, comprising 48% of HAPO Follow-Up Study participants, in an ancillary CVH study. Participants were from 9 field centers across the United States, Barbados, United Kingdom, China, Thailand, and Canada. EXPOSURES Maternal gestational CVH at a target of 28 weeks' gestation, based on 5 metrics: body mass index, blood pressure, total cholesterol level, glucose level, and smoking. Each metric was categorized as ideal, intermediate, or poor using pregnancy guidelines. Total CVH was categorized as follows: all ideal metrics, 1 or more intermediate (but 0 poor) metrics, 1 poor metric, or 2 or more poor metrics. MAIN OUTCOMES AND MEASURES Offspring CVH at ages 10 to 14 years, based on 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Total CVH was categorized as for mothers. RESULTS Among 2302 dyads, the mean (SD) ages were 29.6 (2.7) years for pregnant mothers and 11.3 (1.1) years for children. During pregnancy, the mean (SD) maternal CVH score was 8.6 (1.4) out of 10. Among pregnant mothers, the prevalence of all ideal metrics was 32.8% (95% CI, 30.6%-35.1%), 31.7% (95% CI, 29.4%-34.0%) for 1 or more intermediate metrics, 29.5% (95% CI, 27.2%-31.7%) for 1 poor metric, and 6.0% (95% CI, 3.8%-8.3%) for 2 or more poor metrics. Among children of mothers with all ideal metrics, the prevalence of all ideal metrics was 42.2% (95% CI, 38.4%-46.2%), 36.7% (95% CI, 32.9%-40.7%) for 1 or more intermediate metrics, 18.4% (95% CI, 14.6%-22.4%) for 1 poor metric, and 2.6% (95% CI, 0%-6.6%) for 2 or more poor metrics. Among children of mothers with 2 or more poor metrics, the prevalence of all ideal metrics was 30.7% (95% CI, 22.0%-40.4%), 28.3% (95% CI, 19.7%-38.1%) for 1 or more intermediate metrics, 30.7% (95% CI, 22.0%-40.4%) for 1 poor metric, and 10.2% (95% CI, 1.6%-20.0%) for 2 or more poor metrics. The adjusted relative risks associated with 1 or more intermediate, 1 poor, and 2 or more poor (vs all ideal) metrics, respectively, in mothers during pregnancy were 1.17 (95% CI, 0.96-1.42), 1.66 (95% CI, 1.39-1.99), and 2.02 (95% CI, 1.55-2.64) for offspring to have 1 poor (vs all ideal) metrics, and the relative risks were 2.15 (95% CI, 1.23-3.75), 3.32 (95% CI,1.96-5.62), and 7.82 (95% CI, 4.12-14.85) for offspring to have 2 or more poor (vs all ideal) metrics. Additional adjustment for categorical birth factors (eg, preeclampsia) did not fully explain these significant associations (eg, relative risk for association between 2 or more poor metrics among mothers during pregnancy and 2 or more poor metrics among offspring after adjustment for an extended set of birth factors, 6.23 [95% CI, 3.03-12.82]). CONCLUSIONS AND RELEVANCE In this multinational cohort, better maternal CVH at 28 weeks' gestation was significantly associated with better offspring CVH at ages 10 to 14 years.
Collapse
Affiliation(s)
- Amanda M. Perak
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nicola Lancki
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alan Kuang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Norrina B. Allen
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Svati H. Shah
- Duke University Medical Center, Durham, North Carolina
| | - Lynn P. Lowe
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jean M. Lawrence
- Kaiser Permanente of Southern California, Pasadena
- currently with Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | - William L. Lowe
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | |
Collapse
|
8
|
Kurti AN. Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control. Exp Clin Psychopharmacol 2020; 28:501-516. [PMID: 31855002 PMCID: PMC8168442 DOI: 10.1037/pha0000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tobacco use has unique, adverse health consequences for reproductive-aged women, particularly should these women become pregnant. Thus, successful efforts to reduce tobacco use among this population have strong potential to improve public health and reduce health disparities. The present review examines contributions to reducing tobacco use among women of childbearing age spanning the domains of tobacco regulatory science and tobacco control from the passage of the Family Smoking Prevention and Tobacco Control Act in 2009 through September 2019. In the domain of tobacco regulatory science, such efforts include research conducted by various National Institutes of Health/Food and Drug Administration (FDA)-supported Tobacco Centers of Regulatory Science, epidemiological surveillance studies, as well as studies examining the potential impact of tobacco regulatory policies currently under consideration by the FDA (e.g., reduced nicotine content cigarettes, health warning labels). Tobacco control efforts within this same 10-year timeframe include developments in pharmacological and psychosocial approaches to promoting tobacco cessation, mHealth interventions, and tobacco control policy. Emerging issues pertinent to ongoing efforts to reduce tobacco use within the domains of both tobacco regulatory science and tobacco control are also reviewed, including e-cigarettes, comorbid health conditions, course of tobacco and other drugs of abuse, and obstacles to the dissemination and implementation of evidence-based treatment and policy. Although the past decade has seen numerous important contributions to reducing tobacco use among reproductive-aged women within both domains, existing obstacles must be surmounted to continue reducing tobacco use and protecting health among this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
9
|
Li M, Okamoto R, Tada A, Kiya M. Factors Associated with Prenatal Smoking Cessation Interventions among Public Health Nurses in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6135. [PMID: 32846936 PMCID: PMC7503931 DOI: 10.3390/ijerph17176135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 11/27/2022]
Abstract
This study aimed to identify the factors associated with prenatal smoking cessation interventions based on the 5As model among public health nurses (PHNs) in Japan. A nationwide cross-sectional study was conducted from December 2019 to February 2020 via a self-administered questionnaire. The study subjects were 1988 PHNs working in 431 health centers of municipalities and special wards across the country. Of the 1988 questionnaires mailed, 521 responses (26.2%) were included in the analysis. Of the 521 responses, most of the respondents were female (98.1%) and the mean age was 37.5 years. There were statistically significant differences on age, work regions, experience years working as a PHN and smoking cessation training after becoming a PHN in implementing the 5As. Self-efficacy, professional development competency, research utilization competency, age and experience years working as a PHN were positively associated with the 5As. Social nicotine dependence was negatively associated with the 5As. Furthermore, self-efficacy mediated the relationship between the 5As and professional development competency, research utilization competency, social nicotine dependence, age and experience years working as a PHN. In the future, smoking cessation intervention training should be widely implemented to improve self-efficacy and prenatal smoking cessation interventions among Japanese PHNs.
Collapse
Affiliation(s)
| | - Reiko Okamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka Prefecture, Japan; (M.L.); (A.T.); (M.K.)
| | | | | |
Collapse
|
10
|
Abstract
Alcohol, tobacco, and cannabis are the substances most frequently used during pregnancy, and opioid-exposed pregnancies have increased fourfold. The purpose of this review is to describe the prevalence and consequences of prenatal exposure to alcohol, tobacco, cannabis, and opioids. Currently available screening questionnaires for prenatal substance use are summarized and contrasted with the measures available for prenatal alcohol use. Because screening for prenatal alcohol and substance use is but the prelude to efforts to mitigate the potential adverse consequences, attempts for the modification of these consequences are briefly reviewed. In addition, areas of future research related to the criminalization of prenatal substance use, which may inhibit both inquiry and disclosure, are discussed. Indeed, the full potential of effective interventions has yet to be realized.
Collapse
Affiliation(s)
- Grace Chang
- U.S. Department of Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts
| |
Collapse
|
11
|
Ko JY, Tong VT, Haight SC, Terplan M, Stark L, Snead C, Schulkin J. Obstetrician-gynecologists' practices and attitudes on substance use screening during pregnancy. J Perinatol 2020; 40:422-432. [PMID: 31666646 PMCID: PMC7047638 DOI: 10.1038/s41372-019-0542-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/29/2019] [Accepted: 10/20/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe obstetrician-gynecologists' practices and attitudes related to substance use screening in pregnant patients. STUDY DESIGN A 2017 cross-sectional survey assessed US obstetrician-gynecologists' (n = 462; response rate = 34%) practices (substance use screening frequency and methods) and attitudes (practice priority of screening, confidence in treating, and responsibility statements). Chi-squared tests and adjusted modified Poisson regression were used to estimate associations between practices and attitudes. RESULTS Of 353 respondents with screening information, 79% frequently screen for substance use and 11% used a validated instrument. Confidence was the highest for treating pregnant patients using tobacco (81%). Respondents whose practices make it a high priority to screen for all substances were 1.2 times as likely to frequently screen as their counterparts (95% CI: 1.1-1.3). CONCLUSIONS Four out of five obstetricians-gynecologists reported a high frequency of substance use screening in pregnant patients. Findings highlight the importance of increasing priority of substance use screening by obstetrician-gynecologists.
Collapse
Affiliation(s)
- Jean Y Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-S107-2, Atlanta, GA, 30341, USA.
- United States Public Health Service, Commissioned Corps, Rockville, MD, 20857, USA.
| | - Van T Tong
- Division of Congenital and Developmental Disorders, National Center for Birth Defects and Developmental Disorders, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-S106-3, Atlanta, GA, 30341, USA
| | - Sarah C Haight
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-S107-2, Atlanta, GA, 30341, USA
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Ave Suite 103, Baltimore, MD, 21201, USA
| | - Lauren Stark
- Research Department, American College of Obstetricians and Gynecologists (ACOG), 409 12th Street SW, Washington, DC, 20024, USA
| | - Carrie Snead
- Research Department, American College of Obstetricians and Gynecologists (ACOG), 409 12th Street SW, Washington, DC, 20024, USA
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Box 356460, Seattle, WA, 98195, USA
| |
Collapse
|
12
|
Tran DT, Preen DB, Einarsdottir K, Kemp-Casey A, Randall D, Jorm LR, Choi SKY, Havard A. Use of smoking cessation pharmacotherapies during pregnancy is not associated with increased risk of adverse pregnancy outcomes: a population-based cohort study. BMC Med 2020; 18:15. [PMID: 32019533 PMCID: PMC7001233 DOI: 10.1186/s12916-019-1472-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Varenicline, bupropion and nicotine replacement therapy (NRT) are three effective pharmacotherapies for smoking cessation, but data about their safety in pregnancy are limited. We assessed the risk of adverse perinatal outcomes and major congenital anomalies associated with the use of these therapies in pregnancy in Australia. METHODS Perinatal data for 1,017,731 deliveries (2004 to 2012) in New South Wales and Western Australia were linked to pharmaceutical dispensing, hospital admission and death records. We identified 97,875 women who smoked during pregnancy; of those, 233, 330 and 1057 were exposed to bupropion, NRT and varenicline in pregnancy, respectively. Propensity scores were used to match exposed women to those who were unexposed to any smoking therapy (1:10 ratio). Propensity scores and gestational age at exposure were used to match varenicline-exposed to NRT-exposed women (1:1 ratio). Time-dependent Cox proportional hazards models estimated hazard ratios (HR) with 95% confidence intervals (95% CI) for any adverse perinatal event (a composite of 10 unfavourable maternal and neonatal outcomes) and any major congenital anomaly. RESULTS The risk of any adverse perinatal event was not significantly different between bupropion-exposed and unexposed women (39.2% versus 39.3%, HR 0.93, 95% CI 0.73-1.19) and between NRT-exposed and unexposed women (44.8% vs 46.3%, HR 1.02, 95% CI 0.84-1.23), but it was significantly lower in women exposed to varenicline (36.9% vs 40.1%, HR 0.86, 95% CI 0.77-0.97). Varenicline-exposed infants were less likely than unexposed infants to be born premature (6.5% vs 8.9%, HR 0.72, 95% CI 0.56-0.92), be small for gestational age (11.4% vs 15.4%, HR 0.68, 95% CI 0.56-0.83) and have severe neonatal complications (6.6% vs 8.2%, HR 0.74, 95% CI 0.57-0.96). Among infants exposed to varenicline in the first trimester, 2.9% had a major congenital anomaly (3.5% in unexposed infants, HR 0.91, 95% CI 0.72-1.15). Varenicline-exposed women were less likely than NRT-exposed women to have an adverse perinatal event (38.7% vs 51.4%, HR 0.58, 95% CI 0.33-1.05). CONCLUSIONS Pregnancy exposure to smoking cessation pharmacotherapies does not appear to be associated with an increased risk of adverse birth outcomes. Lower risk of adverse birth outcomes in varenicline-exposed pregnancies is inconsistent with recommendations that NRT be used in preference to varenicline.
Collapse
Affiliation(s)
- Duong Thuy Tran
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia.
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Kristjana Einarsdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anna Kemp-Casey
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Deborah Randall
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Stephanie K Y Choi
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| |
Collapse
|
13
|
Polachek A, Eder L. Pregnancy Outcome in Inflammatory Arthropathies - Are Population Database Studies the Right Tool? J Rheumatol 2020; 47:161-163. [PMID: 32007941 DOI: 10.3899/jrheum.190631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ari Polachek
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Lihi Eder
- Department of Medicine, University of Toronto, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Kurti AN, Bunn JY, Tang K, Nighbor T, Gaalema DE, Coleman-Cowger V, Coleman SRM, Higgins ST. Impact of electronic nicotine delivery systems and other respondent characteristics on tobacco use transitions among a U.S. national sample of women of reproductive age. Drug Alcohol Depend 2020; 207:107801. [PMID: 31855658 PMCID: PMC6981035 DOI: 10.1016/j.drugalcdep.2019.107801] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Identifying predictors of tobacco use patterns that differ in harm among reproductive-aged women may inform efforts to protect women and children against adverse health impacts of tobacco use. METHODS Changes in tobacco use patterns were examined among women (18-49 years) who completed Wave 1 (W1) and Wave 2 (W2), or W2 and Wave 3 (W3) of the U.S. Population Assessment of Tobacco and Health (PATH, 2013-2016) study, and were using cigarettes, filtered cigars and/or cigarillos in the first wave over which data were included for that respondent (Time 1; T1). We examined the proportion of respondents whose tobacco use transitions from T1 to Time 2 (T2) were harm-maintaining (continued using combusted tobacco), harm-reducing (transitioned to electronic nicotine delivery systems (ENDS), or harm-eliminating (quit tobacco). Multinomial logistic regressions (with harm-maintaining as the baseline category) were conducted to examine associations between ENDS use, demographic, and psychosocial characteristics with each transition. RESULTS A majority of women (83 %) exhibited harm-maintaining transitions, followed by harm-eliminating (14.7 %) and harm-reducing (2.3 %) transitions. Use of ENDS at T1 was associated with increased odds of harm reduction and decreased odds of harm elimination. Younger women were more likely to make both harm-reducing and harm-eliminating transitions. Increased educational attainment, identifying as Black or Hispanic, increased psychiatric symptoms, and pregnancy were associated with harm elimination, whereas living at or above poverty was associated with harm reduction. CONCLUSIONS Study results contribute new information on the impact of ENDS, sociodemographic characteristics, psychiatric symptoms, and pregnancy on tobacco use transitions among reproductive-aged women.
Collapse
Affiliation(s)
- Allison N Kurti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA.
| | - Janice Y Bunn
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Katherine Tang
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Tyler Nighbor
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | | | - Sulamunn R M Coleman
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA
| |
Collapse
|
15
|
Womack LS, Rossen LM, Hirai AH. Urban-Rural Infant Mortality Disparities by Race and Ethnicity and Cause of Death. Am J Prev Med 2020; 58:254-260. [PMID: 31735480 PMCID: PMC6980981 DOI: 10.1016/j.amepre.2019.09.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Infant mortality rates are higher in nonmetropolitan areas versus large metropolitan areas. Variation by race/ethnicity and cause of death has not been assessed. Urban-rural infant mortality rate differences were quantified by race/ethnicity and cause of death. METHODS National Vital Statistics System linked birth/infant death data (2014-2016) were analyzed in 2019 by 3 urban-rural county classifications: large metropolitan, medium/small metropolitan, and nonmetropolitan. Excess infant mortality rates (rate differences) by urban-rural classification were calculated relative to large metropolitan areas overall and for each racial/ethnic group. The number of excess deaths, population attributable fraction, and proportion of excess deaths attributable to underlying causes of death was calculated. RESULTS Nonmetropolitan areas had the highest excess infant mortality rate overall. Excess infant mortality rates were substantially lower for Hispanic infants than other races/ethnicities. Overall, 7.4% of infant deaths would be prevented if all areas had the infant mortality rate of large metropolitan areas. With more than half of births occurring outside of large metropolitan areas, the population attributable fraction was highest for American Indian/Alaska Natives (20.3%) and whites, non-Hispanic (14.3%). Excess infant mortality rates in both nonmetropolitan and medium/small metropolitan areas were primarily attributable to sudden unexpected infant deaths (42.3% and 31.9%) and congenital anomalies (30.1% and 26.8%). This pattern was consistent for all racial/ethnic groups except black, non-Hispanic infants, for whom preterm-related and sudden unexpected infant deaths accounted for the largest share of excess infant mortality rates. CONCLUSIONS Infant mortality increases with rurality, and excess infant mortality rates are predominantly attributable to sudden unexpected infant deaths and congenital anomalies, with differences by race/ethnicity regarding magnitude and cause of death.
Collapse
Affiliation(s)
- Lindsay S Womack
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; U.S Public Health Service Commissioned Corps, Rockville, Maryland.
| | - Lauren M Rossen
- Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Ashley H Hirai
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland
| |
Collapse
|
16
|
Mallinson DC, Larson A, Berger LM, Grodsky E, Ehrenthal DB. Estimating the effect of Prenatal Care Coordination in Wisconsin: A sibling fixed effects analysis. Health Serv Res 2020; 55:82-93. [PMID: 31701531 PMCID: PMC6980950 DOI: 10.1111/1475-6773.13239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To estimate Prenatal Care Coordination's (PNCC) effect on birth outcomes for Wisconsin Medicaid-covered deliveries. DATA SOURCE A longitudinal cohort of linked Wisconsin birth records (2008-2012), Medicaid claims, and state-administered social services. STUDY DESIGN We defined PNCC treatment dichotomously (none vs. any) and by service level (none vs. assessment/care plan only vs. service uptake). Outcomes were birthweight (grams), low birthweight (<2500 g), gestational age (completed weeks), and preterm birth (<37 weeks). We estimated PNCC's effect on birth outcomes, adjusting for maternal characteristics, using inverse-probability of treatment weighted and sibling fixed effects regressions. DATA COLLECTION/EXTRACTION METHODS We identified 136 224 Medicaid-paid deliveries, of which 33 073 (24.3 percent) linked to any PNCC claim and 22 563 (16.6 percent) linked to claims for PNCC service uptake. PRINCIPAL FINDINGS Sibling fixed effects models-which best adjust for unobserved confounding and treatment selection-produced the largest estimates for all outcomes. For example, in these models, PNCC service uptake was associated with a 1.3 percentage point (14 percent) reduction and a 1.8 percentage point (17 percent) reduction in the probabilities of low birthweight and preterm birth, respectively (all P < .05). CONCLUSIONS PNCC's modest but significant improvement of birth outcomes should motivate stronger PNCC outreach and implementation of similar programs elsewhere.
Collapse
Affiliation(s)
- David C. Mallinson
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Andrea Larson
- Department of Obstetrics and GynecologySchool of Medicine & Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
| | | | - Eric Grodsky
- Department of SociologyCollege of Letters & ScienceUniversity of Wisconsin‐MadisonMadisonWisconsin
- Department of Educational Policy StudiesSchool of EducationUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Deborah B. Ehrenthal
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
- Department of Obstetrics and GynecologySchool of Medicine & Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
| |
Collapse
|
17
|
Lee ML, Tran DT, Welsh A, Kennedy D, Havard A. Health-care providers' concern regarding smoking cessation pharmacotherapies during pregnancy: Calls to a teratology information service. Drug Alcohol Rev 2020; 39:223-231. [PMID: 31984591 DOI: 10.1111/dar.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Few smokers use smoking cessation pharmacotherapies during pregnancy. It is hypothesised that health-care providers' reluctance due to safety concerns contributes to their low use. This study examined the extent of providers' concern regarding smoking cessation pharmacotherapies, relative to other medications in the same and other pregnancy risk categories. Calls made to a teratology information service (MotherSafe, Australia) were taken as a proxy indicator of concern regarding safety during pregnancy. DESIGN AND METHODS The primary exposure discussed in 66 687 calls made to MotherSafe between 2001 and 2016 was categorised as nicotine replacement therapy (NRT), bupropion, varenicline or category A (low risk), B1, B2, B3, C, D or X (teratogenic). Separate logistic regression models estimated the odds that calls regarding pharmacotherapies were from providers, relative to medications in the same and other risk categories. Models adjusted for caller remoteness and socio-economic status. RESULTS Calls regarding bupropion were more likely to be made by providers than calls regarding other medications in its corresponding risk category [B2, adjusted odds ratio (aOR): 2.77, 95% confidence interval (CI) 1.17, 6.59]. Calls about varenicline were also more likely to be from providers than calls regarding other category B3 medications (aOR 95% CI 2.33:1.30, 4.17). Calls regarding NRT were not more or less likely to be from providers than calls regarding other category D medications. DISCUSSION AND CONCLUSIONS Providers were more concerned about bupropion and varenicline than other medications within the same pregnancy risk categories. As this overestimation of risk may limit cessation pharmacotherapy use during pregnancy, research investigating strategies for correcting this imbalance is warranted.
Collapse
Affiliation(s)
- Mei Lin Lee
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Duong T Tran
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Alec Welsh
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia.,School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, Australia
| | - Debra Kennedy
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, Australia.,MotherSafe, Royal Hospital for Women, Sydney, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| |
Collapse
|
18
|
Desai N. Smoking and pregnancy: The era of electronic nicotine delivery systems. Obstet Med 2020; 13:154-158. [PMID: 33343691 DOI: 10.1177/1753495x19893224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022] Open
Abstract
Electronic nicotine delivery systems have been commercially available in the United States since 2007. Despite a decrease in combustible cigarette use, electronic nicotine delivery systems use has dramatically increased among both adults and adolescents. These devices have been marketed as smoking cessation aids, although data on their efficacy are scarce. Pregnant women are an especially vulnerable population susceptible to claims of safety and efficacy, and the medical community remains inadequately informed on how to counsel these women. The purpose of this article is to review known literature regarding the use of electronic nicotine delivery systems in pregnancy, to understand the differences between cigarettes and electronic nicotine delivery systems use in pregnancy, and to further guide clinicians on how to advise the pregnant woman on their use.
Collapse
Affiliation(s)
- Nikita Desai
- Respiratory Institute, Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
19
|
Hawkins SS, Baum CF. The downstream effects of state tobacco control policies on maternal smoking during pregnancy and birth outcomes. Drug Alcohol Depend 2019; 205:107634. [PMID: 31669802 DOI: 10.1016/j.drugalcdep.2019.107634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/27/2019] [Accepted: 08/03/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has demonstrated that the implementation of tobacco control policies is associated with improved birth outcomes. Ascertainment of prenatal smoking on the US birth certificate has changed over the past decade to record smoking across each trimester. METHODS Using 2005-2015 birth certificate data on 26,436,541 singletons from 47 states and DC linked to state-level cigarette taxes and smoke-free legislation, we conducted conditional mixed-process models to examine the impact of tobacco control policies on prenatal smoking and quitting, then on the associated changes in birth outcomes. We included interactions between race/ethnicity, education, and taxes and present average marginal effects. RESULTS Among white and black mothers with less than a high school degree, 36.0% and 14.1%, respectively, smoked during the first trimester and their babies had the poorest birth outcomes. However, they were the most responsive to cigarette taxes. Every $1.00 increase in taxes was associated with a 3.45 percentage point decrease in prenatal smoking among white mothers and a 1.20 percentage point decrease among black mothers. These reductions translated to increases in birth weight by 4.19 g for babies born to white mothers and 0.89 g for babies born to black mothers. Among smokers, there was some evidence that taxes increased quitting and improved birth outcomes, although most associations were not statistically significant. We found limited effects of smoke-free legislation on smoking, quitting or birth outcomes. CONCLUSIONS Cigarette taxes continue to have important downstream effects on reducing prenatal smoking and improving birth outcomes among the most vulnerable mothers and infants.
Collapse
Affiliation(s)
- Summer Sherburne Hawkins
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
| | - Christopher F Baum
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA; Boston College, Department of Economics, Maloney Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA; German Institute for Economic Research (DIW Berlin), Department of Macroeconomics, Mohrenstraße 58, 10117 Berlin, Germany
| |
Collapse
|
20
|
Affiliation(s)
- Buyun Liu
- College of Public Health, Department of Epidemiology, University of Iowa, Iowa City
| | - Wei Bao
- College of Public Health, Department of Epidemiology, University of Iowa, Iowa City
| |
Collapse
|
21
|
Breland A, McCubbin A, Ashford K. Electronic nicotine delivery systems and pregnancy: Recent research on perceptions, cessation, and toxicant delivery. Birth Defects Res 2019; 111:1284-1293. [PMID: 31364280 PMCID: PMC7121906 DOI: 10.1002/bdr2.1561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/09/2023]
Abstract
Electronic nicotine delivery systems (ENDS), which includes e-cigarettes (ECIGs), are a rapidly-expanding class of products that heat a liquid (which may or may not contain nicotine) to produce an aerosol. The variation of ECIG components is extensive as are their effects on users. Epidemiological data show that while both adults and youth use ECIGs, use among youth has increased dramatically in recent years. Other epidemiological data show that women of reproductive age and some pregnant women are also using ECIGs. The goal of this article is to provide readers with background information about ECIGs, with a focus on recent findings about ECIG use in pregnancy and potential implications. Among pregnant women, correlates of ECIG use include current cigarette smoking, among other factors. Regarding pregnant women's perceptions of ECIG use in pregnancy, two themes emerge from the literature: many pregnant women perceive ECIGs to be safer than conventional cigarettes, and that ECIGs can aid with smoking cessation. In contrast to these perceptions, there is little concrete evidence that ECIGs help smokers quit. In addition, there are concerns about ECIG nicotine and other toxicant delivery. Nicotine is a toxicant of particular concern for pregnant women, as nicotine is known to harm a developing fetus. There are many limitations to existing research, and the literature is scant in this area. Further, new "pod mod"-style ECIGs such as JUUL present new challenges. Overall, with limited evidence of their effectiveness, and concerns about developmental toxicology, the authors do not recommend that pregnant women use ECIGs.
Collapse
Affiliation(s)
- Alison Breland
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Andrea McCubbin
- Perinatal Research and Wellness Center, College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Kristin Ashford
- Perinatal Research and Wellness Center, College of Nursing, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
22
|
Kamke K, Grenen E, Robinson C, El-Toukhy S. Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study. JMIR Mhealth Uhealth 2019; 7:e14699. [PMID: 31593542 PMCID: PMC6803886 DOI: 10.2196/14699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/24/2022] Open
Abstract
Background Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. Objective Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. Methods Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. Results The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor’s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. Conclusions Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized.
Collapse
Affiliation(s)
- Kristyn Kamke
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | | | | | - Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
23
|
Kondracki AJ. Prevalence and patterns of cigarette smoking before and during early and late pregnancy according to maternal characteristics: the first national data based on the 2003 birth certificate revision, United States, 2016. Reprod Health 2019; 16:142. [PMID: 31519184 PMCID: PMC6743116 DOI: 10.1186/s12978-019-0807-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The objective of this study was to examine the prevalence of smoking by intensity status before pregnancy and during early (first and second trimester) and late (third trimester) pregnancy according to race/ethnicity, age, and educational attainment of women who gave birth in the United States in 2016. METHODS This cross-sectional study was based on the 2016 National Center for Health Statistics (NCHS) Natality File of 3,956,112 live births, the first year that it became 100% nationally representative. Self-reported smoking data were used to create new seven smoking intensity status categories to capture natural variability in smoking patterns during pregnancy and to identify maternal smokers by race/ethnicity, age, and educational attainment. The risk of smoking at low and high intensity in early pregnancy was estimated in multivariable logistic regression analyses. RESULTS Nearly 9.4% of women reported smoking before pregnancy and 7.1% during pregnancy, both at high and low intensity, and smoking rates were higher in the first trimester (7.1%) than in the second (6.1%) or the third (5.7%) trimester. Non-Hispanic White women, women 20-24 years old, and women with less than a high school education were the strongest predictors of smoking anytime during pregnancy. The odds of smoking in early pregnancy at high intensity were 88% lower (aOR 0.12, 95% CI: 0.11, 0.13) for Hispanic women, compared to non-Hispanic White women; 16% higher (aOR 1.16, 95% CI: 1.12, 1.21) for women 20-24 years old and 16% lower (aOR 0.84, 95% CI: 0.80, 0.89) for women ≥35 years old, compared to women 25-29 years old; as well as 13% higher (aOR 1.13, 95% CI: 1.09, 1.18) for women with less than a high school education and 92% lower (aOR 0.08, 95% CI: 0.08, 0.09) for women with a bachelor's degree or higher, compared to women with a high school diploma. CONCLUSIONS Despite the high prevalence of high intensity smoking before and during pregnancy, future intervention strategies need to focus on the proportion of low intensity quitters and reducers, who are ready to stop smoking. Continual monitoring of trends in smoking intensity patterns is necessary, including neonatal outcomes over time.
Collapse
Affiliation(s)
- Anthony J Kondracki
- University of Maryland, School of Public Health, Maternal and Child Health, 4200 Valley Drive, College Park, MD, 20742, USA.
| |
Collapse
|
24
|
Diamanti A, Papadakis S, Schoretsaniti S, Rovina N, Vivilaki V, Gratziou C, Katsaounou PA. Smoking cessation in pregnancy: An update for maternity care practitioners. Tob Induc Dis 2019; 17:57. [PMID: 31582946 PMCID: PMC6770622 DOI: 10.18332/tid/109906] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/10/2019] [Accepted: 06/06/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION This paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings. METHODS We conducted a qualitative review of published peer reviewed and grey literature. RESULTS There is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quit-smoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high. CONCLUSIONS There have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes.
Collapse
Affiliation(s)
- Athina Diamanti
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sotiria Schoretsaniti
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Center for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Rovina
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- 1st Department of Respiratory Medicine, ‘Sotiria’ Chest Disease Hospital, Athens, Greece
| | | | - Christina Gratziou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Evgenidio Hospital, Athens, Greece
| | - Paraskevi A. Katsaounou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- First ICU, Evangelismos Hospital, Athens, Greece
| |
Collapse
|
25
|
McEvoy CT, Tepper RS, Gonzales D, Spindel ER, Morris CD. Reply to Braillon: Vitamin C to Pregnant Smokers and Infant Airway Function: Missing the Forest for the Trees? Am J Respir Crit Care Med 2019; 200:397-398. [PMID: 30950629 PMCID: PMC6680303 DOI: 10.1164/rccm.201903-0642le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
26
|
Galper Grossman S. Vape Gods and Judaism-E-cigarettes and Jewish Law. Rambam Maimonides Med J 2019; 10:RMMJ.10372. [PMID: 31335312 PMCID: PMC6649778 DOI: 10.5041/rmmj.10372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review current medical literature on the risks and potential benefits of e-cigarette use and its permissibility under Jewish law. METHODS A survey of current medical literature about the risks and potential benefits of e-cigarette use, and a review of existing rabbinic literature regarding both combustible and e-cigarette products. RESULTS E-cigarettes contain fewer harmful materials than do combustible cigarettes. However, they are not risk-free. Their skyrocketing use among youth is of concern, as e-cigarettes lead to nicotine addiction and are a gateway to combustible cigarettes. Preliminary data indicate that e-cigarettes increase the risk of myocardial infarction, chronic obstructive pulmonary disease (COPD), and emphysema and are no more effective as aids to smoking cessation than US Food and Drug Administration (FDA)-approved interventions with acceptable safety profiles. Few halakhic decisors have opined on the permissibility of e-cigarettes, but extrapolating from halakhic discussions regarding combustible cigarettes strongly suggests that they would prohibit e-cigarettes based on government warnings and preliminary data demonstrating increased risk of cardiovascular and respiratory diseases, at the least because of possible danger (safek sakana). Among youth and pregnant women, for whom e-cigarettes are particularly dangerous and for whom the government has administered explicit warnings, a Jewish legal prohibition should be absolute. There is a unique obligation to prevent youth from obtaining these products. Jewish law might also prohibit deriving benefit from the sale or advertisement of these products. CONCLUSIONS Extrapolating from rabbinic literature regarding combustible cigarettes, the preliminary data establishing the dangers of e-cigarettes and the government warnings against usage would render these products prohibited under Jewish law, especially for youth and pregnant women.
Collapse
Affiliation(s)
- Sharon Galper Grossman
- Halakhic Advisor (Morah L’Halakha), Matan HaSharon, Ra’annana, Israel; and Oncology Consultant, Ra’annana, Israel
| |
Collapse
|
27
|
Miyazaki M, Suzuki S. Influence of smoking habits on mental status in Japanese women during the first trimester of pregnancy. J Matern Fetal Neonatal Med 2019; 34:1284-1287. [PMID: 31220968 DOI: 10.1080/14767058.2019.1635110] [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: 10/26/2022]
Abstract
PURPOSE We examined the relation between smoking habits and maternal mental status such as depression and anxiety during the first trimester of pregnancy. MATERIAL AND METHODS Between July 2016 and June 2018, we examined the increased odds of depressive and anxiety symptoms in the women with smoking habits during prepregnancy with and without smoking cessation during the first trimester of pregnancy in comparison with those without smoking habits using self-administered questionnaires. RESULTS The rate of depressive and anxiety symptom in the women with smoking habits during prepregnancy (46.4 and 47.3%, respectively) was higher than those in the women without smoking habits during the first trimester of pregnancy irrespective of smoking cessation. The rate of depressive or anxiety symptom during the first trimester of pregnancy did not change significantly by smoking cessation in the women with smoking habits during prepregnancy (depressive symptom: 44.6 versus 53.7%, p = .13; anxiety symptom: 45.3 versus 55.2%, p = .17). CONCLUSIONS Smoking habits during prepregnancy seemed to be associated with the increased perinatal mental disorders irrespective of smoking cessation.
Collapse
Affiliation(s)
- Miwa Miyazaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
| |
Collapse
|
28
|
Olson AL, Boardman MB, Johnson DJ. Smoke-Free Moms: Financial Rewards for Smoking Cessation by Low-Income Rural Pregnant Women. Am J Prev Med 2019; 56:852-859. [PMID: 31003804 PMCID: PMC6527358 DOI: 10.1016/j.amepre.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Maternal smoking places the child at risk during pregnancy and postpartum. Most women who quit smoking do so early when they first learn of pregnancy. Few low-income women quit once they enter prenatal care. The purpose of this study is to test in a clinical prenatal care setting the effectiveness of the Smoke-Free Moms intervention, which provides pregnant women a series of financial incentives for smoking cessation. STUDY DESIGN A prospective nonrandomized controlled trial that collected control population data of smoking-cessation rates at each clincal visit during pregnancy and postpartum with usual smoking counseling in 2013-2014. In 2015-2016, the same data were collected during the implementation of the Smoke-Free Moms intervention of financial incentives. Data analysis occurred in 2017. SETTING/PARTICIPANTS Women who were smoking at the first prenatal visit at four federally qualified health centers in rural New Hampshire. INTERVENTION All women received 5A's smoking counseling from clinic staff. At each clinic visit, with point-of-care confirmed negative urinary cotinine, intervention women received gift cards. MAIN OUTCOME MEASURES Cotinine confirmed smoking cessation without relapse: (1) during pregnancy and (2) smoking cessation in both pregnancy and postpartum. RESULTS Of 175 eligible pregnant women enrolled, 134 women were followed to the postpartum visit (Intervention n=66, Control n=68). The quit rates during pregnancy did not differ between groups (Intervention 36.4%, Control 29.4%, p=0.46). However, significantly more intervention mothers quit and continued as nonsmokers postpartum (Intervention 31.8%, Control 16.2%, p=0.04). In a logistic regression model including baseline sociodemographic, depressed mood, stress, and readiness to quit items, confidence in being able to quit predicted both cessation outcomes. The financial incentive intervention was an independent predictor of cessation in pregnancy through postpartum. CONCLUSIONS Financial incentives with existing smoking-cessation counseling by staff in low-income clinical prenatal programs led to cessation that continued during the postpartum period. Further study in larger populations is indicated.
Collapse
Affiliation(s)
- Ardis L Olson
- Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover, New Hampshire; Department of Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
| | - Maureen B Boardman
- Department of Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Deborah J Johnson
- Department of Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| |
Collapse
|
29
|
Rockhill KM, England LJ, Tong VT, Sharma AJ. Biochemically confirmed smoking cessation and gestational weight gain. Birth 2019; 46:326-334. [PMID: 30633363 PMCID: PMC11268955 DOI: 10.1111/birt.12414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prenatal smoking cessation has substantial health benefits for mothers and offspring, but concerns about weight gain may be a barrier to quitting. We quantified gestational weight gain associated with biochemically confirmed smoking cessation. METHODS Data originated from a randomized controlled cessation trial: Smoking Cessation in Pregnancy project (1987-1991). We calculated gestational weight gain using self-reported prepregnancy weight and measured weight at 30-34 weeks of gestation. We used linear regression to estimate adjusted mean differences in gain for quitters versus continuing smokers by the last trimester. The effects of quitting earlier (by 2nd trimester) versus later (by 3rd trimester) were calculated. We assessed the percentages who gained weight according to Institute of Medicine (IOM) recommendations within 2 weeks of a full-term delivery. RESULTS At 30-34 weeks, nulliparous and multiparous quitters gained an average of 3.0 pounds (95% CI 0.9-5.1 pounds) (1.4 kg [0.4-2.3 kg]) and 6.6 pounds (95% CI 4.3-8.9 pounds) (3.0 kg [1.9-4.0 kg]) more, respectively, than continuing smokers. Weight gain in early quitters did not differ significantly from that in late quitters. Quitters were more likely than continuing smokers to gain above current guidelines (60.3% vs 46.3%) and were less likely to gain below guidelines (11.5% vs 21.6%) (P = 0.002). CONCLUSIONS Although quitters had modest additional weight gain by 30-34 weeks compared to continuing smokers, a high proportion in both groups gained in excess of IOM recommendations. Both quitters and continuing smokers may need support to achieve optimal gestational weight gain.
Collapse
Affiliation(s)
- Karilynn M. Rockhill
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Lucinda J. England
- Division of Congenital and Developmental Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
- U.S. Public Health Service Commissioned Corps, Atlanta, Georgia
| | - Van T. Tong
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea J. Sharma
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- U.S. Public Health Service Commissioned Corps, Atlanta, Georgia
| |
Collapse
|
30
|
Abstract
Risks, benefits, alternatives, and appropriateness of psychotropic medications, including risks of no treatment, are discussed for antidepressants, mood-stabilizing medications, anxiolytic/sedative hypnotic medications, stimulants, and medication-assisted treatment of substance use disorders. Early screening, diagnosis, and intervention prior to and/or during pregnancy often reduce morbidity and mortality of mental health disorders for mothers and infants.
Collapse
Affiliation(s)
- Edwin R Raffi
- Perinatal and Reproductive Psychiatry Program, Massachusetts General Hospital Center for Women's Mental Health, Harvard Medical School, Simches Research Building, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA.
| | - Ruta Nonacs
- Perinatal and Reproductive Psychiatry Program, Massachusetts General Hospital Center for Women's Mental Health, Harvard Medical School, Simches Research Building, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA
| | - Lee S Cohen
- Perinatal and Reproductive Psychiatry Program, Massachusetts General Hospital Center for Women's Mental Health, Harvard Medical School, Simches Research Building, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Tolosa JE, Scherman A, Stamilio DM, McEvoy CT. Tobacco and nicotine exposure prevention in pregnancy: a priority to improve perinatal and maternal outcomes. Am J Obstet Gynecol MFM 2019; 1:19-23. [PMID: 33319752 PMCID: PMC8023387 DOI: 10.1016/j.ajogmf.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jorge E Tolosa
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, St. Luke's University Health Network, Bethlehem, PA; Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Oregon Health & Science University, Portland, OR; Global Network for Perinatal & Reproductive Health, FUNDARED-MATERNA, Bogotá, Colombia; Departamento de Obstetricia y Ginecología, NACER Salud Sexual y Reproductiva, Universidad de Antioquia, Medellín, Colombia.
| | - Ashley Scherman
- Oregon Health & Science University, Pediatrics, Portland, OR
| | - David M Stamilio
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, NC
| | - Cindy T McEvoy
- Department of Pediatrics, Division of Neonatology, Oregon Health & Science University, Portland, OR
| |
Collapse
|
33
|
Kapaya M, D’Angelo DV, Tong VT, England L, Ruffo N, Cox S, Warner L, Bombard J, Guthrie T, Lampkins A, King BA. Use of Electronic Vapor Products Before, During, and After Pregnancy Among Women with a Recent Live Birth - Oklahoma and Texas, 2015. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:189-194. [PMID: 30817748 PMCID: PMC6394383 DOI: 10.15585/mmwr.mm6808a1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Electronic vapor products (EVPs) comprise a diverse group of devices, including electronic cigarettes (e-cigarettes). EVP users inhale an aerosol that typically contains nicotine, flavorings, and other additives (1). Nicotine is a developmental toxicant that adversely affects pregnancy and infant outcomes (2). Data from the 2015 Pregnancy Risk Assessment Monitoring System (PRAMS) for Oklahoma and Texas were analyzed to estimate population-based EVP use among women with a recent live birth. EVP use before pregnancy (defined as >3 months before pregnancy) and around the time of pregnancy (defined as any time during the 3 months before pregnancy, the last 3 months of pregnancy, or 2-6 months after delivery), reasons for EVP use, and dual use of EVPs and cigarettes were assessed. Prevalence of EVP use was 10.4% before pregnancy and 7.0% around the time of pregnancy, including 1.4% during the last 3 months of pregnancy. Among women using EVPs during the last 3 months of pregnancy, 38.4% reported use of EVPs containing nicotine, and 26.4% were unsure of nicotine content. Among women who had used EVPs and cigarettes, dual use prevalence was 38.0% in the 3 months before pregnancy, 7.7% during the last 3 months of pregnancy, and 11.8% in the 2-6 months after delivery. The most frequently reported reasons for EVP use around the time of pregnancy were curiosity (54.0%), the perception that EVPs might help with quitting or reducing cigarette smoking (45.2%), and the perception of reduced harm to the mother, when compared with cigarette smoking (45.2%). Clear messages that EVP use is not safe during pregnancy are needed, and broad, barrier-free access to evidence-based tobacco cessation strategies need to be made available.
Collapse
|
34
|
Bartick M, Tomori C. Sudden infant death and social justice: A syndemics approach. MATERNAL & CHILD NUTRITION 2019; 15:e12652. [PMID: 30136404 PMCID: PMC7198924 DOI: 10.1111/mcn.12652] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/01/2018] [Accepted: 06/21/2018] [Indexed: 01/31/2023]
Abstract
Sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) prevention has focused on modifying individual behavioural risk factors, especially bedsharing. Yet these deaths are most common among poor and marginalized people in wealthy countries, including U.S. Blacks, American Indians/Alaskan Natives, New Zealand Māori, Australian Aborigines, indigenous Canadians, and low-income British people. The United States now has the world's highest prevalence of SUID/SIDS, where even Whites' SIDS prevalence now approaches that of the Māori. Using public databases and the literature, we examine SUID/SIDS prevalence and the following risk factors in selected world populations: maternal smoking, preterm birth, alcohol use, poor prenatal care, sleep position, bedsharing, and formula feeding. Our findings suggest that risk factors cluster in high-prevalence populations, many are linked to poverty and discrimination and have independent effects on perinatal outcomes. Moreover, populations with the world's lowest rates of SUID/SIDS have low income-inequality or high relative wealth, yet have high to moderate rates of bedsharing. Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co-occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation. Medical organizations play an important role in advocating for policies that address the root causes of infant mortality via poverty and discrimination interventions, tobacco control, and culturally appropriate support to families.
Collapse
Affiliation(s)
- Melissa Bartick
- Department of MedicineCambridge Health Alliance and Harvard Medical SchoolCambridgeMassachusetts
| | - Cecília Tomori
- Department of Anthropology, Parent–Infant Sleep LabDurham UniversityDurhamUK
| |
Collapse
|
35
|
Medi-Cal Incentives to Quit Smoking Program: Reach to Pregnant and Parenting Women. Am J Prev Med 2018; 55:S205-S213. [PMID: 30454675 DOI: 10.1016/j.amepre.2018.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/10/2018] [Accepted: 07/13/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In California, half of pregnant women and children are on California's Medicaid (Medi-Cal). The Medi-Cal Incentives to Quit Smoking program provided incentives to adults on Medi-Cal to call the California Smokers Helpline (Helpline) from March 2012 to July 2015. This analysis examined reach of the Medi-Cal Incentives to Quit Smoking program among pregnant and parenting women. METHODS This study examined caller data from the Helpline from 2010 to 2015 among women of reproductive age (18-45 years) enrolled in Medi-Cal (n=32,691; analyzed in 2017/2018). The authors calculated the annual percentage of the target population reached who called the Helpline by pregnancy status and used adjusted prevalence ratios to examine the associations between Medi-Cal Incentives to Quit Smoking incentive period, pregnancy/parenting status, Medi-Cal Incentives to Quit Smoking incentives ($20 gift card and nicotine patch), and counseling. RESULTS Over the study period, the percentage of the target population reached increased for women of reproductive age (2.1% in 2011 to 3.0% in 2014) and pregnant women (2.1% in 2011 to 3.3% in 2014). The percentage of women who asked for the $20 gift card (13.6%) was not substantially different by pregnancy status, and WIC and nonprofits were important referral sources. Pregnant women were less likely to receive nicotine patches, but there was a 3- to 4-fold increase during the Medi-Cal Incentives to Quit Smoking incentive period for both pregnant and nonpregnant women. Among nonpregnant women, counseling decreased 14% during the Medi-Cal Incentives to Quit Smoking incentive period. CONCLUSIONS Results suggest that the nicotine patch incentives motivated women to call the Helpline, even pregnant women who needed a physician's approval consistent with current American College of Obstetricians and Gynecologists cautions about the appropriateness of the patch during pregnancy. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
Collapse
|
36
|
Wedel AV, Stevens EM, Molina N, Leavens ELS, Roberts C, Wagener TL. Examining pregnant smokers' attitudes toward cessation aids and electronic nicotine delivery systems. THE JOURNAL OF THE OKLAHOMA STATE MEDICAL ASSOCIATION 2018; 111:812-816. [PMID: 31404418 PMCID: PMC6688761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Tobacco remains one of the most commonly used substances during pregnancy. Despite the many health risks, pregnant women report low nicotine replacement therapy (NRT) adherence and associated quit rates due partially to perceptions of increased harm related to NRT use. The health risks coupled with the continuation of tobacco use reinforce the need for a greater understanding of these behaviors and attitudes towards NRT and electronic nicotine delivery systems (ENDS) in pregnant women. Therefore, the current study aims to understand pregnant smokers' attitudes towards cessation aids and various tobacco products. METHODS Pregnant women who reported current cigarette smoking (N = 85) were recruited from a Perinatal Center. Participants completed a 19-item self-administered survey relating to tobacco use and NRT interest. RESULTS Overall, participants reported smoking fewer cigarettes per day since becoming pregnant. Those who had used NRT and/or ENDS prior were willing to use them during their current or future pregnancies. Overall, interest in ENDS use was high (50.6% during pregnancy, 53.5% after pregnancy), despite only 5.9% of participants currently reporting use. DISCUSSION This study is the first to find that pregnant smokers may be hesitant to use NRT and ENDS instead of combustible tobacco during pregnancy, potentially due to the perceived harmfulness of these products, but feel more willing to use products that they have used previously. Therefore, education and counseling by medical providers regarding varying levels of harm related to use of NRT and nicotine/tobacco products should be included in the routine healthcare of pregnant smokers.
Collapse
Affiliation(s)
- Amelia V. Wedel
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Elise M. Stevens
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
| | - Neil Molina
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
| | - Eleanor L. S. Leavens
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | - Caroline Roberts
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | - Theodore L. Wagener
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| |
Collapse
|
37
|
Godleski SA, Shisler S, Eiden RD, Huestis MA. Co-use of tobacco and marijuana during pregnancy: Pathways to externalizing behavior problems in early childhood. Neurotoxicol Teratol 2018; 69:39-48. [PMID: 30081085 PMCID: PMC6396313 DOI: 10.1016/j.ntt.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022]
Abstract
Use and co-use of tobacco and marijuana during pregnancy are associated with the development of social, cognitive, and behavioral problems for infants and children. However, less is known about the potential developmental impact of the use of tobacco and marijuana in tandem. The present study examined an etiological model for the development of externalizing behavior problems (EBP) in early childhood in a high risk sample (N = 247) of mother-infant dyads with prospective data from pregnancy to 36 months of child age. Co-use during pregnancy and continued maternal tobacco and marijuana use from infancy through early childhood were investigated. Although direct pathways from exposure during pregnancy to EBP were not significant, there was a significant indirect pathway from prenatal tobacco use to EBP via lower breastfeeding duration to lower maternal warmth/sensitivity to EBP, and a pathway from higher maternal affective dysregulation to higher EBP. These results highlight the importance of considering cascading effects of substance use during pregnancy on parental processes within the context of developmental risk and protection.
Collapse
Affiliation(s)
- Stephanie A Godleski
- College of Liberal Arts, Rochester Institute of Technology, 18 Lomb Memorial Drive, Rochester, NY 14623, USA.
| | - Shannon Shisler
- Research Institute on Addictions, University at Buffalo, The State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
| | - Rina D Eiden
- Department of Psychology, University at Buffalo, The State University of New York, 204 Park Hall, Buffalo, NY 14260, USA
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA 19107, USA
| |
Collapse
|
38
|
Management of Attention Deficit Hyperactivity Disorder During Pregnancy. Obstet Gynecol Clin North Am 2018; 45:495-509. [DOI: 10.1016/j.ogc.2018.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|