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Bonello K, Figoni H, Blanchard E, Vignier N, Avenin G, Melchior M, Cadwallader JS, Chastang J, Ibanez G. Prevalence of smoking during pregnancy and associated social inequalities in developed countries over the 1995-2020 period: A systematic review. Paediatr Perinat Epidemiol 2023; 37:555-565. [PMID: 37427978 DOI: 10.1111/ppe.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Smoking during pregnancy (SDP) is an important source of preventable morbidity and mortality for both mother and child. OBJECTIVES The aim of this study was to describe changes in the prevalence of SDP over the last 25 years in developed countries (Human Development Index >0.8 in 2020) and associated social inequalities. DATA SOURCES A systematic review was conducted based on a search in PubMed, Embase and PsycInfo databases and government sources. STUDY SELECTION AND DATA EXTRACTION Published studies between January 1995 and March 2020, for which the primary outcome was to assess the national prevalence of SDP and the secondary outcome was to describe related socio-economic data were included in the analysis. The selected articles had to be written in English, Spanish, French or Italian. SYNTHESIS The articles were selected after successive reading of the titles, abstracts and full-length text. An independent double reading with intervention of a third reader in case of disagreement allowed including 35 articles from 14 countries in the analysis. RESULTS The prevalence of SDP differed across the countries studied despite comparable levels of development. After 2015, the prevalence of SDP ranged between 4.2% in Sweden and 16.6% in France. It was associated with socio-economic factors. The prevalence of SDP slowly decreased over time, but this overall trend masked inequalities within populations. In Canada, France and the United States, the prevalence decreased more rapidly in women of higher socio-economic status, and inequalities in maternal smoking were more marked in these countries. In the other countries, inequalities tended to decrease but remained significant. CONCLUSIONS During pregnancy, that is a period described as a window of opportunity, smoking and social vulnerability factors need to be detected to implement targeted prevention strategies aiming at reducing related social inequalities.
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Affiliation(s)
- Kim Bonello
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
| | - Hugo Figoni
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
| | - Estelle Blanchard
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
| | - Nicolas Vignier
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Guillaume Avenin
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
| | - Maria Melchior
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Jean-Sébastien Cadwallader
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Julie Chastang
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Gladys Ibanez
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
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Krebs NF, Belfort MB, Meier PP, Mennella JA, O'Connor DL, Taylor SN, Raiten DJ. Infant factors that impact the ecology of human milk secretion and composition-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 3. Am J Clin Nutr 2023; 117 Suppl 1:S43-S60. [PMID: 37173060 PMCID: PMC10356564 DOI: 10.1016/j.ajcnut.2023.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/08/2022] [Accepted: 01/03/2023] [Indexed: 05/15/2023] Open
Abstract
Infants drive many lactation processes and contribute to the changing composition of human milk through multiple mechanisms. This review addresses the major topics of milk removal; chemosensory ecology for the parent-infant dyad; the infant's inputs into the composition of the human milk microbiome; and the impact of disruptions in gestation on the ecology of fetal and infant phenotypes, milk composition, and lactation. Milk removal, which is essential for adequate infant intake and continued milk synthesis through multiple hormonal and autocrine/paracrine mechanisms, should be effective, efficient, and comfortable for both the lactating parent and the infant. All 3 components should be included in the evaluation of milk removal. Breastmilk "bridges" flavor experiences in utero with postweaning foods, and the flavors become familiar and preferred. Infants can detect flavor changes in human milk resulting from parental lifestyle choices, including recreational drug use, and early experiences with the sensory properties of these recreational drugs impact subsequent behavioral responses. Interactions between the infant's own developing microbiome, that of the milk, and the multiple environmental factors that are drivers-both modifiable and nonmodifiable-in the microbial ecology of human milk are explored. Disruptions in gestation, especially preterm birth and fetal growth restriction or excess, impact the milk composition and lactation processes such as the timing of secretory activation, adequacy of milk volume and milk removal, and duration of lactation. Research gaps are identified in each of these areas. To assure a sustained and robust breastfeeding ecology, these myriad infant inputs must be systematically considered.
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Affiliation(s)
- Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | | | - Deborah L O'Connor
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah N Taylor
- Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Montes Martínez A, Pérez-Ríos M, Ortiz C, Gtt-See, Galán Labaca I. [Changes in smoking cessation in Spain, 1987-2020]. Med Clin (Barc) 2023; 160:237-244. [PMID: 36049977 DOI: 10.1016/j.medcli.2022.06.024] [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: 05/15/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The goal of this study was to estimate and to describe the smoking cessation changes in Spain from 1987 to 2020, according to the main sociodemographic characteristics. MATERIAL AND METHOD Analysis of the historical series of the Spanish National Health Survey and the European Health Survey in Spain. Quit rate (QR) was defined as the number of former smokers among the total number of people who are smokers or have smoked at some time in their life. Other included variables were year of survey, age, gender and educational level. Poisson regression models were simultaneously adjusted for sociodemographic characteristics, estimating QR and its 95% confidence intervals (CIs) for each year. RESULTS The absolute difference in standardized QR increased from 1987 to 2017 by 18.6% (95%CI: 16.8-20.4), being moderately higher in men (19.2%; 95%CI: 17.1-21.4) than in women (16.5%; 95%CI: 13.3-19.7). An increase in QR was observed in all age groups, but its magnitude increased with age, estimating a difference in QR between 1987 and 2017 of 22.4% (95%CI: 17.7-27.1) in those aged over 64. People having university studies showed a higher QR during the period, 32.7% (95%CI: 27.5-38.0), especially when compared to those with a lower level of education (9.0%; 95%CI: 4.8-13.2). CONCLUSION QR has increased sharply and steadily since 1987, however important differences were detected according to age and educational level, highlighting the large increase in inequity observed in these 33years of evolution.
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Affiliation(s)
- Agustín Montes Martínez
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela / Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago de Compostela, A Coruña, España/Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | - Mónica Pérez-Ríos
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela / Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago de Compostela, A Coruña, España/Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Cristina Ortiz
- Centro Nacional de Epidemiología, Instituto de Salud CarlosIII, Madrid, España
| | - Gtt-See
- Grupo de trabajo de Tabaquismo de la Sociedad Española de Epidemiologia, Barcelona, España
| | - Iñaki Galán Labaca
- Centro Nacional de Epidemiología, Instituto de Salud CarlosIII / Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
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Román-Gálvez MR, Martín-Peláez S, Hernández-Martínez L, Cano-Ibáñez N, Olmedo-Requena R, Martínez-Galiano JM, Bueno-Cavanillas A, Amezcua-Prieto C. Caffeine Intake throughout Pregnancy, and Factors Associated with Non-Compliance with Recommendations: A Cohort Study. Nutrients 2022; 14:5384. [PMID: 36558543 PMCID: PMC9785327 DOI: 10.3390/nu14245384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Maternal caffeine consumption is associated with adverse gestational outcomes. The aim of this study was to assess the intake of caffeine and factors associated with the non-adherence to caffeine intake recommendations in a cohort of 463 women before (T0) and in each trimester of gestation (T1, T2, and T3), by using validated questionnaires. Caffeine intake (median (mg/day), IQR) was 100.0 (181.1) at T0, 9.42 (66.2) at T1, 12.5 (65.6) at T2, and 14.0 (61.1) at T3 (p < 0.001). Non-compliance prevalence (intake > 200 mg/day) was 6.2% at T1, 4.2% at T2, and 2.7% at T3. Not being an active smoker at T1 (OR = 0.17; 95% CI 0.05−0.59) and T2 (OR = 0.22; 95% CI 0.09−0.52), adherence to the Mediterranean Diet at T1 (OR = 0.50; 95% CI 0.28−0.88) and T2 (OR = 0.39; 95% CI 0.15−1.02), and moderate physical activity at T1 (OR = 0.50; 95% CI 0.28−0.88) were inversely associated with caffeine consumption. Although caffeine intake may be considered low, intake prevalence increases throughout pregnancy. Although the main source of caffeine during pregnancy is coffee, attention must be also paid to the increasingly intake of chocolate, of which the effect during pregnancy is controversial. Smoking, non-adherence to a good quality diet, and light physical activity are associated with a higher caffeine intake and a lower compliance with caffeine intake recommendations. Perinatal dietary and lifestyle educational policies are needed.
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Affiliation(s)
- María Rosario Román-Gálvez
- Unit of Clinical Management Alhama de Granada, Andalusian Health Service, 18120 Alhama de Granada, Spain
- Department of Nursing, University of Granada, 18006 Granada, Spain
| | - Sandra Martín-Peláez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), 18014 Granada, Spain
| | | | - Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Rocío Olmedo-Requena
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Juan Miguel Martínez-Galiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Nursing, University of Jaén, 23071 Jaén, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Willemse E, Walters BH, Springvloet L, Bommelé J, Willemsen MC. “If the social circle is engaged, more pregnant women will successfully quit smoking”: a qualitative study of the experiences of midwives in the Netherlands with smoking cessation care. BMC Health Serv Res 2022; 22:1106. [PMID: 36045362 PMCID: PMC9429426 DOI: 10.1186/s12913-022-08472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background If smoking is common within a pregnant woman’s social circle, she is more likely to smoke and her chances of succeeding in quitting smoking are reduced. It is therefore important to encourage smoking cessation in a pregnant woman’s social circle. Midwives are ideally positioned to help pregnant women and members of their social circle quit smoking but there is currently little knowledge about if and how midwives approach smoking cessation with pregnant women’s social circles. Methods In 2017 and 2018, semi-structured interviews were conducted with 14 birth care providers in the Netherlands. Interviews were inductively coded; data were analyzed thematically. Results In the interviews, midwives reported that they don’t commonly provide smoking cessation support to members of pregnant women’s social circles. The respondents noted that they primarily focused on mothers and weren’t always convinced that advising the partners, family, and friends of pregnant women to quit smoking was their responsibility. Data from the interviews revealed that barriers to giving advice to the social circle included a lack of a trusting relationship with the social circle, concerns about raising the topic and giving unwanted advice on cessation to members of the social circle and a lack of opportunity to discuss smoking. Conclusions Midwives in the Netherlands were reluctant to actively provide smoking cessation advice to the social circle of pregnant women. To overcome barriers to addressing cessation to the social circle, educational programs or new modules for existing programs could be used to improve skills related to discussing smoking. Clear guidelines and protocols on the role of midwives in providing cessation support to the social circle could help midwives overcome ambivalence that they might have. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08472-7.
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Meghea CI. Successful Strategies to Increase Cessation Rates Among Low-Income Maternal Smokers. Am J Public Health 2022; 112:351-353. [PMID: 35196062 PMCID: PMC8887156 DOI: 10.2105/ajph.2021.306655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Cristian I Meghea
- Cristian I. Meghea is with the Department of Obstetrics, Gynecology, and Reproductive Biology, in the College of Human Medicine, Michigan State University, East Lansing, and with the Department of Public Health, College of Political, Administrative, and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
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"Just Be There": Desired Partner Behaviors Among Pregnant People Living With Opioid Use Disorder, a Qualitative Study. J Addict Med 2022; 16:e390-e398. [PMID: 35802610 PMCID: PMC9932989 DOI: 10.1097/adm.0000000000001000] [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: 02/02/2023]
Abstract
OBJECTIVES Elicit how partners impact pregnant peoples experience living with opioid use disorder (OUD) during pregnancy and summarize participant recommendations to improve partner support from people engaged in treatment for OUD during pregnancy. METHODS In this qualitative study, we completed 20 in-depth interviews in pregnant people with OUD at an outpatient clinic in Tennessee. We employed inductive and deductive coding based on a relationship intimacy model and thematic analysis to elicit the perspectives, attitudes, and experiences that shaped desired partner behaviors during their pregnancy. We placed our findings in a modified relationship intimacy model of couple adaptation to OUD. Finally, we summarized interviewed participants' recommendations on how to best educate and involve their partners. RESULTS Our analysis generated 24 codes and 5 themes. Previous lived experience and interpersonal factors influenced participants' experiences with relationship-compromising and relationship-enhancing behaviors. They also reported that positive, or relationship-enhancing behaviors, could mitigate some of their negative intrapersonal feelings such as self-stigma. Participants agreed that partners should display emotional intelligence and empathy, provide supportive logistic and physical behaviors, and be open to improve. Participants also suggested that partners be equipped with information about expected physiological changes during pregnancy, supportive behavior examples, and information about OUD treatment. CONCLUSIONS Additional input from pregnant people and partners in future projects can build on these findings and guide the creation and assessment of comprehensive interventions to improve care for pregnant people with OUD.
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Kaarid KP, Vu N, Bartlett K, Patel T, Sharma S, Honor RD, Shea AK. Assessing the prevalence and correlates of prenatal cannabis consumption in an urban Canadian population: a cross-sectional survey. CMAJ Open 2021; 9:E703-E710. [PMID: 34162662 PMCID: PMC8248560 DOI: 10.9778/cmajo.20200181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recreational cannabis use was legalized in Canada in October 2018. We aimed to determine the prevalence and correlates of cannabis consumption among pregnant individuals in a single Canadian city following national legalization. METHODS Over the period May to October 2019, we distributed an anonymous cross-sectional survey to pregnant patients attending family practice, midwifery, and low-risk and high-risk obstetrics clinics in Hamilton, Ontario. Eligibility was based on English literacy and current pregnancy. The survey included questions regarding lifetime and in-pregnancy cannabis use, intent for postpartum use and patterns of use. We also collected demographic information. We calculated descriptive statistics and performed logistic regression analyses to explore the relations between cannabis consumption and demographic characteristics. RESULTS Of 531 pregnant individuals approached, 478 agreed and were able to participate, for a 90% participation rate. Among these 478 respondents, 54 (11%) reported consuming cannabis at some point during the pregnancy and 20 (4%) reported currently consuming cannabis. Among the 460 respondents who intended to breastfeed, 23 (5%) planned to consume cannabis during the postpartum period. Of 20 current users, 13 (65%) reported consuming cannabis at least weekly and 19 (95%) reported nausea, sleep problems or anxiety as reasons for use. Respondents without postsecondary education had 10.0-fold (95% confidence interval [CI] 4.6-23.5) greater odds of prenatal cannabis consumption than university-educated respondents. In addition, respondents who reported that their partners used cannabis had 3.9-fold (95% CI 2.2-7.3) greater odds of prenatal cannabis consumption than those who reported that their partners did not use cannabis. INTERPRETATION Lower educational attainment and partners' cannabis consumption were associated with greater odds of inpregnancy cannabis use. These results may help to inform early intervention strategies to decrease cannabis consumption during this vulnerable period of fetal and neonatal development.
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Affiliation(s)
- Kaija P Kaarid
- Department of Obstetrics and Gynecology (Kaarid, Vu, Bartlett, Patel, Sharma, Shea), McMaster University, Hamilton, Ont.; Department of Biology (Honor), Queen's University, Kingston, Ont
| | - Nancy Vu
- Department of Obstetrics and Gynecology (Kaarid, Vu, Bartlett, Patel, Sharma, Shea), McMaster University, Hamilton, Ont.; Department of Biology (Honor), Queen's University, Kingston, Ont
| | - Katelyn Bartlett
- Department of Obstetrics and Gynecology (Kaarid, Vu, Bartlett, Patel, Sharma, Shea), McMaster University, Hamilton, Ont.; Department of Biology (Honor), Queen's University, Kingston, Ont
| | - Tejal Patel
- Department of Obstetrics and Gynecology (Kaarid, Vu, Bartlett, Patel, Sharma, Shea), McMaster University, Hamilton, Ont.; Department of Biology (Honor), Queen's University, Kingston, Ont
| | - Sapna Sharma
- Department of Obstetrics and Gynecology (Kaarid, Vu, Bartlett, Patel, Sharma, Shea), McMaster University, Hamilton, Ont.; Department of Biology (Honor), Queen's University, Kingston, Ont
| | - Richard D Honor
- Department of Obstetrics and Gynecology (Kaarid, Vu, Bartlett, Patel, Sharma, Shea), McMaster University, Hamilton, Ont.; Department of Biology (Honor), Queen's University, Kingston, Ont
| | - Alison K Shea
- Department of Obstetrics and Gynecology (Kaarid, Vu, Bartlett, Patel, Sharma, Shea), McMaster University, Hamilton, Ont.; Department of Biology (Honor), Queen's University, Kingston, Ont.
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Geyer C, McHugh J, Tollefson M. Lifestyle Medicine for Women: The Time Is Now! Am J Lifestyle Med 2021; 15:366-371. [PMID: 34366733 DOI: 10.1177/15598276211004233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/28/2022] Open
Abstract
As the founders of the American College of Lifestyle Medicine's Women's Health Member Interest Group, we welcome this issue focused on the important issues facing women, their providers, and researchers in this field. Women's health extends beyond sex-specific reproductive health issues, by also encompassing the medical conditions that are more prevalent in women as well as conditions that are expressed differently in women. Inadequate representation of women in clinical research has contributed to poorer outcomes. As lifestyle medicine forms the foundation of true health, the time is now to recognize and address these issues with research, education, and advocacy.
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Affiliation(s)
| | - John McHugh
- The Keck School of Medicine of the University of Southern California, Los Angeles, California
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Houston-Ludlam AN, Waldron M, Lian M, Cahill AG, McCutcheon VV, Madden PAF, Bucholz KK, Heath AC. Marital status, partner acknowledgment of paternity, and neighborhood influences on smoking during first pregnancy: findings across race/ethnicity in linked administrative and census data. Drug Alcohol Depend 2020; 217:108273. [PMID: 32971390 PMCID: PMC8075321 DOI: 10.1016/j.drugalcdep.2020.108273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Improving prediction of cigarette smoking during pregnancy (SDP), including differences by race/ethnicity and geography, is necessary for interventions to achieve greater and more equitable SDP reductions. METHODS Using individual-level data on singleton first births, 2010-2017 (N = 182,894), in a US state with high SDP rates, we predicted SDP risk as a function of reproductive partner relationship (marital status, paternity acknowledgement), maternal and residential census tract sociodemographics, and census tract five-year SDP rate. RESULTS SDP prevalence was 12.7% (white non-Hispanics, WNH), 6.8% (Black/African Americans, AA), 19.5% (Native American, NA), 4.7% (Hispanic, H), and 2.8% (Asian, AS). In WNH and AA, with similar trends in other groups, after adjustment for non-linear effects of maternal age and education and for census tract risk-factors, there was a consistent risk-ordering of SDP rates by reproductive partner relationship: married/with paternity acknowledged < unmarried/acknowledged < unmarried/unacknowledged < married/unacknowledged. Associations with census tract SDP rate, adjusted for maternal and census tract sociodemographics, were stronger for AA and H (OR 2.65-2.67) than for NA (OR = 1.91), WNH (OR = 1.75), or AS (NS). AA SDP was increased in tracts having a higher proportion of WNH residents and was reduced in comparison with WNH at every combination of age, education and partner relationship. CONCLUSIONS Inattention to differences by race/ethnicity may obscure SDP risk factors. Despite marked race/ethnic differences in unmarried-partner cohabitation rates, failure to acknowledge paternity emerged as an important and consistent risk-predictor. Census-tract five-year SDP rates have heterogeneous origins, but the association of AA SDP risk with increased racial heterogeneity suggests an important influence of neighbor risk behaviors.
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Affiliation(s)
- Alexandra N Houston-Ludlam
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid, CB 8134, St. Louis, MO, 63110, USA; Medical Scientist Training Program, Washington University School of Medicine, 660 S Euclid, CB 8226, St. Louis, MO, 63110, USA; Human and Statistical Genetics, Division of Biology and Biomedical Sciences, Washington University School of Medicine, 660 S Euclid, CB 8134, St. Louis, MO, 63110, USA.
| | - Mary Waldron
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid, CB 8134, St. Louis, MO, 63110, USA; School of Education, Indiana University, 201 N. Rose Ave, Bloomington, IN, 47405, USA
| | - Min Lian
- Department of Medicine, Washington University School of Medicine, 660 S Euclid, CB 8134, St. Louis, MO, 63110, USA
| | - Alison G Cahill
- Department of Women's Health, University of Texas at Austin, Dell Medical School, 1301 W 38th St Suite 705, Austin, TX, 78705, USA
| | - Vivia V McCutcheon
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid, CB 8134, St. Louis, MO, 63110, USA
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid, CB 8134, St. Louis, MO, 63110, USA
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid, CB 8134, St. Louis, MO, 63110, USA
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid, CB 8134, St. Louis, MO, 63110, USA
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Maternal health behaviors during pregnancy in rural Northwestern China. BMC Pregnancy Childbirth 2020; 20:745. [PMID: 33256673 PMCID: PMC7708178 DOI: 10.1186/s12884-020-03444-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022] Open
Abstract
Background Maternal health during pregnancy is a key input in fetal health and child development. This study aims to systematically describe the health behaviors of pregnant women in rural China and identify which subgroups of women are more likely to engage in unhealthy behaviors during pregnancy. Methods We surveyed 1088 pregnant women in rural northwestern China on exposure to unhealthy substances, nutritional behaviors, the timing and frequency of antenatal care, and demographic characteristics. Results Pregnant women were active in seeking antenatal care and had low rates of alcohol consumption (5.1%), exposure to toxins (4.8%), and exposure to radiation (2.9%). However, tobacco exposure was widespread (40.3%), as was low dietary diversity (61.8%), unhealthy weight gain (59.7%), unhealthy pre-pregnancy BMI (29.7%), and no folic acid intake (17.1%). Maternal education is closely linked to better health behaviors, whereas experience with a previous pregnancy is not. Conclusions Tobacco exposure and unhealthy nutritional behaviors are common among pregnant women in rural northwestern China. The findings indicate that in the absence of professional health information, relying on experience of previous pregnancies alone may not help rural women avoid unhealthy maternal behaviors. Maternal health education campaigns targeting nutrition and tobacco exposure during pregnancy may improve maternal, fetal, and child health in rural China.
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Implementing a healthy postpartum lifestyle after gestational diabetes or preeclampsia: a qualitative study of the partner's role. BMC Pregnancy Childbirth 2020; 20:66. [PMID: 32005183 PMCID: PMC6995219 DOI: 10.1186/s12884-020-2769-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/27/2020] [Indexed: 01/13/2023] Open
Abstract
Background Women with preeclampsia (PE) and gestational diabetes mellitus (GDM) are at increased risk for later cardiovascular disease, and lifestyle measures are recommended to prevent subsequent disease. Partner support has been shown to be important in lifestyle modification in other diseases, but there is a lack of knowledge of partner involvement in PE and GDM. The aim of this study was to explore the partner’s experiences and knowledge of gestational diseases, and how the partner wishes to contribute to lifestyle change. Methods A qualitative study with one focus group interview and seven in-depth individual interviews, involving eleven partners of women with a pregnancy complicated by GDM or PE. The interview data were inductively analysed using four-step systematic text condensation, supported by interdependence theory. Results Partners experienced a strong “we-feeling” and wanted to support the woman in lifestyle changes. At the same time, they felt insecure, worried, foolish and left out and they missed information from clinicians. The partners felt that their involvement was crucial to lasting lifestyle changes and expected that the clinicians would routinely invite them to discuss lifestyle change. Conclusions Partners considered themselves an important resource for lifestyle changes for women with PE and GDM, but missed being more directly invited, informed and included in maternity care and wanted to participate in the care that followed the gestational disease. This study can help health professionals to realize that partners are an overlooked resource that can make important contributions to improve the health of the whole family if they are involved and supported by health services.
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