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Ussher M, Fleming J, Brose L. Vaping during pregnancy: a systematic review of health outcomes. BMC Pregnancy Childbirth 2024; 24:435. [PMID: 38902658 PMCID: PMC11191278 DOI: 10.1186/s12884-024-06633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Smoking during pregnancy is harmful to maternal and child health. Vaping is used for smoking cessation but evidence on health effects during pregnancy is scarce. We conducted a systematic review of health outcomes of vaping during pregnancy. METHODS We searched six databases for maternal/fetal/infant outcomes and vaping, including quantitative, English language, human studies of vaping during pregnancy, to November 10th, 2023. We assessed study quality with the Mixed-Methods Appraisal Tool. We focused on comparisons of exclusive-vaping with non-use of nicotine and tobacco products and with smoking. Presentation is narrative as the studies were of insufficient quality to conduct meta-analysis. RESULTS We included 26 studies, with 765,527 women, with one randomised controlled trial (RCT) comparing vaping and nicotine replacement therapy for smoking cessation, 23 cohort studies and two case-control studies. While the RCT met 4/5 quality criteria, the quality of the cohort studies and case-control studies was poor; none adequately assessed exposure to smoking and vaping. For studies comparing exclusive-vaping with 'non-use', more reported no increased risk for vaping (three studies) than reported increased risk for maternal pregnancy/postpartum outcomes (one study) and for fetal and infant outcomes (20 studies no increased risk, four increased risk), except for birth-weight and neurological outcomes where two studies each observed increased and no increased risk. When the RCT compared non-users with those not smoking but vaping or using NRT, irrespective of randomisation, they reported no evidence of risk for vaping/NRT. For studies comparing exclusive-vaping and exclusive-smoking, most studies provided evidence for a comparable risk for different outcomes. One maternal biomarker study revealed a lower risk for vaping. For small-for-gestational-age/mean-birth-centile equal numbers of studies found lower risk for vaping than for smoking as found similar risk for the two groups (two each). CONCLUSIONS While more studies found no evidence of increased risk of exclusive-vaping compared with non-use and evidence of comparable risk for exclusive-vaping and exclusive-smoking, the quality of the evidence limits conclusions. Without adequate assessment of exposure to vaping and smoking, findings cannot be attributed to behaviour as many who vape will have smoked and many who vape may do so at low levels. STUDY REGISTRATION https://osf.io/rfx4q/ .
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Affiliation(s)
- Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK.
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK.
| | - Joy Fleming
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK
| | - Leonie Brose
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8BB, UK
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Shorey-Kendrick LE, Davis B, Gao L, Park B, Vu A, Morris CD, Breton CV, Fry R, Garcia E, Schmidt RJ, O’Shea TM, Tepper RS, McEvoy CT, Spindel ER. Development and Validation of a Novel Placental DNA Methylation Biomarker of Maternal Smoking during Pregnancy in the ECHO Program. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:67005. [PMID: 38885141 PMCID: PMC11218700 DOI: 10.1289/ehp13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/27/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Maternal cigarette smoking during pregnancy (MSDP) is associated with numerous adverse health outcomes in infants and children with potential lifelong consequences. Negative effects of MSDP on placental DNA methylation (DNAm), placental structure, and function are well established. OBJECTIVE Our aim was to develop biomarkers of MSDP using DNAm measured in placentas (N = 96 ), collected as part of the Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function double-blind, placebo-controlled randomized clinical trial conducted between 2012 and 2016. We also aimed to develop a digital polymerase chain reaction (PCR) assay for the top ranking cytosine-guanine dinucleotide (CpG) so that large numbers of samples can be screened for exposure at low cost. METHODS We compared the ability of four machine learning methods [logistic least absolute shrinkage and selection operator (LASSO) regression, logistic elastic net regression, random forest, and gradient boosting machine] to classify MSDP based on placental DNAm signatures. We developed separate models using the complete EPIC array dataset and on the subset of probes also found on the 450K array so that models exist for both platforms. For comparison, we developed a model using CpGs previously associated with MSDP in placenta. For each final model, we used model coefficients and normalized beta values to calculate placental smoking index (PSI) scores for each sample. Final models were validated in two external datasets: the Extremely Low Gestational Age Newborn observational study, N = 426 ; and the Rhode Island Children's Health Study, N = 237 . RESULTS Logistic LASSO regression demonstrated the highest performance in cross-validation testing with the lowest number of input CpGs. Accuracy was greatest in external datasets when using models developed for the same platform. PSI scores in smokers only (n = 72 ) were moderately correlated with maternal plasma cotinine levels. One CpG (cg27402634), with the largest coefficient in two models, was measured accurately by digital PCR compared with measurement by EPIC array (R 2 = 0.98 ). DISCUSSION To our knowledge, we have developed the first placental DNAm-based biomarkers of MSDP with broad utility to studies of prenatal disease origins. https://doi.org/10.1289/EHP13838.
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Affiliation(s)
- Lyndsey E. Shorey-Kendrick
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
| | - Brett Davis
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Lina Gao
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- Bioinformatics & Biostatistics Core, Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Byung Park
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- Bioinformatics & Biostatistics Core, Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Health & Science University–Portland State University School of Public Health, Portland, Oregon, USA
| | - Annette Vu
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Cynthia D. Morris
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Rebecca Fry
- Department of Environmental Sciences and Engineering, UNC Gillings School of Public Health, Chapel Hill, North Carolina, USA
| | - Erika Garcia
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Rebecca J. Schmidt
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California, USA
- MIND Institute, School of Medicine, University of California Davis, Davis, California, USA
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Robert S. Tepper
- Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Eliot R. Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
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Clark MM, Cooper S, Naughton F, Ussher M, Emery J, McDaid L, Thomson R, Phillips L, Bauld L, Aveyard P, Torgerson D, Berlin I, Lewis S, Parrott S, Hewitt C, Welch C, Parkinson G, Dickinson A, Sutton S, Brimicombe J, Bowker K, McEwen A, Vedhara K, Coleman T. Smoking, nicotine and pregnancy 2 (SNAP2) trial: protocol for a randomised controlled trial of an intervention to improve adherence to nicotine replacement therapy during pregnancy. BMJ Open 2024; 14:e087175. [PMID: 38806422 PMCID: PMC11138292 DOI: 10.1136/bmjopen-2024-087175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Smoking during pregnancy is harmful to unborn babies, infants and women. Nicotine replacement therapy (NRT) is offered as the usual stop-smoking support in the UK. However, this is often used in insufficient doses, intermittently or for too short a time to be effective. This randomised controlled trial (RCT) explores whether a bespoke intervention, delivered in pregnancy, improves adherence to NRT and is effective and cost-effective for promoting smoking cessation. METHODS AND ANALYSIS A two-arm parallel-group RCT was conducted for pregnant women aged ≥16 years and who smoke ≥1 daily cigarette (pre-pregnancy smoked ≥5) and who agree to use NRT in an attempt to quit. Recruitment is from antenatal care settings and via social media adverts. Participants are randomised using blocked randomisation with varying block sizes, stratified by gestational age (<14 or ≥14 weeks) to receive: (1) usual care (UC) for stop smoking support or (2) UC plus an intervention to increase adherence to NRT, called 'Baby, Me and NRT' (BMN), comprising adherence counselling, automated tailored text messages, a leaflet and website. The primary outcome is biochemically validated smoking abstinence at or around childbirth, measured from 36 weeks gestation. Secondary outcomes include NRT adherence, other smoking measures and birth outcomes. Questionnaires collect follow-up data augmented by medical record information. We anticipate quit rates of 10% and 16% in the control and intervention groups, respectively (risk ratio=1.6). By recruiting 1320 participants, the trial should have 90% power (alpha=5%) to detect this intervention effect. An economic analysis will use the Economics of Smoking in Pregnancy model to determine cost-effectiveness. ETHICS AND DISSEMINATION Ethics approval was granted by Bloomsbury National Health Service's Research Ethics Committee (21/LO/0123). Written informed consent will be obtained from all participants. Findings will be disseminated to the public, funders, relevant practice/policy representatives, researchers and participants. TRIAL REGISTRATION NUMBER ISRCTN16830506. PROTOCOL VERSION 5.0, 10 Oct 2023.
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Affiliation(s)
- Miranda M Clark
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Felix Naughton
- Addiction Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Joanne Emery
- Addiction Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lisa McDaid
- Addiction Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Ross Thomson
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Phillips
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Usher Institute and Behavioural Research UK, The University of Edinburgh, Edinburgh, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ivan Berlin
- Department of Medical Pharmacology, Pitié Salpêtrière Hospital-Sorbonne Université, Paris, France
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Charlie Welch
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Gill Parkinson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Anne Dickinson
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Cambridge Research Methods Hub, University of Cambridge, Cambridge, UK
| | - Katharine Bowker
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew McEwen
- National Centre for Smoking Cessation and Training (NCSCT), Dorchester, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | | | - Tim Coleman
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Authement AK, Isoherranen N. The impact of pregnancy and associated hormones on the pharmacokinetics of Δ 9-tetrahydrocannabinol. Expert Opin Drug Metab Toxicol 2024; 20:73-93. [PMID: 38258511 DOI: 10.1080/17425255.2024.2309213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION (-)-Δ9-tetrahydrocannabinol (THC) is the main psychoactive component of cannabis. Cannabis is the most widely used drug of abuse by pregnant individuals, but its maternal-fetal safety is still unclear. The changes in THC disposition during pregnancy may affect THC safety and pharmacology. AREAS COVERED This review summarizes the current literature on THC metabolism and pharmacokinetics in humans. It provides an analysis of how hormonal changes during pregnancy may alter the expression of cannabinoid metabolizing enzymes and THC and its metabolite pharmacokinetics. THC is predominately (>70%) cleared by hepatic metabolism to its psychoactive active metabolite, 11-OH-THC by cytochrome P450 (CYP) 2C9 and to other metabolites (<30%) by CYP3A4. Other physiological processes that change during pregnancy and may alter cannabinoid disposition are also reviewed. EXPERT OPINION THC and its metabolites disposition likely change during pregnancy. Hepatic CYP2C9 and CYP3A4 are induced in pregnant individuals and in vitro by pregnancy hormones. This induction of CYP2C9 and CYP3A4 is predicted to lead to altered THC and 11-OH-THC disposition and pharmacodynamic effects. More in vitro studies of THC metabolism and induction of the enzymes metabolizing cannabinoids are necessary to improve the prediction of THC pharmacokinetics in pregnant individuals.
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Affiliation(s)
- Aurora K Authement
- Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, WA, USA
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Jackson MA, Brown AL, Baker AL, Bonevski B, Haber P, Bonomo Y, Blandthorn J, Attia J, Perry N, Barker D, Gould GS, Dunlop AJ. Tobacco treatment incorporating contingency management, nicotine replacement therapy, and behavioral counseling for pregnant women who use substances: a feasibility trial. Front Psychiatry 2023; 14:1207955. [PMID: 37654991 PMCID: PMC10467262 DOI: 10.3389/fpsyt.2023.1207955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Most pregnant women with substance use problems smoke, and few will quit during their pregnancy. Tobacco treatment is often overlooked, with the focus usually placed on other substance use. Additionally, few targeted effective treatments for this group exist. To address this, the feasibility of an intensive tobacco treatment incorporating contingency management (CM) that featured non-face-to-face delivery was examined. Methods A single-arm pre-post design feasibility trial was conducted in three antenatal services that support women who use substances in metropolitan Australia. Participants were over the age of 15, had <33-week gestation, and smoked tobacco daily. They received financial incentives for daily carbon monoxide-verified smoking abstinence or reduction through an internet-based CM programme, nicotine replacement therapy (NRT) posted to women and partners or household members who smoked and telephone-delivered behavioral counseling from study enrolment to birth. Results Of the 101 referrals, 46 women (46%) consented. The mean (SD) age was 31(±6) years, and the gestation period was 22(±6) weeks. Nineteen (41%) of those enrolled were retained for 12-week postpartum. Of 46 women, 32 (70%) utilized CM; 32 (70%) used NRT for ≥2 weeks; 23 (50%) attended ≥1 counseling session; and 15 (22%) received NRT for partners/household members. Fifteen (33%) were verified abstinent from tobacco at delivery after a median (IQR) period of abstinence of 65(36-128) days. All non-smokers at birth utilized NRT and financial incentives, and 9/15 (60%) utilized counseling. Four (9%) were abstinent at 12-week postpartum. Median cigarettes smoked/day reduced from baseline to delivery (10(6-20) to 1(0-6) p =< 0.001). Women who quit smoking had more education (72% vs. 33% p =< 0.02), completed more CO samples (median (IQR) 101(59-157) vs. 2(0-20) p =< 0.001), and received more incentives (median (IQR) $909($225-$1980) vs. $34($3-$64) p =< 0.001). Intervention acceptability was rated favorably by participants (9 items rated 0-10 with scores >5 considered favorable). Discussion This study demonstrated the feasibility and acceptability of a consumer-informed, non-face-to-face intensive tobacco treatment, highlighting the potential of remotely delivered technology-based CM to reduce the health impact of tobacco smoking in high-priority populations. The intervention demonstrates scale-up potential. Future studies should extend treatment into the postpartum period, utilizing new technologies to enhance CM delivery and improve counseling provision and partner support. Clinical trial registration https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374196, ACTRN1261800056224.
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Affiliation(s)
- Melissa A. Jackson
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
| | - Amanda L. Brown
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Paul Haber
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
- Edith Collins Centre, Sydney Local Health District, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Yvonne Bonomo
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Julie Blandthorn
- Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia
| | - John Attia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Natasha Perry
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
| | - Daniel Barker
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Gillian S. Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Adrian J. Dunlop
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
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Przulj D, Pesola F, Myers Smith K, McRobbie H, Coleman T, Lewis S, Griffith C, Walton R, Whitemore R, Clark M, Ussher M, Sinclair L, Seager E, Cooper S, Bauld L, Naughton F, Sasieni P, Manyonda I, Hajek P. Helping pregnant smokers quit: a multi-centre randomised controlled trial of electronic cigarettes versus nicotine replacement therapy. Health Technol Assess 2023; 27:1-53. [PMID: 37840301 PMCID: PMC10599072 DOI: 10.3310/agth6901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background Some pregnant smokers try e-cigarettes, but effectiveness and safety of such use are unknown. Objectives To compare effectiveness and safety of nicotine patches and e-cigarettes in pregnancy. Design A pragmatic multi-centre randomised controlled trial. Setting Twenty-three hospitals across England, and a Stop Smoking Service in Scotland. Participants One thousand one hundred and forty pregnant daily smokers (12-24 weeks' gestation) motivated to stop smoking, with no strong preference for using nicotine patches or e-cigarettes. Interventions Participants in the e-cigarette arm were posted a refillable e-cigarette device with two 10 ml bottles of tobacco-flavoured e-liquid (18 mg nicotine). Participants in the nicotine patches arm were posted a 2-week supply of 15 mg/16-hour nicotine patches. Supplies were provided for up to 8 weeks. Participants sourced further supplies themselves as needed. Participants in both arms received support calls prior to their target quit date, on the quit date, and weekly for the next 4 weeks. Outcome measures The primary outcome was validated prolonged abstinence at the end of pregnancy. Participants lost to follow-up or not providing biochemical validation were included as non-abstainers. Secondary outcomes included self-reported abstinence at different time points, treatment adherence and safety outcomes. Results Only 55% of self-reported abstainers mailed back useable saliva samples. Due to this, validated sustained abstinence rates were low (6.8% vs. 4.4% in the e-cigarettes and nicotine patches arms, respectively, risk ratio = 1.55, 95% confidence interval 0.95 to 2.53; Bayes factor = 2.7). In a pre-specified sensitivity analysis that excluded abstainers using non-allocated products, the difference became significant (6.8% vs. 3.6%, risk ratio = 1.93, 95% confidence interval 1.14 to 3.26; Bayes factor = 10). Almost a third of the sample did not set a target quit date and the uptake of support calls was low, as was the initial product use. At end of pregnancy, 33.8% versus 5.6% of participants were using their allocated product in the e-cigarettes versus nicotine patches arm (risk ratio = 6.01, 95% confidence interval 4.21 to 8.58). Regular use of e-cigarettes in the nicotine patches arm was more common than use of nicotine replacement products in the e-cigarette arm (17.8% vs. 2.8%). Rates of adverse events and adverse birth outcomes were similar in the two study arms, apart from participants in the e-cigarette arm having fewer infants with low birthweight (<2500 g) (9.6% vs. 14.8%, risk ratio = 0.65, 95% confidence interval 0.47 to 0.90; Bayes factor = 10.3). Limitations Low rates of validation reduced the study power. A substantial proportion of participants did not use the support on offer sufficiently to test its benefits. Sample size may have been too small to detect differences in less frequent adverse effects. Conclusions E-cigarettes were not significantly more effective than nicotine patches in the primary analysis, but when e-cigarettes use in the nicotine patches arm was accounted for, e-cigarettes were almost twice as effective as patches in all abstinence outcomes. In pregnant smokers seeking help, compared to nicotine patches, e-cigarettes are probably more effective, do not pose more risks to birth outcomes assessed in this study and may reduce the incidence of low birthweight. Future work Routine monitoring of smoking cessation and birth outcomes in pregnant women using nicotine patches and e-cigarettes and further studies are needed to confirm these results. Trial registration This trial is registered as ISRCTN62025374 and Eudract 2017-001237-65. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Dunja Przulj
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Katie Myers Smith
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Christopher Griffith
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Robert Walton
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Miranda Clark
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK; Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Lesley Sinclair
- Usher Institute and SPECTRUM Consortium, Centre for Population Health Sciences, Old Medical School, Edinburgh, UK
| | - Emily Seager
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sue Cooper
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, Centre for Population Health Sciences, Old Medical School, Edinburgh, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Peter Sasieni
- The Cancer Research UK and King's College London Cancer Prevention Trials Unit, King's College London, Institute of Psychiatry, London, UK
| | - Isaac Manyonda
- St George's University Hospital NHS Foundation Trust, London, UK
| | - Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Fuemmeler BF, Glasgow TE, Schechter JC, Maguire R, Sheng Y, Bidopia T, Barsell DJ, Ksinan A, Zhang J, Lin Y, Hoyo C, Murphy S, Qin J, Wang X, Kollins S. Prenatal and Childhood Smoke Exposure Associations with Cognition, Language, and Attention-Deficit/Hyperactivity Disorder. J Pediatr 2023; 256:77-84.e1. [PMID: 36513211 PMCID: PMC10962780 DOI: 10.1016/j.jpeds.2022.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/09/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the relationships of prenatal and childhood smoke exposure with specific neurodevelopmental and behavioral problems during early childhood. STUDY DESIGN A subsample (n = 386) of mother-child dyads from the Newborn Epigenetic Study (NEST) prebirth cohort participated in the study. Cotinine concentrations were used to objectively measure prenatal and childhood smoke exposure when youth were aged 3-13 years. Multivariable regression models were used to estimate associations of prenatal and childhood cotinine concentrations with performance on the National Institutes of Health (NIH) Toolbox and attention-deficit/hyperactivity disorder and behavioral symptoms, measured using the Behavior Assessment System for Children, 2nd edition (BASC-2). RESULTS After adjusting for confounders, childhood cotinine concentrations were associated with poorer cognitive performance on tasks measuring cognitive flexibility (B = -1.29; P = .03), episodic memory (B = -0.97; P = .02), receptive language development (B = -0.58; P = .01), and inhibitory control and attention (B = -1.59; P = .006). Although childhood cotinine concentration was associated with higher levels of attention problems (B = 0.83; P = .004) on the BASC-2, after adjustment for confounders, the association is nonsignificant. Although associations for maternal cotinine concentrations were null, an interaction was detected between prenatal and childhood cotinine concentrations on the NIH Toolbox Picture Vocabulary Task (P = .02). CONCLUSIONS Our findings suggest that childhood tobacco smoke exposure may lead to poorer attention regulation and language acquisition, complex visual processing ability, and attention problems.
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Affiliation(s)
- Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA.
| | - Trevin E Glasgow
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Julia C Schechter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Rachel Maguire
- Department of Biological Sciences, North Carolina State University, Raleigh, NC; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC
| | | | - Tatyana Bidopia
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - D Jeremy Barsell
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Albert Ksinan
- Research Center for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Junfeng Zhang
- Nicholas School of the Environment, Duke University, Durham, NC
| | - Yan Lin
- Nicholas School of the Environment, Duke University, Durham, NC
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC
| | - Susan Murphy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Jian Qin
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Xiangtian Wang
- Nicholas School of the Environment, Duke University, Durham, NC
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Pizzi G, Mazzola SM, Pecile A, Bronzo V, Groppetti D. Tobacco Smoke Exposure in Pregnant Dogs: Maternal and Newborn Cotinine Levels: A Pilot Study. Vet Sci 2023; 10:vetsci10050321. [PMID: 37235404 DOI: 10.3390/vetsci10050321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Active and passive smoking in pregnant women is associated with perinatal morbidity and mortality risk, including abortion, preterm birth, low birthweight, and malformations. No data are available on intrauterine exposure to smoking during pregnancy in dogs. This study aimed to fill this gap by exploring the detectability and quantity of cotinine, the major metabolite of nicotine, in maternal (serum and hair) and newborn (amniotic fluid and hair) biospecimens collected at birth in dogs. For this purpose, twelve pregnant bitches, six exposed to the owner's smoke and six unexposed, were enrolled. A further six non-pregnant bitches exposed to passive smoke were included to investigate the role of pregnancy status on cotinine uptake. Exposed dogs, dams, and puppies had greater cotinine concentrations than unexposed ones. Although without statistical significance, serum and hair cotinine concentrations were higher in pregnant compared to non-pregnant bitches, suggesting a different sensitivity to tobacco smoke exposure during gestation. The present results provide evidence for cotinine transplacental passage in the dog. It is conceivable that fragile patients such as pregnant, lactating, and neonate dogs may be more susceptible to the harmful effects of second-hand smoke exposure. Owners should be sensitized to the risk of smoke exposure for their pets.
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Affiliation(s)
- Giulia Pizzi
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Silvia Michela Mazzola
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Alessandro Pecile
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Valerio Bronzo
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Debora Groppetti
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
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9
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Emery J, Huang Y, Naughton F, Cooper S, McDaid L, Dickinson A, Clark M, Kinahan-Goodwin D, Thomson R, Phillips L, Lewis S, Coleman T. Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy Among Pregnant Women: Observational Study. JMIR Form Res 2023; 7:e35045. [PMID: 36881452 PMCID: PMC10031440 DOI: 10.2196/35045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have investigated how to best measure adherence to smoking cessation medications, but continuous usage measures are recommended. OBJECTIVE In this first study of its kind, we compared methods for measuring adherence to nicotine replacement therapy (NRT) among pregnant women, investigating the completeness and validity of data collected from daily assessments using a smartphone app versus data collected from retrospective questionnaires. METHODS Women aged ≥16 years who were daily smokers and <25 weeks pregnant were offered smoking-cessation counseling and encouraged to use NRT. For 28 days after setting a quit date (QD), women were asked to report NRT use daily to a smartphone app and to questionnaires administered in person or remotely at 7 and 28 days. For both data collection methods, we provided up to £25 (~US $30) as compensation for the time taken providing research data. Data completeness and NRT use reported to the app and in questionnaires were compared. For each method, we also correlated mean daily nicotine doses reported within 7 days of the QD with Day 7 saliva cotinine concentrations. RESULTS Of the 438 women assessed for eligibility, 40 participated and 35 accepted NRT. More participants (31/35) submitted NRT usage data to the app by Day 28 (median 25, IQR 11 days) than completed the Day 28 questionnaire (24/35) or either of the two questionnaires (27/35). Data submitted to the app showed a lower reported duration of NRT use compared to that indicated in the questionnaire (median for app 24 days, IQR 10.25; median for questionnaire 28 days, IQR 4.75; P=.007), and there appeared to be specific cases of overreporting to the questionnaire. Mean daily nicotine doses between the QD and Day 7 were lower when calculated using app data (median for app 40 mg, IQR 52.1; median for questionnaire 40 mg, IQR 63.1; P=.001), and some large outliers were evident for the questionnaire. Mean daily nicotine doses, adjusted for cigarettes smoked, were not associated with cotinine concentrations for either method (app rs=0.184, P=.55; questionnaire rs=0.031, P=.92), but the small sample size meant that the analysis was likely underpowered. CONCLUSIONS Daily assessment of NRT use via a smartphone app facilitated more complete data (a higher response rate) than questionnaires, and reporting rates over 28 days were encouraging among pregnant women. App data had better face validity; retrospective questionnaires appeared to overestimate NRT use for some participants.
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Affiliation(s)
- Joanne Emery
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Yue Huang
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Sue Cooper
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Lisa McDaid
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Anne Dickinson
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Miranda Clark
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Darren Kinahan-Goodwin
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
- Adult Social Care and Health, Derbyshire County Council, Matlock, United Kingdom
| | - Ross Thomson
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Lucy Phillips
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Tim Coleman
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
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10
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Latour M, Lal D, Yim MT. Sex Differences in Airway Diseases. Otolaryngol Clin North Am 2023; 56:55-63. [DOI: 10.1016/j.otc.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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Piloting a complex intervention to promote a tobacco and alcohol-free pregnancy: the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study. BMC Pregnancy Childbirth 2023; 23:19. [PMID: 36627569 PMCID: PMC9830616 DOI: 10.1186/s12884-022-05320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Tobacco smoking and alcohol consumption before and during pregnancy increase the risk of adverse health outcomes for mother and child. Interventions to address smoking and drinking before and during pregnancy have the potential to reduce early-life health inequalities. In the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pilot study we aimed to evaluate the acceptability, feasibility and effectiveness of a complex intervention supporting women in smoking and alcohol cessation before and during pregnancy. METHODS From February 2019 till March 2021, we piloted the SAFER pregnancy intervention among pregnant women and women planning pregnancy in South-West Netherlands in an uncontrolled before-after study. Participants were supported in smoking and alcohol cessation via up to six group sessions and an online platform. In addition, biochemically validated cessation was rewarded with incentives (i.e. shopping vouchers) amounting up to 185 euros. We aimed to include 66 women. The primary outcome was smoking and/or alcohol cessation at 34-38 weeks of gestation (if pregnant) or after six group sessions (if not pregnant). Quantitative data were analysed using descriptive statistics. Focus group interviews among those involved in the study were conducted at the end of the study to explore their experiences. Qualitative data was analysed using thematic analysis. RESULTS Thirty-nine women who smoked were included; no women who consumed alcohol were referred to the study. Unemployment (51%), financial problems (36%) and a smoking partner (72%) were common. Thirteen women (33%) dropped out, often due to other problems impeding smoking cessation or 'being too busy' to participate in the group sessions. Eleven women (28%) had quit smoking at the study's endpoint. The personal and positive approach was highly valued and biochemical validation was felt to be helpful. CONCLUSION The SAFER pregnancy intervention seems appropriate for women in need of extra support for smoking cessation before and during pregnancy. Its impact on alcohol cessation could not be studied due to recruitment issues. Recruitment and prevention of early dropout need attention in further development of this intervention. TRIAL REGISTRATION Netherlands Trial Register: NL7493. Date registered: 04/02/2019.
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12
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Morales-Suárez-Varela M, Puig BM, Kaerlev L, Peraita-Costa I, Perales-Marín A. Safety of Nicotine Replacement Therapy during Pregnancy: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:250. [PMID: 36612572 PMCID: PMC9819948 DOI: 10.3390/ijerph20010250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Smoking during pregnancy is a public health problem worldwide and the leading preventable cause of fetal morbidity and mortality and obstetric disease. Although the risk of tobacco-related harm can be substantially reduced if mothers stop smoking in the first trimester, the proportion of women who do so remains modest; therefore, the treatment of smoking in pregnant women will be the first therapeutic measure that health professionals should adopt when providing care to pregnant women. The recommendation of nicotine replacement therapy during pregnancy remains controversial due to the potential effects on the health of the fetus. PURPOSE The aim of this review was to provide an overview of human studies about the use of nicotine replacement therapy during pregnancy, evaluating the efficacy and safety of the different formulations. METHODS The electronic databases PubMed and EMBASE were searched from May 2012 to May 2022. A total of 95 articles were identified through database searching using a combination of keywords. Out of 79 screened articles and after the removal of duplicates, 28 full-text articles were assessed for eligibility and 12 articles were finally included for review. RESULTS Although demonstrated to be effective in adult smokers, evidence in support of NRT in pregnant women is limited. The results of the apparent safety of the use of NRT during pregnancy contradict the FDA classification of the different NRT formulations. Faster-acting formulations seem to be the safest and even most beneficial forms for the offspring. CONCLUSIONS NRT is not completely harmless for the fetus or for the mother; however, if an adequate assessment of the risk-benefit binomial is made, its use during pregnancy to aid in quitting smoking does seem appropriate. It is necessary to establish individual recommendations on the formulation and dose to be used during pregnancy based on individual nicotinic needs.
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Affiliation(s)
- María Morales-Suárez-Varela
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, University of Valencia, Av. Vicente Andrés Estellés s/n, 46100 Burjassot, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3–5 Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Beatriz Marcos Puig
- Department of Obstetrics, La Fe University Hospital, Av. Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Linda Kaerlev
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark
- Research Unit of Clinical Epidemiology, Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216 Ground Floor East, 5000 Odense, Denmark
| | - Isabel Peraita-Costa
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, University of Valencia, Av. Vicente Andrés Estellés s/n, 46100 Burjassot, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3–5 Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Alfredo Perales-Marín
- Department of Obstetrics, La Fe University Hospital, Av. Fernando Abril Martorell 106, 46026 Valencia, Spain
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13
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Blostein FA, Fisher J, Dou J, Schneper L, Ware EB, Notterman DA, Mitchell C, Bakulski KM. Polymethylation scores for prenatal maternal smoke exposure persist until age 15 and are detected in saliva in the Fragile Families and Child Wellbeing cohort. Epigenetics 2022; 17:2223-2240. [PMID: 35980258 PMCID: PMC9665138 DOI: 10.1080/15592294.2022.2112815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023] Open
Abstract
Prenatal maternal smoking is associated with low birthweight, neurological disorders, and asthma in exposed children. DNA methylation signatures can function as biomarkers of prenatal smoke exposure. However, the robustness of DNA methylation signatures across child ages, genetic ancestry groups, or tissues is not clear. Using coefficients from a meta-analysis of prenatal smoke exposure and DNA methylation in newborn cord blood, we created polymethylation scores of saliva DNA methylation from children at ages 9 and 15 in the Fragile Families and Child Wellbeing study. In the full sample at age 9 (n = 753), prenatal smoke exposure was associated with a 0.51 (95%CI: 0.35, 0.66) standard deviation higher polymethylation score. The direction and magnitude of the association was consistent in European and African genetic ancestry samples. In the full sample at age 15 (n = 747), prenatal smoke exposure was associated with a 0.48 (95%CI: 0.32, 0.63) standard deviation higher polymethylation score, and the association was attenuated among the European and Admixed-Latin genetic ancestry samples. The polymethylation score classified prenatal smoke exposure accurately (AUC age 9 = 0.77, age 15 = 0.76). Including the polymethylation score increased the AUC of base model covariates by 5 (95% CI: (2.1, 7.2)) percentage points, while including a single candidate site in the AHRR gene did not (P-value = 0.19). Polymethylation scores for prenatal smoking were portable across genetic ancestries and more accurate than an individual DNA methylation site. Polymethylation scores from saliva samples could serve as robust and practical biomarkers of prenatal smoke exposure.
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Affiliation(s)
- Freida A. Blostein
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jonah Fisher
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - John Dou
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Lisa Schneper
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
| | - Erin B. Ware
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
| | - Daniel A. Notterman
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly M. Bakulski
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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14
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Ratsch A, Bogossian F, Burmeister EA, Ryu B, Steadman KJ. Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for Central Australian Aboriginal pregnancies. BMC Public Health 2022; 22:2157. [DOI: 10.1186/s12889-022-14609-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
In central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships between maternal self-reported tobacco use and maternal and neonatal outcomes.
Methods
Central Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites.
Results
A sample of 73 women were enrolled who self-reported: no-tobacco use (n = 31), tobacco chewing (n = 19), or smoking (n = 23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group.
Conclusions
This research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in a wide range of maternal and neonatal biological samples and that exposure may be associated with adverse maternal and neonatal outcomes. Screening for the use of all tobacco and nicotine products during pregnancy rather than focusing solely on smoking would provide a more comprehensive assessment and contribute to a more accurate determination of tobacco and nicotine exposure. This knowledge will better inform maternal and foetal care, direct attention to targeted cessation strategies and ultimately improve long-term clinical outcomes, not only in this vulnerable population, but also for the wider population.
Note to readers
In this research, the central Australian Aboriginal women chose the term ‘Aboriginal’ to refer to themselves, and ‘Indigenous’ to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.
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15
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Oh S, Kim S, Sung E, Kim CH, Kang JH, Shin H, Cho IY. The association between cotinine-measured smoking
intensity and sleep quality. Tob Induc Dis 2022; 20:77. [PMID: 36118556 PMCID: PMC9443078 DOI: 10.18332/tid/152221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/29/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION METHODS RESULTS CONCLUSIONS
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Affiliation(s)
- Supa Oh
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sinae Kim
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eunju Sung
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-Hwan Kim
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hocheol Shin
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Young Cho
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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16
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Britton GR, Collier R, Rhodes Keefe JM, Gallagher WF, Feeney A, Sprague LM, James GD. The Development and Testing of a Perinatal Tobacco Attitudes and Behaviors Survey. J Nurs Meas 2022; 30:419-432. [PMID: 34518426 DOI: 10.1891/jnm-d-20-00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Accurate assessment of tobacco use in pregnant smokers is key to effective nursing intervention. There is a lack of valid and reliable tools easily integrated into prenatal care. Therefore, the purpose of this study was to develop and test a perinatal survey, guided by the Health Promotion Model (HPM). Methods: The survey was tested with 107 pregnant women via iPad. Urine cotinine assays and a process evaluation were conducted. Results: Reliability yielded a Cronbach's alpha of .873 for the ever-smoker sample and .835 for the total sample. Factors dovetailed with HPM constructs. Conclusions: Perinatal Tobacco Attitudes and Behaviors Survey (PTABS) exhibits high reliability and validity and is easily utilized. Updates need to include questions on all nicotine products and to be streamlined. With accurate identification of nicotine users nurses can provide targeted interventions early in pregnancy.
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Affiliation(s)
| | - Rosemary Collier
- Binghamton University, State University of New York, Binghamton, New York
| | | | - Wendi F Gallagher
- Binghamton University, State University of New York, Binghamton, New York
| | - Ann Feeney
- University of Scranton, Scranton, Pennsylvania
| | - Lori M Sprague
- Binghamton University, State University of New York, Binghamton, New York
| | - Gary D James
- Binghamton University, State University of New York, Binghamton, New York
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17
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Pereira Júnior AA, de Amorim GES, Garcia RCT, Ribeiro JM, Silva AO, Almeida CADF, Ceron CS, Ruginsk SG, Antunes-Rodrigues J, Elias LLK, Dias MVS, Marcourakis T, Torres LH. Nicotine exposure through breastfeeding affects BDNF and synaptic proteins levels in the brain of stressed adult female mice. Int J Dev Neurosci 2022; 82:759-771. [PMID: 36018565 DOI: 10.1002/jdn.10227] [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: 05/29/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
Nicotine has been used during pregnancy and lactation as a tobacco harm reduction strategy. However, it is unclear whether nicotine exposure during a critical development period negatively impacts stress responses in adulthood. This study investigated how nicotine, administered via breastfeeding, affects the brain-derived neurotrophic factor (BDNF), synaptic proteins levels, and anxiety-like behavior in adult female mice subjected to stress. Female Swiss mice were exposed to saline or nicotine (8 mg/kg/day) through breastfeeding between their fourth and 17th postnatal days (P) via implanted osmotic mini pumps. The unpredictable chronic mild stress (UCMS) protocol was performed during their adulthood (P65) for 10 consecutive days, followed by the elevated plus maze (EPM) test one day after the protocol. Animals were euthanized and their blood, collected for plasma corticosterone measurements and their brain structures, dissected for BDNF and synaptic proteins analyses. We found no significant differences in corticosterone levels between groups (Saline/Non-stress, Nicotine/Non-stress, Saline/Stress, and Nicotine/Stress). The UCMS protocol hindered weight gain. Mice exposed to nicotine through breastfeeding with or without the UCMS protocol in adulthood showed higher grooming and head dipping frequency; decreased BDNF levels in cerebellum and striatum; increased postsynaptic density protein 95 (PSD-95), synapsin I, and synaptophysin levels in cerebellum; and decreased PSD-95 and synapsin I levels in brainstem. Our results indicate that nicotine exposure through breastfeeding leads to long-lasting behavioral effects and synaptic protein changes, most of which were independent of the UCMS protocol, even after a long nicotine-free period, highlighting the importance of further studies on nicotine exposure during development.
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Affiliation(s)
- Antonio Alves Pereira Júnior
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | | | - Raphael Caio Tamborelli Garcia
- Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo Diadema, São Paulo, Brazil
| | - Jéssyca Milene Ribeiro
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Alessandra Oliveira Silva
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | | | - Carla Speroni Ceron
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Silvia Graciela Ruginsk
- Department of Physiological Sciences, Biomedical Sciences Institute, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - José Antunes-Rodrigues
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucila Leico Kagohara Elias
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Tania Marcourakis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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18
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Hajek P, Przulj D, Pesola F, Griffiths C, Walton R, McRobbie H, Coleman T, Lewis S, Whitemore R, Clark M, Ussher M, Sinclair L, Seager E, Cooper S, Bauld L, Naughton F, Sasieni P, Manyonda I, Myers Smith K. Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial. Nat Med 2022; 28:958-964. [PMID: 35577966 PMCID: PMC9117131 DOI: 10.1038/s41591-022-01808-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/31/2022] [Indexed: 01/26/2023]
Abstract
Nicotine replacement therapy, in the form of nicotine patches, is commonly offered to pregnant women who smoke to help them to stop smoking, but this approach has limited efficacy in this population. Electronic cigarettes (e-cigarettes) are also used by pregnant women who smoke but their safety and efficacy in pregnancy are unknown. Here, we report the results of a randomized controlled trial in 1,140 participants comparing refillable e-cigarettes with nicotine patches. Pregnant women who smoked were randomized to e-cigarettes (n = 569) or nicotine patches (n = 571). In the unadjusted analysis of the primary outcome, validated prolonged quit rates at the end of pregnancy in the two study arms were not significantly different (6.8% versus 4.4% in the e-cigarette and patch arms, respectively; relative risk (RR) = 1.55, 95%CI: 0.95-2.53, P = 0.08). However, some participants in the nicotine patch group also used e-cigarettes during the study. In a pre-specified sensitivity analysis excluding abstinent participants who used non-allocated products, e-cigarettes were more effective than patches (6.8% versus 3.6%; RR = 1.93, 95%CI: 1.14-3.26, P = 0.02). Safety outcomes included adverse events and maternal and birth outcomes. The safety profile was found to be similar for both study products, however, low birthweight (<2,500 g) was less frequent in the e-cigarette arm (14.8% versus 9.6%; RR = 0.65, 95%CI: 0.47-0.90, P = 0.01). Other adverse events and birth outcomes were similar in the two study arms. E-cigarettes might help women who are pregnant to stop smoking, and their safety for use in pregnancy is similar to that of nicotine patches. ISRCTN62025374.
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Affiliation(s)
- Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Dunja Przulj
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Chris Griffiths
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Robert Walton
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Coleman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rachel Whitemore
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Miranda Clark
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Division of Population Heath Sciences and Education, St Georges, University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Lesley Sinclair
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Emily Seager
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sue Cooper
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Peter Sasieni
- The Cancer Research UK and King's College London Cancer Prevention Trials Unit, King's College, London, UK
| | | | - Katie Myers Smith
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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19
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Yamasaki K, Mitsuda N, J-P NA, Eitoku M, Maeda N, Fujieda M, Suganuma N. Dose-response relationships between maternal urinary cotinine and placental weight and ratio of placental weight to birth weight: The Japan Environment and Children's Study. ENVIRONMENTAL RESEARCH 2022; 205:112470. [PMID: 34883079 DOI: 10.1016/j.envres.2021.112470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Studies on the relationship between maternal self-reported smoking status and placental weight report inconsistent results. This study examined the relationships between maternal urinary cotinine concentration and placental weight and the ratio of placental weight to birth weight (PW/BW ratio). The study also examined the relationship between maternal smoking status, as determined by cotinine concentration, with placental weight and with PW/BW ratio, stratified by sex of offspring. METHODS Our analysis used information of 91,049 mother-child pairs enrolled in the Japan Environment and Children's Study. Maternal urinary cotinine concentration was quantified (during the second or third trimester) with high-performance liquid chromatography-tandem mass spectrometry. Using restricted cubic splines, placental weight and PW/BW ratio were plotted against natural log-transformed cotinine concentration. Taking cotinine levels of <0.17 ng/mL, 0.17 to <21.5 ng/mL (natural log-transformed values, -1.77 to 3.07), and ≥21.5 ng/mL as indicative of non-smokers, passive smokers, and active smokers, respectively, the relationships between maternal smoking status and placental weight and PW/BW ratio were examined, adjusting for confounders. RESULTS Placental weight and PW/BW ratio increased with increasing cotinine concentration. After cotinine reached a certain concentration, the placental weight decreased in male offspring whereas it plateaued in female offspring. Compared with not smoking, active smoking during pregnancy significantly increased placental weight and PW/BW ratio. CONCLUSION Placental weight responded as an inverted U-shape whereas the PW/BW ratio followed a J-shape with increasing maternal urinary cotinine concentration measured during pregnancy, suggesting exposure to tobacco smoke induces a disproportionate reduction in fetal growth. The effect of tobacco smoke on placental growth varied by sex of offspring.
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Affiliation(s)
- Keiko Yamasaki
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan
| | - Naomi Mitsuda
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan
| | - Naw Awn J-P
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan
| | - Masamitsu Eitoku
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan.
| | - Nagamasa Maeda
- Department of Obstetrics and Gynecology, Kochi Medical School, Kochi University, Japan
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan
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20
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Maternal nicotine metabolism moderates the impact of maternal cigarette smoking on infant birth weight: A Collaborative Perinatal Project investigation. Drug Alcohol Depend 2022; 233:109358. [PMID: 35247723 PMCID: PMC8977115 DOI: 10.1016/j.drugalcdep.2022.109358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Maternal cigarette smoking is an important modifiable risk factor for low birth weight in the US. We investigated the maternal nicotine metabolite ratio (NMR; trans-3'-hydroxycotinine/cotinine) - a genetically-informed biomarker of nicotine clearance - as a moderator of links between prenatal cigarette use and birth weight. We also explored the role of race in these associations. METHODS Participants were 454 pregnant women (Mage = 25 years; 11% Black) who smoked cigarettes and their 537 infants from the Collaborative Perinatal Project. Cigarettes smoked per day were assessed at each prenatal visit; maternal NMR was assayed from third trimester serum. Birth weight was obtained from medical records. Generalized estimating equations were used to evaluate associations between cigarette smoking, NMR, race, and birth weight. RESULTS NMR moderated continuous associations between cigarettes per day over pregnancy and infant birth weight (p = .025). Among women who smoked at moderate levels (<15 cigarettes per day), those with slower NMR showed ~50-100 g decrements in birth weight versus those with faster NMR., while there were no significant associations between NMR and birth weight among women who smoked 15+ cigarettes per day. Although effects of NMR on birthweight were similar for Black and white women, Black women showed significantly slower NMR (p < .001). CONCLUSIONS This is the first demonstration that the maternal nicotine metabolism phenotype moderates associations between maternal smoking during pregnancy and birth weight. Infants of women with slower nicotine metabolism - including disproportionate representation of Black women - may be at heightened risk for morbidity from maternal smoking.
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21
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Slaich B, Claire R, Emery J, Lewis S, Cooper S, Thomson R, Phillips L, Kinahan‐Goodwin D, Naughton F, McDaid L, Clark M, Dickinson A, Coleman T. Comparison of saliva cotinine and exhaled carbon monoxide concentrations when smoking and after being offered dual nicotine replacement therapy in pregnancy. Addiction 2022; 117:751-759. [PMID: 34427009 PMCID: PMC9290515 DOI: 10.1111/add.15671] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Although English Stop Smoking Services routinely offer dual nicotine replacement therapy (NRT) to help pregnant women to quit smoking, little is known about how nicotine and tobacco smoke exposures following this compare with that from smoking. We compared, in pregnant women when smoking and after being offered dual NRT, saliva cotinine and exhaled carbon monoxide (CO) concentrations and numbers of daily cigarettes smoked. DESIGN AND SETTING Secondary analysis of data from three sequential, observational, mixed-methods cohort studies conducted as part of the Nicotine Replacement Effectiveness and Delivery in Pregnancy programme. Participants were recruited on-line or in Nottingham University Hospitals (UK) antenatal clinics between June 2019 and September 2020. PARTICIPANTS Forty pregnant women, who agreed to try stopping smoking. INTERVENTION Participants were offered dual NRT, agreed a smoking quit date and received an intervention to improve adherence to NRT. MEASUREMENTS Saliva cotinine and exhaled CO concentrations and reported number of cigarettes smoked per day. FINDINGS There were no differences in saliva cotinine concentrations at baseline and day 7 post quit date [n = 20, mean difference = -32.31 ng/ml, 95% confidence interval (CI) = -68.11 to 3.5 ng/ml; P = 0.074, Bayes factor = 0.04]. There were reductions in the reported number of cigarettes smoked per day (n = 26, mean difference = -7 cigarettes, 95% CI = -8.35 to -5.42 cigarettes, P < 0.001) and concurrently in exhaled CO concentrations (n = 17, ratio of geometric means = 0.30 p.p.m., 95% CI = 0.17-0.52 p.p.m.; P < 0.001). CONCLUSION Pregnant women who smoke and are offered dual nicotine replacement therapy (NRT) appear to show no change in their exposure to cotinine compared with their pre-NRT exposure levels but they report smoking fewer cigarettes, as validated by reductions in exhaled carbon monoxide concentrations.
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Affiliation(s)
| | - Ravinder Claire
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Joanne Emery
- School of Health SciencesUniversity of East AngliaNorwichUK
| | - Sarah Lewis
- Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Sue Cooper
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Ross Thomson
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Lucy Phillips
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | | | - Felix Naughton
- School of Health SciencesUniversity of East AngliaNorwichUK
| | - Lisa McDaid
- School of Health SciencesUniversity of East AngliaNorwichUK
| | - Miranda Clark
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Anne Dickinson
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Tim Coleman
- Division of Primary CareUniversity of NottinghamNottinghamUK
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22
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Archie SR, Sharma S, Burks E, Abbruscato T. Biological determinants impact the neurovascular toxicity of nicotine and tobacco smoke: A pharmacokinetic and pharmacodynamics perspective. Neurotoxicology 2022; 89:140-160. [PMID: 35150755 PMCID: PMC8958572 DOI: 10.1016/j.neuro.2022.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/30/2022] [Accepted: 02/05/2022] [Indexed: 01/01/2023]
Abstract
Accumulating evidence suggests that the detrimental effect of nicotine and tobacco smoke on the central nervous system (CNS) is caused by the neurotoxic role of nicotine on blood-brain barrier (BBB) permeability, nicotinic acetylcholine receptor expression, and the dopaminergic system. The ultimate consequence of these nicotine associated neurotoxicities can lead to cerebrovascular dysfunction, altered behavioral outcomes (hyperactivity and cognitive dysfunction) as well as future drug abuse and addiction. The severity of these detrimental effects can be associated with several biological determinants. Sex and age are two important biological determinants which can affect the pharmacokinetics and pharmacodynamics of several systemically available substances, including nicotine. With regard to sex, the availability of gonadal hormone is impacted by the pregnancy status and menstrual cycle resulting in altered metabolism rate of nicotine. Additionally, the observed lower smoking cessation rate in females compared to males is a consequence of differential effects of sex on pharmacokinetics and pharmacodynamics of nicotine. Similarly, age-dependent alterations in the pharmacokinetics and pharmacodynamics of nicotine have also been observed. One such example is related to severe vulnerability of adolescence towards addiction and long-term behavioral changes which may continue through adulthood. Considering the possible neurotoxic effects of nicotine on the central nervous system and the deterministic role of sex as well as age on these neurotoxic effects of smoking, it has become important to consider sex and age to study nicotine induced neurotoxicity and development of treatment strategies for combating possible harmful effects of nicotine. In the future, understanding the role of sex and age on the neurotoxic actions of nicotine can facilitate the individualization and optimization of treatment(s) to mitigate nicotine induced neurotoxicity as well as smoking cessation therapy. Unfortunately, however, no such comprehensive study is available which has considered both the sex- and age-dependent neurotoxicity of nicotine, as of today. Hence, the overreaching goal of this review article is to analyze and summarize the impact of sex and age on pharmacokinetics and pharmacodynamics of nicotine and possible neurotoxic consequences associated with nicotine in order to emphasize the importance of including these biological factors for such studies.
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Affiliation(s)
- Sabrina Rahman Archie
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center (TTUHSC), Amarillo, TX, USA
| | - Sejal Sharma
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center (TTUHSC), Amarillo, TX, USA
| | - Elizabeth Burks
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center (TTUHSC), Amarillo, TX, USA
| | - Thomas Abbruscato
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center (TTUHSC), Amarillo, TX, USA.
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23
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Peacock JL, Palys TJ, Halchenko Y, Sayarath V, Takigawa CA, Murphy SE, Peterson LA, Baker ER, Karagas MR. Assessing tobacco smoke exposure in pregnancy from self-report, urinary cotinine and NNAL: a validation study using the New Hampshire Birth Cohort Study. BMJ Open 2022; 12:e054535. [PMID: 35131829 PMCID: PMC8823089 DOI: 10.1136/bmjopen-2021-054535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Accurate assessment of tobacco smoke exposure is key to evaluate its effects. We sought to validate and establish cut-offs for self-reported smoking and secondhand smoke (SHS) exposure during pregnancy using urinary cotinine and 4-(methylnitrosamino)-1-(-3-pyridyl)-1-butanol (NNAL) in a large contemporary prospective study from the USA, with lower smoking prevalence than has previously been evaluated. DESIGN Prospective birth cohort. SETTING Pregnancy clinics in New Hampshire and Vermont, USA. PARTICIPANTS 1396 women enrolled in the New Hampshire Birth Cohort Study with self-reported smoking, urinary cotinine, NNAL and pregnancy outcomes. PRIMARY AND SECONDARY OUTCOME MEASURES Cut-offs for urinary cotinine and NNAL concentrations were estimated from logistic regression models using Youden's method to predict SHS and active smoking. Cotinine and NNAL were each used as the exposure in separate multifactorial models for pregnancy outcomes. RESULTS Self-reported maternal smoking was: 72% non-smokers, 5.7% ex-smokers, 6.4% SHS exposure, 6.2% currently smoked, 10% unreported. Cotinine and NNAL levels were low and highly intercorrelated (r=0.91). Geometric mean cotinine, NNAL were 0.99 ng/mL, 0.05 pmol/mL, respectively. Cotinine cut-offs for SHS, current smoking were 1.2 ng/mL and 1.8 ng/mL (area under curve (AUC) 95% CI: 0.52 (0.47 to 0.57), 0.90 (0.85 to 0.94)). NNAL cut-off for current smoking was 0.09 pmol/mL (AUC=0.82 (95% CI 0.77 to 0.87)). Using cotinine and NNAL cut-offs combined gave similar AUC to cotinine alone, 0.87 (95% CI 0.82 to 0.91). Cotinine and NNAL gave almost identical effect estimates when modelling pregnancy outcomes. CONCLUSIONS In this population, we observed high concordance between self-complete questionnaire smoking data and urinary cotinine and NNAL. With respect to biomarkers, either cotinine or NNAL can be used as a measure of tobacco smoke exposure overall but only cotinine can be used to detect SHS.
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Affiliation(s)
- Janet L Peacock
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Thomas J Palys
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Yuliya Halchenko
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Vicki Sayarath
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Cindy A Takigawa
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa A Peterson
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emily R Baker
- Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
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24
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Fan Z, Gong X, Xu H, Wang H, Zeng N, Li L, Yan C, Wu L, Chen Y. Gender differences in the associations between tobacco smoke exposure and depressive symptoms among U.S. adults: NHANES 2007-2018. J Psychiatr Res 2022; 146:249-257. [PMID: 34799126 DOI: 10.1016/j.jpsychires.2021.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Findings concerning gender differences in the associations between tobacco smoke exposure (TSE) and depression are inconsistent. This study aimed to investigate the gender-specific associations between active and passive TSE with depressive symptoms in a large, nationally representative sample of U.S. adults. METHODS Data were from 27,175 adults aged ≥20 years in the 2007-2018 National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression was used to adjust for possible confounders. Whether the TSE-depression relationships may differ by age, race/ethnicity, socioeconomic status, body mass index (BMI), and self-reported health status was examined. RESULTS After adjustment for lifestyle- and health-related variables, no significant associations between active (OR, 1.16 [95% CI, 0.87-1.55]) and passive TSE (OR, 0.84 [95% CI, 0.59-1.19]) and depressive symptoms were found among men. Among women, active TSE was associated with depressive symptoms (OR, 1.90 [95% CI, 1.51-2.39]), while the association for passive TSE was nonsignificant (OR, 1.11 [95% CI, 0.91-1.34]) after adjusting for lifestyle- and health-related variables. Interaction and subgroup analyses showed that self-reported health status could modify the relationship between passive TSE and depressive symptoms among women. Furthermore, a dose-response relationship between serum cotinine and depressive symptoms was found in women, but not in men. CONCLUSIONS This study suggests a stronger TSE-depression association in women than in men. Understanding these gender-specific patterns and identifying the potential moderators of such relationships will enable better targeting of public health interventions.
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Affiliation(s)
- Zhixin Fan
- Research Center for Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xiayu Gong
- Research Center for Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Hanfang Xu
- Research Center for Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Hanzhang Wang
- Research Center for Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Ningxi Zeng
- Research Center for Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Ling Li
- Research Center for Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Can Yan
- Research Center for Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Lili Wu
- Research Center for Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
| | - Yuan Chen
- Animal Laboratory Center, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
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25
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Silva AI, Camelo A, Madureira J, Reis AT, Machado AP, Teixeira JP, Costa C. Urinary cotinine assessment of maternal smoking and environmental tobacco smoke exposure status and its associations with perinatal outcomes: a cross-sectional birth study. ENVIRONMENTAL RESEARCH 2022; 203:111827. [PMID: 34363802 DOI: 10.1016/j.envres.2021.111827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 06/13/2023]
Abstract
Tobacco consumption and environmental tobacco smoke (ETS) exposure remains an important public health concern. Pregnant women require particular attention as active and passive smoking during pregnancy are associated with multiple adverse perinatal outcomes. This study aimed to biochemically validate self-reported smoking and ETS exposure status among pregnant women, to more precisely ascertain its association with adverse perinatal outcomes. Data refers to 595 pregnant women who sought prenatal care in a public hospital in Porto, Portugal. A standard questionnaire on smoking and ETS-related variables was completed. Urinary cotinine (UC) concentrations were assessed by solid-phase competitive ELISA, in maternal urine samples collected on the day of delivery. The results showed that the optimal UC cut-off value to distinguish smokers from non-smokers and within non-smokers those who were exposed to ETS from those non-exposed in the third trimester of pregnancy was 74.1 ng/mL (sensitivity and specificity of 96.7% and 98.0%, respectively) and 1.6 ng/mL (sensitivity of 66.2% and specificity of 75.7%, respectively). The agreement between maternal self-reported and UC-based smoking status was very good (κ=0.919, p<0.001), but much lower for ETS exposure (κ=0.386, p<0.001). Maternal active smoking in the third trimester of pregnancy was associated with a significant decrease in birth weight, length and head circumference of 157.66 g (95% CI: -245.81, -69.52; p<0.001), 0.78 cm (95% CI: -1.22, -0.34; p=0.001) and 0.39 cm (95% CI: -0.70, -0.07; p=0.016), respectively. Maternal ETS exposure in the third trimester of pregnancy was associated with a non-significant increase in birth weight of 38.37 g (95% CI: -28.91, 105.64; p=0.263). Furthermore, maternal smoking cessation was associated with the increase of approximately 172 g in birth weight (95% CI: 50.00, 293.19). As such, there is an urgent need for increased public health awareness campaigns to encourage smoking cessation during pregnancy, in order to improve perinatal outcomes.
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Affiliation(s)
- Ana Inês Silva
- Environmental Health Department, National Institute of Health, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal; ICBAS - Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
| | - Alexandra Camelo
- Environmental Health Department, National Institute of Health, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Joana Madureira
- Environmental Health Department, National Institute of Health, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.
| | - Ana Teresa Reis
- Environmental Health Department, National Institute of Health, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Ana Paula Machado
- Department of Obstetrics and Gynaecology, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Paulo Teixeira
- Environmental Health Department, National Institute of Health, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Carla Costa
- Environmental Health Department, National Institute of Health, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal
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26
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Hall ES, McAllister JM, Kelly EA, Setchell KDR, Megaraj V, Jimenez KL, Nidey N, Greenberg JM, Wexelblatt SL. Regional comparison of self-reported late pregnancy cigarette smoking to mass spectrometry analysis. J Perinatol 2021; 41:2417-2423. [PMID: 33758398 DOI: 10.1038/s41372-021-01045-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/25/2021] [Accepted: 03/11/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To report a more accurate prevalence estimate of late pregnancy nicotine exposures. STUDY DESIGN A cross-sectional study during a 2-month period in 2019. Participants were women delivering in any of the six county maternity hospitals who consented to universal drug testing at the time of delivery as part of routine hospital admission. RESULTS Of 2531 tested samples, 18.7% tested positive for high levels of cotinine indicating primary smoking or other primary use of tobacco products. Together, 33.0% of the study population tested positive for nicotine exposure during late pregnancy compared to vital records which reported 8.2% cigarette smoking during the third trimester of pregnancy and 10.5% cigarette smoking at any time during pregnancy through maternal self-report. CONCLUSION Captured vital birth smoking measures vastly underreport actual primary exposures to nicotine products. Vital birth data also fail to capture secondhand exposures which constitute a significant proportion of the population.
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Affiliation(s)
- Eric S Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Jennifer M McAllister
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elizabeth A Kelly
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kenneth D R Setchell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pathology and Laboratory Medicine, Clinical Mass Spectrometry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Vandana Megaraj
- Division of Pathology and Laboratory Medicine, Clinical Mass Spectrometry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kristine L Jimenez
- Division of Pathology and Laboratory Medicine, Clinical Mass Spectrometry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nichole Nidey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James M Greenberg
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Scott L Wexelblatt
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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27
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Gwon SH, Jeong S, Bullock L. Cotinine Fluctuation in Maternal Saliva During and After Pregnancy: Implications for Perinatal Outcomes. MCN Am J Matern Child Nurs 2021; 46:293-298. [PMID: 34162791 PMCID: PMC8373790 DOI: 10.1097/nmc.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine maternal cotinine levels in saliva at the first (T-1) and third trimesters of pregnancy (T-2), and postpartum (T-3) among women who reported smoking a consistent number of cigarettes. The goal was to generate data to provide suggestions about how nurses can improve patient outcomes for women who smoke. METHODS Saliva cotinine values obtained from the randomized controlled trial (BabyBEEP) were used for this secondary analysis. We examined variations in saliva cotinine between the first and third trimesters of pregnancy and postpartum among light and heavy smokers. Cotinine values for pregnant smokers who were in the control group (not randomized to any intervention) and reported smoking the same range of cigarettes during and after pregnancy were used for the analyses (n = 43). Descriptive statistics and repeated-measures ANOVA were used for analyses. RESULTS There were differences in maternal saliva cotinine levels across the different time points and between the groups. There was a significant interaction effect between time and group. Cotinine decreased from T-1 to T-2 in heavy smokers and increased from T-2 to T-3 among both light and heavy smokers. Cotinine at T-3 was higher than T-1 among light smokers. CLINICAL IMPLICATIONS Findings support accelerated nicotine metabolism during pregnancy and need for smoking cessation efforts throughout pregnancy to help women stay smoke free during postpartum.
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Chen MM, Guo SE, Yuan CP, Okoli C, Liao YC. Association between Self-Reported Survey Measures and Biomarkers of Second-Hand Tobacco Smoke Exposure in Non-Smoking Pregnant Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179197. [PMID: 34501784 PMCID: PMC8431449 DOI: 10.3390/ijerph18179197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022]
Abstract
Second-hand tobacco smoke (SHS) causes adverse health outcomes in adults. Further studies are needed to evaluate psychosocial SHS exposure measures in comparison to SHS exposure biomarkers, particularly in pregnant women. This study aimed to compare self-reported SHS exposure to urinary cotinine levels in pregnant women. A cross-sectional correlation design was conducted using a convenience sample of 70 non-smoking pregnant women. Measures included self-reported questionnaires and laboratory confirmation of cotinine levels in the urinary samples. Multiple regression analysis was used to assess the correlation after controlling for potential confounding variables. The average level of urinary cotinine among non-smoking pregnant women was 6.77 ng/mL. Medium-strength correlations were found among psychosocial SHS exposure measures and urine cotinine levels. Questions regarding ‘instances of smoking in front of the individual’ and ‘subjective perceived frequency of SHS exposure in past 7 days’ are feasible items for pregnant women in clinics (particularly the first question). Hence, we suggest that these simple questions should be used to assist pregnant women in reducing the harm associated with SHS exposure.
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Affiliation(s)
- Meiman Maggie Chen
- Department of Nursing and Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology (CGUST), Puzi City 613016, Taiwan; (M.M.C.); (S.-E.G.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology (CGUST), Puzi City 613016, Taiwan
| | - Su-Er Guo
- Department of Nursing and Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology (CGUST), Puzi City 613016, Taiwan; (M.M.C.); (S.-E.G.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology (CGUST), Puzi City 613016, Taiwan
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Puzi City 613016, Taiwan
- Department of Safety Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City 243303, Taiwan
| | - Chi-Pin Yuan
- Department of Nursing, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City 600566, Taiwan;
| | - Chizimuzo Okoli
- Behavioral Health Wellness Environments for Living and Learning (BH WELL), College of Nursing, University of Kentucky, 315 College of Nursing Building, Lexington, KY 40536, USA;
| | - Yen-Chi Liao
- Department of Nursing, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City 600566, Taiwan;
- Correspondence: ; Tel.: +886-5-2765041-1248
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Amice B, Ho H, Zhang E, Bullen C. Physiologically Based Pharmacokinetic Modelling for Nicotine and Cotinine Clearance in Pregnant Women. Front Pharmacol 2021; 12:688597. [PMID: 34354586 PMCID: PMC8329445 DOI: 10.3389/fphar.2021.688597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Physiologically based pharmacokinetic (PBPK) models for the absorption, disposition, metabolism and excretion (ADME) of nicotine and its major metabolite cotinine in pregnant women (p-PBPK) are rare. The aim of this short research report is to present a p-PBPK model and its simulations for nicotine and cotinine clearance. Methods: The maternal-placental-fetal compartments of the p-PBPK model contain a total of 16 compartments representing major maternal and fetal organs and tissue groups. Qualitative and quantitative data of nicotine and cotinine disposition and clearance have been incorporated into pharmacokinetic parameters. Results: The p-PBPK model reproduced the higher clearance rates of nicotine and cotinine in pregnant women than non-pregnant women. Temporal profiles for their disposition in organs such as the brain were also simulated. Nicotine concentration reaches its maximum value within 2 min after an intravenous injection. Conclusion: The proposed p-PBPK model produces results consistent with available data sources. Further pharmacokinetic experiments are required to calibrate clearance parameters for individual organs, and for the fetus.
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Affiliation(s)
- Basile Amice
- ENSEEIHT, National Polytechnic Institute of Toulouse, Toulouse, France
| | - Harvey Ho
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - En Zhang
- Chongqing Institute for Food and Drug Control, Chongqing, China
| | - Chris Bullen
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
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Nicotine metabolite ratio: Comparison of the three urinary versions to the plasma version and nicotine clearance in three clinical studies. Drug Alcohol Depend 2021; 223:108708. [PMID: 33873029 PMCID: PMC8133391 DOI: 10.1016/j.drugalcdep.2021.108708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Variation in CYP2A6 activity influences tobacco smoking behaviors and smoking-related health outcomes. Plasma Nicotine Metabolite Ratio (NMR) is a robust phenotypic biomarker of CYP2A6 activity and nicotine clearance. In urine, the NMR has been calculated as a ratio of free trans-3'-hydroxycotinine to free cotinine (NMRF/F), total trans-3'-hydroxycotinine to free cotinine (NMRT/F), or total trans-3'-hydroxycotinine to total cotinine (NMRT/T). We evaluated these three urinary NMR versions relative to plasma NMR and nicotine clearance and elucidated mechanisms of discrepancies among them. METHODS Baseline plasma and urine biomarker data were available from two smoking cessation clinical trials and one nicotine pharmacokinetic study (total N = 768). NMRs were compared using Pearson correlations, linear regressions and ANOVA analyses. UGT2B10 and UGT2B17 were genotyped. RESULTS Urinary NMRT/F was the most highly related to plasma NMR (R2 = 0.70, P <2.2e-16) followed by NMRF/F (R2 = 0.68, P <2.2e-16), while NMRT/T was less strongly related (R2 = 0.60, P <2.2e-16); consistent across study, ethnicity, sex, heaviness of smoking, and analyte analysis. Controlling for cotinine glucuronidation, as a phenotype or UGT2B10 genotype, corrected the NMRT/T discordance with plasma NMR (Panova<0.001). Similar findings were obtained for relationships of nicotine clearance with plasma NMR > urinary NMRT/F > NMRF/F > NMRT/T (R2 = 0.41 > 0.37 > 0.35 > 0.25 respectively). CONCLUSION Urinary NMRT/F followed by NMRF/F are the best urinary alternatives to plasma NMR or nicotine clearance. NMRT/T has the least utility as it is influenced substantially by variation in cotinine glucuronidation. IMPACT This work highlighted the variation in urinary NMRs, and identified mechanisms for disparities among them, which facilitates their use in predicting smoking-related outcomes.
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Epigenetic Alterations of Maternal Tobacco Smoking during Pregnancy: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105083. [PMID: 34064931 PMCID: PMC8151244 DOI: 10.3390/ijerph18105083] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022]
Abstract
In utero exposure to maternal tobacco smoking is the leading cause of birth complications in addition to being associated with later impairment in child’s development. Epigenetic alterations, such as DNA methylation (DNAm), miRNAs expression, and histone modifications, belong to possible underlying mechanisms linking maternal tobacco smoking during pregnancy and adverse birth outcomes and later child’s development. The aims of this review were to provide an update on (1) the main results of epidemiological studies on the impact of in utero exposure to maternal tobacco smoking on epigenetic mechanisms, and (2) the technical issues and methods used in such studies. In contrast with miRNA and histone modifications, DNAm has been the most extensively studied epigenetic mechanism with regard to in utero exposure to maternal tobacco smoking. Most studies relied on cord blood and children’s blood, but placenta is increasingly recognized as a powerful tool, especially for markers of pregnancy exposures. Some recent studies suggest reversibility in DNAm in certain genomic regions as well as memory of smoking exposure in DNAm in other regions, upon smoking cessation before or during pregnancy. Furthermore, reversibility could be more pronounced in miRNA expression compared to DNAm. Increasing evidence based on longitudinal data shows that maternal smoking-associated DNAm changes persist during childhood. In this review, we also discuss some issues related to cell heterogeneity as well as downstream statistical analyses used to relate maternal tobacco smoking during pregnancy and epigenetics. The epigenetic effects of maternal smoking during pregnancy have been among the most widely investigated in the epigenetic epidemiology field. However, there are still huge gaps to fill in, including on the impact on miRNA expression and histone modifications to get a better view of the whole epigenetic machinery. The consistency of maternal tobacco smoking effects across epigenetic marks and across tissues will also provide crucial information for future studies. Advancement in bioinformatic and biostatistics approaches is key to develop a comprehensive analysis of these biological systems.
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McDaid L, Thomson R, Emery J, Coleman T, Cooper S, Phillips L, Naughton F. Agreement and Disparities between Women and Stop-Smoking Specialists about How to Promote Adherence to Nicotine Replacement Therapy in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094673. [PMID: 33924763 PMCID: PMC8125676 DOI: 10.3390/ijerph18094673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022]
Abstract
Evidence for the effectiveness of nicotine replacement therapy (NRT) for smoking-cessation in pregnancy is weak. This has been attributed to insufficient dosing and low adherence. This study investigated the acceptability of key messages and delivery modes for a behavioral intervention to increase NRT adherence in pregnancy. Semi-structured telephone interviews were carried out with pregnant or postpartum women aged ≥16 from across England, who had been offered NRT during pregnancy as part of a quit attempt and who struggled to quit (n = 10), and a focus group with stop-smoking specialists from across England (n = 6). The two data sources were coded separately using a thematic approach and then integrated to compare perspectives. Women and specialists agreed on message tone and delivery modes. However, views diverged on the most influential sources for certain messages and whether some information should be given proactively or reactively. There was also disagreement over which messages were novel and which were routinely delivered. This study demonstrates the value of capturing and integrating different perspectives and informational requirements when developing behavior-change interventions. The findings provide useful insights for designing a pregnancy-specific NRT adherence intervention that is acceptable to both those who will deliver and receive it.
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Affiliation(s)
- Lisa McDaid
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
- Correspondence:
| | - Ross Thomson
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Joanne Emery
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Lucy Phillips
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Felix Naughton
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
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Moyse M, Hunter A. Newspaper media representation of electronic cigarette use during pregnancy. J Public Health (Oxf) 2021; 43:e85-e91. [PMID: 32383738 DOI: 10.1093/pubmed/fdaa048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking during pregnancy is associated with many adverse foetal outcomes, and electronic cigarettes (EC) have the potential to aid women to quit smoking in pregnancy. The mass media influence how people feel about products and treatments, so it is important to establish how they portray EC use during pregnancy. METHODS UK newspaper articles which mentioned EC use during pregnancy were identified using the database Lexis Library. Articles were assigned a category (positive, negative or neutral), and an inductive thematic analysis was conducted to identify themes within the articles. RESULTS Of the 55 newspaper articles, 16 (29%) were positive, 32 (58%) were negative and 7 (13%) were neutral. Four overarching themes were found within the 55 articles: 'advice', 'impact on health of the foetus', 'uncertainty' and 'awareness'. Large increases in the frequency of articles reporting on EC were noticed between November 2015 and March 2016 and between February and March 2018. CONCLUSIONS The UK mass media mainly portray EC use during pregnancy as negative, which could impact women's decisions to use these devices in pregnancy. More research is needed to investigate the true effectiveness of EC to aid smoking cessation in pregnancy.
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Affiliation(s)
- Max Moyse
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | - Abby Hunter
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.,UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
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Edwards KC, Naz T, Stanton CA, Goniewicz ML, Hatsukami DK, Smith DM, Wang L, Villanti A, Pearson J, Blount BC, Bansal-Travers M, Feng J, Niaura R, Manderski MTB, Sosnoff CS, Delnevo CD, Duffy K, Del Valle-Pinero AY, Rostron BL, Everard C, Kimmel HL, van Bemmel DM, Hyland A. Urinary Cotinine and Cotinine + Trans-3'-Hydroxycotinine (TNE-2) Cut-points for Distinguishing Tobacco Use from Nonuse in the United States: PATH Study (2013-2014). Cancer Epidemiol Biomarkers Prev 2021; 30:1175-1184. [PMID: 33827982 DOI: 10.1158/1055-9965.epi-20-0997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/11/2020] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Determine the overall, sex-, and racially/ethnically-appropriate population-level cotinine and total nicotine equivalents (TNE-2, the molar sum of the two major nicotine metabolites) cut-points to distinguish tobacco users from nonusers across multiple definitions of use (e.g., exclusive vs. polytobacco, and daily vs. non-daily). METHODS Using Wave 1 (2013-2014) of the U.S. Population Assessment of Tobacco and Health (PATH) Study, we conducted weighted Receiver Operating Characteristic (ROC) analysis to determine the optimal urinary cotinine and TNE-2 cut-points, stratified by sex and race/ethnicity. RESULTS For past 30-day exclusive cigarette users, the cotinine cut-point that distinguished them from nonusers was 40.5 ng/mL, with considerable variation by sex (male: 22.2 ng/mL; female: 43.1 ng/mL) and between racial/ethnic groups (non-Hispanic other: 5.2 ng/mL; non-Hispanic black: 297.0 ng/mL). A similar, but attenuated, pattern emerged when assessing polytobacco cigarette users (overall cut-point = 39.1 ng/mL, range = 5.5 ng/mL-80.4 ng/mL) and any tobacco users (overall cut-point = 39.1 ng/mL, range = 4.8 ng/mL-40.0 ng/mL). Using TNE-2, which is less impacted by racial differences in nicotine metabolism, produced a comparable pattern of results although reduced the range magnitude. CONCLUSIONS Because of similar frequency of cigarette use among polytobacco users, overall cut-points for exclusive cigarette use were not substantially different from cut-points that included polytobacco cigarette use or any tobacco use. Results revealed important differences in sex and race/ethnicity appropriate cut-points when evaluating tobacco use status and established novel urinary TNE-2 cut-points. IMPACT These cut-points may be used for biochemical verification of self-reported tobacco use in epidemiologic studies and clinical trials.
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Affiliation(s)
| | | | | | | | | | | | - Lanqing Wang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - June Feng
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Michelle T Bover Manderski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, New Jersey
| | | | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, New Jersey
| | - Kara Duffy
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | | | - Brian L Rostron
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Colm Everard
- Kelly Government Solutions, Rockville, Maryland
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Heather L Kimmel
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Dana M van Bemmel
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Andrew Hyland
- Westat, Rockville, Maryland
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Daly JB, Dowe S, Tully B, Tzelepis F, Lecathelinais C, Gillham K. Acceptance of smoking cessation support and quitting behaviours of women attending Aboriginal Maternal and Infant Health Services for antenatal care. BMC Pregnancy Childbirth 2021; 21:85. [PMID: 33499811 PMCID: PMC7836151 DOI: 10.1186/s12884-021-03569-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acceptance of smoking cessation support during antenatal care and associated quitting behaviours of pregnant Aboriginal women or women having an Aboriginal baby has not been investigated. This study aimed to determine, among pregnant women who smoke and attended AMIHS for their antenatal care: 1. The acceptance of smoking cessation support, factors associated with acceptance and barriers to acceptance; 2. The prevalence of quitting behaviours and factors associated with quitting behaviours. METHODS A cross-sectional telephone survey of women who attended 11 AMIHSs for their antenatal care during a 12 month period in the Hunter New England Local Health District of New South Wales. RESULTS One hundred women contacted consented to complete the survey (76%). Of those offered cessation support, 68% accepted NRT, 56% accepted follow-up support and 35% accepted a Quitline referral. Participants accepting NRT had greater odds of quitting smoking at least twice during the antenatal period [OR = 6.90 (CI: 1.59-29.7)] and those reporting using NRT for greater than eight weeks had six times the odds of quitting smoking for one day or more [OR = 6.07 (CI: 1.14-32.4)]. CONCLUSIONS Aboriginal women or women having an Aboriginal baby who smoke make multiple attempts to quit during pregnancy and most women accept smoking cessation support when offered by their antenatal care providers. Acceptance of care and quitting success may be improved with increased focus on culturally appropriate care and enhanced training of antenatal care providers to increase skills in treating nicotine addiction and supporting women to use NRT as recommended by treatment guidelines.
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Affiliation(s)
- Justine B Daly
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia. .,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia.
| | - Sarah Dowe
- NSW Rural Doctors Network, 53 Cleary Street, Hamilton, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia.,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia
| | - Flora Tzelepis
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia.,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia.,School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia.,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia.,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia
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Kranzler HR, Washio Y, Zindel LR, Wileyto EP, Srinivas S, Hand DJ, Hoffman M, Oncken C, Schnoll RA. Placebo-controlled trial of bupropion for smoking cessation in pregnant women. Am J Obstet Gynecol MFM 2021; 3:100315. [PMID: 33493703 DOI: 10.1016/j.ajogmf.2021.100315] [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: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although a relatively small proportion of women who become pregnant continue to smoke cigarettes, no smoking cessation medication has been shown to be effective for this subgroup of smokers. Bupropion, a nonnicotine-based medication, is approved for the promotion of smoking cessation in nonpregnant individuals. We chose to study it in pregnant smokers because, although pregnancy increases nicotine metabolism, it does not affect the metabolism of bupropion. OBJECTIVE We evaluated the efficacy and safety of sustained-release bupropion for smoking cessation among pregnant women. STUDY DESIGN We conducted a multiple site, placebo-controlled, randomized clinical trial of bupropion for tobacco use among pregnant women (N=129) (clinical trial number NCT02188459). We enrolled women during the second trimester and randomly assigned them to receive 10 weeks of treatment with either bupropion or placebo, accompanied by a total of 6 smoking cessation counseling sessions (4 during treatment and 2 postpartum). The primary outcome was 7-day point prevalence smoking abstinence, confirmed with breath carbon monoxide measurements, at the end of treatment (week 10) and at week 24. Group differences were assessed as a binary abstinence outcome using a repeated measure generalized estimating equations model with a logit link. Prolonged abstinence and smoking rates were secondary outcomes. Safety measures included maternal treatment-related adverse events, gestational age, the rate of overall and spontaneous preterm births and infant birthweight and size for gestational age, head circumference, and 5-minute Apgar scores. RESULTS There were no significant differences in the safety measures across the treatment arms and bupropion was not efficacious in promoting smoking cessation at the end of treatment (7-day point prevalence quit rates: bupropion, 11.0%; placebo, 18.5%) or week 24 (7-day point prevalence quit rates: bupropion, 9.4%; placebo, 21.5%) (P>.05). African American women and women with a lower severity of nicotine dependence had significantly higher quit rates overall and women with an opioid use disorder who were being treated with opioid agonist therapy had significantly lower quit rates overall, irrespective of the treatment group (all P values <.05). CONCLUSION Although bupropion use was not associated with an elevated risk for pregnancy complications when initiated in the second trimester, it did not increase the likelihood of smoking cessation in this cohort of pregnant women. Because smoking is the major preventable source of poor pregnancy outcomes and psychosocial interventions have only modest beneficial effects, additional studies are needed to identify safe and efficacious smoking cessation medications for pregnant women who continue to smoke.
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Affiliation(s)
- Henry R Kranzler
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Kranzler and Ms Zindel); Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PA (Dr Kranzler).
| | - Yukiko Washio
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC (Dr Washio)
| | - Leah R Zindel
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Kranzler and Ms Zindel)
| | - E Paul Wileyto
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Wileyto)
| | - Sindhu Srinivas
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Srinivas)
| | - Dennis J Hand
- Departments of Obstetrics & Gynecology and Psychiatry & Human Behavior, Thomas Jefferson University, Philadelphia, PA (Dr Hand)
| | - Matthew Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Dr Hoffman)
| | - Cheryl Oncken
- Departments of Medicine and Obstetrics and Gynecology, UConn Health School of Medicine, University of Connecticut, Farmington, CT (Dr Oncken)
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Schnoll)
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Breunis LJ, Been JV, de Jong-Potjer L, Steegers EA, de Beaufort ID, de Kroon ML, Ismaili M'hamdi H. Incentives for Smoking Cessation During Pregnancy: An Ethical Framework. Nicotine Tob Res 2021; 22:1553-1559. [PMID: 31848622 PMCID: PMC7443604 DOI: 10.1093/ntr/ntz231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/16/2019] [Indexed: 01/01/2023]
Abstract
Introduction Smoking during pregnancy increases the risk of morbidity and mortality of the mother and child. The inability of the unborn child to protect itself, raises the social and academic responsibility to protect the child from the harmful effects of smoking. Interventions including rewards (incentives) for lifestyle changes are an upcoming trend and can encourage women to quit smoking. However, these incentives can, as we will argue, also have negative consequences, for example the restriction of personal autonomy and encouragement of smoking to become eligible for participation. To prevent these negative consequences, we developed an ethical framework that enables to assess and address unwanted consequences of incentive-based interventions whereby moral permissibility can be evaluated. Aims and Methods The possible adverse consequences of incentives were identified through an extensive literature search. Subsequently, we developed ethical criteria to identify these consequences based on the biomedical ethical principles of Beauchamp and Childress. Results Our framework consists of 12 criteria. These criteria concern (1) effectiveness, (2) support of a healthy lifestyle, (3) motivational for the target population, (4) stimulating unhealthy behavior, (5) negative attitudes, (6) personal autonomy, (7) intrinsic motivation, (8) privacy, (9) fairness, (10) allocation of incentives, (11) cost-effectiveness, and (12) health inequity. Based on these criteria, the moral permissibility of potential interventions can be evaluated. Conclusions Incentives for smoking cessation are a response to the responsibility to protect the unborn child. But these interventions might have possible adverse effects. This ethical framework aims to identify and address ethical pitfalls in order to avoid these adverse effects. Implications Although various interventions to promote smoking cessation during pregnancy exist, many women still smoke during pregnancy. Interventions using incentives for smoking cessation during pregnancy are a promising and upcoming trend but can have unwanted consequences. This ethical framework helps to identify and address ethical pitfalls in order to avoid these adverse effects. It can be a practical tool in the development and evaluation of these interventions and in evaluating the moral permissibility of interventions using incentives for smoking cessation during pregnancy.
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Affiliation(s)
- Leonieke J Breunis
- Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Rotterdam, The Netherlands
| | - Jasper V Been
- Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Rotterdam, The Netherlands.,Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Department of Paediatrics, Division of Neonatology, Rotterdam, The Netherlands.,Erasmus MC - University Medical Centre Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | - Lieke de Jong-Potjer
- Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Rotterdam, The Netherlands
| | - Eric Ap Steegers
- Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Rotterdam, The Netherlands
| | - Inez D de Beaufort
- Erasmus MC - University Medical Centre Rotterdam, Department of Medical Ethics and Philosophy of Medicine, Rotterdam, The Netherlands
| | - Marlou La de Kroon
- Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Rotterdam, The Netherlands.,University Medical Centre Groningen, University of Groningen, Department of Health Sciences, Groningen, The Netherlands
| | - Hafez Ismaili M'hamdi
- Erasmus MC - University Medical Centre Rotterdam, Department of Medical Ethics and Philosophy of Medicine, Rotterdam, The Netherlands
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Kranzler HR, Washio Y, Zindel LR, Lynch KG, Hand D, Tyndale RF, Oncken C, Schnoll R. Pregnant Smokers Receiving Opioid Agonist Therapy Have an Elevated Nicotine Metabolite Ratio: A Replication Study. Nicotine Tob Res 2021; 22:1923-1927. [PMID: 32303761 PMCID: PMC7542647 DOI: 10.1093/ntr/ntaa066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/15/2020] [Indexed: 12/02/2022]
Abstract
Introduction Pregnant women exposed chronically to opioids smoked more cigarettes per day (CPD) and had a higher nicotine metabolite ratio (NMR), 3-hydroxycotinine/cotinine, a biomarker of nicotine metabolism and clearance, than those not receiving opioids. We examined CPD and NMR in a group of pregnant smokers, a quarter of whom were receiving opioid agonist therapy (OAT). Aims and Methods Pregnant smokers recruited to participate in a placebo-controlled trial of bupropion for smoking cessation provided a blood sample for measurement of NMR. Results Half (52.4%) of the 124 women with NMR data were African American. OAT-treated women (n = 34, 27.4%; 27 receiving methadone and 7 buprenorphine) were more likely to be white (79% vs. 30%, p < .001) and to have a lower mean PHQ-9 total score (2.91 [SD = 2.83] vs. 4.83 [SD = 3.82], p = .007). OAT-treated women reported smoking more CPD (9.50 [SD = 5.26] vs. 7.20 [SD = 3.65], p = .005) and had higher NMR (0.78 [SD = 0.36] vs. 0.56 [SD = 0.25], p = .001) than the non-OAT-treated group. In a linear regression analysis adjusting for race, depression severity, and CPD, NMR was greater in the OAT group (p = .025), among whom the daily methadone-equivalent dosage correlated with NMR (Spearman’s ρ = 0.49, p = .003). Conclusions Consistent with the findings of Oncken et al. (2019), we found that OAT smokers smoked more and had higher NMR than non-OAT smokers. As higher NMR is associated with a reduced likelihood of smoking cessation, the effects on NMR of both pregnancy and OAT could contribute to a lower smoking cessation rate in pregnant smokers receiving chronic opioid therapy. Implications We replicated the finding that the NMR is significantly greater among pregnant smokers receiving OAT than those not receiving this treatment for opioid use disorder. Furthermore, we found that the dosage of the OAT was significantly associated with the NMR level. These findings may contribute to a poorer response to smoking cessation treatment in pregnant women treated with OAT, particularly those receiving high-dose therapy, and raise the question of whether novel approaches are needed to treat smoking in this subgroup of pregnant smokers.
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Affiliation(s)
- Henry R Kranzler
- Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Yukiko Washio
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC
| | - Leah R Zindel
- Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kevin G Lynch
- Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Dennis Hand
- Departments of Obstetrics & Gynecology and Psychiatry & Human Behavior, Thomas Jefferson University, Philadelphia, PA
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Departments of Pharmacology & Toxicology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Cheryl Oncken
- Departments of Medicine and Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
| | - Robert Schnoll
- Center for Interdisciplinary Research on Nicotine Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Ford A, Uny I, Lowes J, Naughton F, Cooper S, Coleman T, Hajek P, Przulj D, Myers Smith K, Bauld L, Sinclair L, Walton R, Clark M, Ussher M. A Qualitative Study of Factors Influencing Adherence among Pregnant Women Taking Part in a Trial of E-Cigarettes for Smoking Cessation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E430. [PMID: 33430407 PMCID: PMC7827544 DOI: 10.3390/ijerph18020430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
Use of e-cigarettes (vaping) has potential to help pregnant women stop smoking. This study explored factors influencing adherence among participants in the vaping arm of the first trial of vaping for smoking cessation in pregnancy. We conducted semi-structured telephone interviews (n = 28) with women at three-months postpartum. Interviews were analysed using thematic analysis, informed by the Theoretical-Domains Framework, Necessity-Concerns Framework and Perceptions and Practicalities Approach. Interviewees generally reported high levels of vaping. We found that: (1) intervention adherence was driven by four necessity beliefs-stopping smoking for the baby, and vaping for harm reduction, smoking cessation or as a last resort; (2) necessity beliefs outweighed vaping concerns, such as dependence and safety; (3) adherence was linked to four practicalities themes, acting as barriers and facilitators to vaping-device and e-liquid perceptions, resources and support, whether vaping became habitual, and social and environmental factors; and (4) intentional non-adherence was rare; unintentional non-adherence was due to device failures, forgetting to vape, and personal circumstances and stress. Pregnant smokers provided with e-cigarettes, and with generally high levels of vaping, had positive beliefs about the necessity of vaping for smoking cessation which outweighed concerns about vaping. Non-adherence was mainly due to unintentional factors.
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Affiliation(s)
- Allison Ford
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK; (I.U.); (J.L.); (M.U.)
| | - Isabelle Uny
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK; (I.U.); (J.L.); (M.U.)
| | - Judith Lowes
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK; (I.U.); (J.L.); (M.U.)
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (T.C.); (M.C.)
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (T.C.); (M.C.)
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; (P.H.); (D.P.); (K.M.S.); (R.W.)
| | - Dunja Przulj
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; (P.H.); (D.P.); (K.M.S.); (R.W.)
| | - Katie Myers Smith
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; (P.H.); (D.P.); (K.M.S.); (R.W.)
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK; (L.B.); (L.S.)
| | - Lesley Sinclair
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK; (L.B.); (L.S.)
| | - Robert Walton
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; (P.H.); (D.P.); (K.M.S.); (R.W.)
| | - Miranda Clark
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (T.C.); (M.C.)
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK; (I.U.); (J.L.); (M.U.)
- Population Health Research Institute, St George’s University of London, London SW17 ORE, UK
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Bano S, Hamid SB, Sajid F, Sharif H. Gender-Based Effects of Chronic Nicotine Administration on Hypothalamic Pituitary Adrenal Axis and Indoleamine 2,3 dioxygenase Activity in Rats. EGYPTIAN JOURNAL OF BASIC AND CLINICAL PHARMACOLOGY 2021. [DOI: 10.32527/2021/101480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Samina Bano
- Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi - 75270, Pakistan
| | - Sumaiya Binte Hamid
- Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi - 75270, Pakistan
| | - Faiza Sajid
- Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi - 75270, Pakistan
| | - Humaira Sharif
- Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi - 75270, Pakistan
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Lin YS, Thummel KE, Thompson BD, Totah RA, Cho CW. Sources of Interindividual Variability. Methods Mol Biol 2021; 2342:481-550. [PMID: 34272705 DOI: 10.1007/978-1-0716-1554-6_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The efficacy, safety, and tolerability of drugs are dependent on numerous factors that influence their disposition. A dose that is efficacious and safe for one individual may result in sub-therapeutic or toxic blood concentrations in others. A significant source of this variability in drug response is drug metabolism, where differences in presystemic and systemic biotransformation efficiency result in variable degrees of systemic exposure (e.g., AUC, Cmax, and/or Cmin) following administration of a fixed dose.Interindividual differences in drug biotransformation have been studied extensively. It is recognized that both intrinsic factors (e.g., genetics, age, sex, and disease states) and extrinsic factors (e.g., diet , chemical exposures from the environment, and the microbiome) play a significant role. For drug-metabolizing enzymes, genetic variation can result in the complete absence or enhanced expression of a functional enzyme. In addition, upregulation and downregulation of gene expression, in response to an altered cellular environment, can achieve the same range of metabolic function (phenotype), but often in a less predictable and time-dependent manner. Understanding the mechanistic basis for variability in drug disposition and response is essential if we are to move beyond the era of empirical, trial-and-error dose selection and into an age of personalized medicine that will improve outcomes in maintaining health and treating disease.
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Affiliation(s)
- Yvonne S Lin
- Department of Pharmaceutics, University of Washington, Seattle, WA, USA.
| | - Kenneth E Thummel
- Department of Pharmaceutics, University of Washington, Seattle, WA, USA
| | - Brice D Thompson
- Department of Pharmaceutics, University of Washington, Seattle, WA, USA
| | - Rheem A Totah
- Department of Medicinal Chemistry, University of Washington, Seattle, WA, USA
| | - Christi W Cho
- Department of Medicinal Chemistry, University of Washington, Seattle, WA, USA
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Zandy M, Chang V, Rao DP, Do MT. Tobacco smoke exposure and sleep: estimating the association of urinary cotinine with sleep quality. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2020; 40:70-80. [PMID: 32162509 DOI: 10.24095/hpcdp.40.3.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION A majority of studies on tobacco smoke exposure and sleep quality have relied on self-reported smoking, resulting in potential exposure misclassification and biases related to self-report. The objective of this study was to investigate associations between urinary cotinine, a biological marker of tobacco smoke exposure, and sleep quality measures, including sleep duration, sleep continuity or efficiency, sleep satisfaction and alertness during normal waking hours. METHODS Using data on a national sample of 10 806 adults (aged 18-79 years) from the Canadian Health Measures Survey (2007-2013), we performed binary logistic regression analyses to estimate associations between urinary cotinine concentrations and sleep quality measures, while controlling for potential confounders. Additionally, we performed ordinal logistic regression to assess the association between urinary cotinine concentrations and increased number of sleep problems. RESULTS Overall, 28.7% of adult Canadian survey respondents had urinary cotinine concentrations above the limit of detection (LOD), nd the prevalence of each sleep problem ranged from 5.5% to 35.6%. Elevated urinary cotinine concentrations (quartile 4 vs. <LOD) were associated with significantly higher odds of short or long sleep duration (OR = 1.41; 95% CI: 1.02-1.95; p-trend = .021), trouble falling or staying asleep (OR = 1.71; 95% CI: 1.28-2.27; p-trend = .003), sleep dissatisfaction (OR = 1.87; 95% CI: 1.21-2.89; p-trend = .011), and increased number of sleep problems (OR = 1.64; 95% CI: 1.19-2.26; p-trend = .001). Stronger associations were observed among females compared to males. CONCLUSION Using a biological marker of tobacco smoke exposure, our study contributes to the body of literature of toxic environmental exposures on sleep quality by supporting an association between tobacco smoke exposure and poorer sleep quality. To address the limitations of a cross-sectional study design and to better assess the temporality of tobacco smoke exposure and sleep quality, longitudinal studies are recommended.
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Affiliation(s)
- Moe Zandy
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Vicky Chang
- Public Health Agency of Canada, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Deepa P Rao
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Minh T Do
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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Fallin-Bennett A, Lofwall M, Waters T, Nuzzo P, Barnett J, Ducas L, McCubbin A, Chavan N, Blair L, Ashford K. Behavioral and Enhanced Perinatal Intervention (B-EPIC): A randomized trial targeting tobacco use among opioid dependent pregnant women. Contemp Clin Trials Commun 2020; 20:100657. [PMID: 33294725 PMCID: PMC7689271 DOI: 10.1016/j.conctc.2020.100657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Opioid use during pregnancy is a significant public health issue. The standard of care for treating opioid use disorder during pregnancy includes medications for opioid disorder (MOUD). However, tobacco use often goes unaddressed among pregnant women on MOUD. In 2018, our team received a National Institute on Drug Abuse (NIDA) funded R34 to conduct a three year-randomized trial to test the feasibility of a novel tobacco intervention for pregnant women receiving MOUD. AIMS The aims of this study are: (1) to determine the impact of the B-EPIC intervention on maternal tobacco use and stage of change; (2) to determine the impact of B-EPIC on tobacco-related maternal and infant health outcomes including gestational age at birth, birthweight, NAS diagnosis and severity, and number of ear and respiratory infections during the first six months; (3) to compare healthcare utilization and costs incurred by pregnant patients that receive the B-EPIC intervention versus TAU. METHODS We plan to enroll 100 pregnant women on MOUD for this randomized controlled trial (B-EPIC intervention n = 50 and treatment as usual n = 50). A major strength of this study is its wide range of health and economic outcomes assessed on mother, neonate and the infant. CONCLUSIONS Despite the very high rates of smoking among pregnant women with OUD, there are few tobacco treatment interventions that have been tailored for this high - risk population. The overall goal of this study is to move towards a tobacco treatment standard for pregnant women receiving treatment for OUD.
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Affiliation(s)
- Amanda Fallin-Bennett
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Michelle Lofwall
- University of Kentucky Department of Behavioral Science & Psychiatry, Center on Drug and Alcohol Research, Kentucky (KY), USA
| | - Teresa Waters
- University of Kentucky College of Public Health, Kentucky (KY), USA
| | - Paul Nuzzo
- University of Kentucky Department of Behavioral Science & Psychiatry, Center on Drug and Alcohol Research, Kentucky (KY), USA
| | - Janine Barnett
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Letitia Ducas
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Andrea McCubbin
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Niraj Chavan
- University of Kentucky College of Medicine, Department of Obstetrics & Gynecology, Kentucky (KY), USA
| | - Lisa Blair
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Kristin Ashford
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
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Lkhagvadorj K, Meyer KF, Verweij LP, Kooistra W, Reinders-Luinge M, Dijkhuizen HW, de Graaf IAM, Plösch T, Hylkema MN. Prenatal smoke exposure induces persistent Cyp2a5 methylation and increases nicotine metabolism in the liver of neonatal and adult male offspring. Epigenetics 2020; 15:1370-1385. [PMID: 32573327 PMCID: PMC7678918 DOI: 10.1080/15592294.2020.1782655] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 02/08/2023] Open
Abstract
Prenatal smoke exposure (PSE) is a risk factor for nicotine dependence. One susceptibility gene for nicotine dependence is Cytochrome P450 (CYP) 2A6, an enzyme responsible for the conversion of nicotine to cotinine and nicotine clearance in the liver. Higher activity of the CYP2A6 enzyme is associated with nicotine dependence, but no research has addressed the PSE effects on the CYP2A6 gene or its mouse homologue Cyp2a5. We hypothesized that PSE affects Cyp2a5 promoter methylation, Cyp2a5 mRNA levels, and nicotine metabolism in offspring. We used a smoke-exposed pregnant mouse model. RNA, DNA, and microsomal protein were isolated from liver tissue of foetal, neonatal, and adult offspring. Enzyme activity, Cyp2a5 mRNA levels, and Cyp2a5 methylation status of six CpG sites within the promoter region were analysed via HPLC, RT-PCR, and bisulphite pyrosequencing. Our data show that PSE induced higher cotinine levels in livers of male neonatal and adult offspring compared to controls. PSE-induced cotinine levels in neonates correlated with Cyp2a5 mRNA expression and promoter methylation at CpG-7 and CpG+45. PSE increased methylation in almost all CpG sites in foetal offspring, and this effect persisted at CpG-74 in male neonatal and adult offspring. Our results indicate that male offspring of mothers which were exposed to cigarette smoke during pregnancy have a higher hepatic nicotine metabolism, which could be regulated by DNA methylation. Given the detected persistence into adulthood, extrapolation to the human situation suggests that sons born from smoking mothers could be more susceptible to nicotine dependence later in life.
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Affiliation(s)
- Khosbayar Lkhagvadorj
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pulmonology and Allergology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Karolin F. Meyer
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura P. Verweij
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wierd Kooistra
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Reinders-Luinge
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk W. Dijkhuizen
- Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Inge A. M. de Graaf
- Department of Pharmacokinetics, Toxicology, and Targeting, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Machteld N. Hylkema
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Valencia S, Callinan L, Shic F, Smith M. Evaluation of the MoMba Live Long Remote Smoking Detection System During and After Pregnancy: Development and Usability Study. JMIR Mhealth Uhealth 2020; 8:e18809. [PMID: 33231550 PMCID: PMC7723738 DOI: 10.2196/18809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/07/2020] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background The smoking relapse rate during the first 12 months after pregnancy is around 80% in the United States. Delivering remote smoking cessation interventions to women in the postpartum period can reduce the burden associated with frequent office visits and can enable remote communication and support. Developing reliable, remote, smoking measuring instruments is a crucial step in achieving this vision. Objective The study presents the evaluation of the MoMba Live Long system, a smartphone-based breath carbon monoxide (CO) meter and a custom iOS smartphone app. We report on how our smoking detection system worked in a controlled office environment and in an out-of-office environment to examine its potential to deliver a remote contingency management intervention. Methods In-office breath tests were completed using both the MoMba Live Long system and a commercial monitor, the piCO+ Smokerlyzer. In addition, each participant provided a urine test for smoking status validation through cotinine. We used in-office test data to verify the validity of the MoMba Live Long smoking detection system. We also collected out-of-office tests to assess how the system worked remotely and enabled user verification. Pregnant adult women in their second or third trimester participated in the study for a period of 12 weeks. This study was carried out in the United States. Results Analyses of in-office tests included 143 breath tests contributed from 10 participants. CO readings between the MoMba Live Long system and the piCO+ were highly correlated (r=.94). In addition, the MoMba Live Long system accurately distinguished smokers from nonsmokers with a sensitivity of 0.91 and a specificity of 0.94 when the piCO+ was used as a gold standard, and a sensitivity of 0.81 and specificity of 1.0 when cotinine in urine was used to confirm smoking status. All participants indicated that the system was easy to use. Conclusions Relatively inexpensive portable and internet-connected CO monitors can enable remote smoking status detection in a wide variety of nonclinical settings with reliable and valid measures comparable to a commercially available CO monitor. Trial Registration ClinicalTrials.gov NCT02237898; https://clinicaltrials.gov/ct2/show/NCT02237898
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Affiliation(s)
- Stephanie Valencia
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Carnegie Mellon University, Pittsburgh, PA, United States
| | - Laura Callinan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Frederick Shic
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Seattle's Children's Research Institute, University of Washington School of Medicine, Seattle, WA, United States
| | - Megan Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Naughton F, Vaz LR, Coleman T, Orton S, Bowker K, Leonardi-Bee J, Cooper S, Vanderbloemen L, Sutton S, Ussher M. Interest in and Use of Smoking Cessation Support Across Pregnancy and Postpartum. Nicotine Tob Res 2020; 22:1178-1186. [PMID: 31570944 PMCID: PMC7291796 DOI: 10.1093/ntr/ntz151] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 08/15/2019] [Indexed: 12/02/2022]
Abstract
Background Limited research exists on interest in and use of smoking cessation support in pregnancy and postpartum. Methods A longitudinal cohort of pregnant smokers and recent ex-smokers were recruited in Nottinghamshire, United Kingdom (N = 850). Data were collected at 8–26 weeks gestation, 34–36 weeks gestation, and 3 months postpartum and used as three cross-sectional surveys. Interest and use of cessation support and belief and behavior measures were collected at all waves. Key data were adjusted for nonresponse and analyzed descriptively, and multiple regression was used to identify associations. Results In early and late pregnancy, 44% (95% CI 40% to 48%) and 43% (95% CI 37% to 49%) of smokers, respectively, were interested in cessation support with 33% (95% CI 27% to 39%) interested postpartum. In early pregnancy, 43% of smokers reported discussing cessation with a midwife and, in late pregnancy, 27% did so. Over one-third (38%) did not report discussing quitting with a health professional during pregnancy. Twenty-seven percent of smokers reported using any National Health Service (NHS) cessation support and 12% accessed NHS Stop Smoking Services during pregnancy. Lower quitting confidence (self-efficacy), higher confidence in stopping with support, higher quitting motivation, and higher age were associated with higher interest in support (ps ≤ .001). A recent quit attempt and greater interest in support was associated with speaking to a health professional about quitting and use of NHS cessation support (ps ≤ .001). Conclusions When asked in early or late pregnancy, about half of pregnant smokers were interested in cessation support, though most did not engage. Cessation support should be offered throughout pregnancy and after delivery. Implications There is relatively high interest in cessation support in early and late pregnancy and postpartum among smokers; however, a much smaller proportion of pregnant or postpartum women access any cessation support, highlighting a gap between interest and engagement. Reflecting women’s interest, offers of cessation support should be provided throughout pregnancy and after delivery. Increasing motivation to quit and confidence in quitting with assistance may enhance interest in support, and promoting the discussion of stopping smoking between women and health practitioners may contribute to higher support engagement rates.
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Affiliation(s)
- Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Luis Reeves Vaz
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Sophie Orton
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Katharine Bowker
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Laura Vanderbloemen
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, UK
| | - Michael Ussher
- Population Health Research Institute, St Georges, University of London, London, UK.,Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study: a before-after study protocol. NPJ Prim Care Respir Med 2020; 30:51. [PMID: 33208752 PMCID: PMC7674488 DOI: 10.1038/s41533-020-00209-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
Despite existing interventions, tobacco smoking and alcohol consumption during pregnancy are common. The Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy intervention combines monthly group sessions, access to a web-based platform and incentives upon biochemically validated cessation for a maximum duration of 6 months to promote cessation of smoking and alcohol use before and during pregnancy. To inform development of the SAFER pregnancy intervention, two focus groups with the target population were held beforehand, with results reported here alongside the final SAFER pregnancy study protocol. In a before−after study we aim to include 66 women who are pregnant or have a wish to become pregnant and who smoke and/or consume alcohol (i.e. target population of the SAFER pregnancy intervention). The primary outcome measure is cessation of smoking and/or alcohol use at 34−38 weeks of gestation, or after six group sessions if women did not become pregnant during the study period. Secondary outcomes focus on the barriers and facilitators for implementation of the SAFER pregnancy intervention.
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Benowitz NL, Bernert JT, Foulds J, Hecht SS, Jacob P, Jarvis MJ, Joseph A, Oncken C, Piper ME. Biochemical Verification of Tobacco Use and Abstinence: 2019 Update. Nicotine Tob Res 2020; 22:1086-1097. [PMID: 31570931 DOI: 10.1093/ntr/ntz132] [Citation(s) in RCA: 299] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The changing prevalence and patterns of tobacco use, the advent of novel nicotine delivery devices, and the development of new biomarkers prompted an update of the 2002 Society for Research on Nicotine and Tobacco (SRNT) report on whether and how to apply biomarker verification for tobacco use and abstinence. METHODS The SRNT Treatment Research Network convened a group of investigators with expertise in tobacco biomarkers to update the recommendations of the 2002 SNRT Biochemical Verification Report. RESULTS Biochemical verification of tobacco use and abstinence increases scientific rigor and is recommended in clinical trials of smoking cessation, when feasible. Sources, appropriate biospecimens, cutpoints, time of detection windows and analytic methods for carbon monoxide, cotinine (including over the counter tests), total nicotine equivalents, minor tobacco alkaloids, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol are reviewed, as well as biochemical approaches to distinguishing cigarette smoking from use of electronic nicotine delivery devices (ENDS). CONCLUSIONS Recommendations are provided for whether and how to use biochemical verification of tobacco use and abstinence. Guidelines are provided on which biomarkers to use, which biospecimens to use, optimal cutpoints, time windows to detection, and methodology for biochemical verifications. Use of combinations of biomarkers is recommended for assessment of ENDS use. IMPLICATIONS Biochemical verification increases scientific rigor, but there are drawbacks that need to be assessed to determine whether the benefits of biochemical verification outweigh the costs, including the cost of the assays, the feasibility of sample collection, the ability to draw clear conclusions based on the duration of abstinence, and the variability of the assay within the study population. This paper provides updated recommendations from the 2002 SRNT report on whether and how to use biochemical markers in determining tobacco use and abstinence.
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Affiliation(s)
- Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Departments of Medicine and Biopharmaceutical Sciences; Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - John T Bernert
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jonathan Foulds
- Departments of Public Health Sciences and Psychiatry, Penn State College of Medicine, Hershey, PA
| | - Stephen S Hecht
- Departments of Laboratory Medicine and Pathology, Pharmacology, and Medicinal Chemistry, University of Minnesota, Masonic Cancer Center, Minneapolis, MN
| | - Peyton Jacob
- Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, CA
| | - Martin J Jarvis
- Department of Behavioural Science and Health, University College London, London, UK
| | - Anne Joseph
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Cheryl Oncken
- Department of Medicine, University of Connecticut, Farmington, CT
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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Alolabi H, Alchallah MO, Mohsen F, Shibani M, Ismail H, Alzabibi MA, Sawaf B. Prevalence and behavior regarding cigarette and water pipe smoking among Syrian undergraduates. Heliyon 2020; 6:e05423. [PMID: 33204883 PMCID: PMC7653068 DOI: 10.1016/j.heliyon.2020.e05423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/13/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The devastating Syrian crisis has raised concern regarding the social acceptance of smoking especially with water pipe use becoming a growing epidemic. We aim to determine the prevalence of cigarette and water pipe smoking among university students, along with identifying the addictive behavior among university students. METHODS A cross-sectional study was conducted at the Syrian Private University during World No-Tobacco Day, in Damascus, Syria during the war crisis. The survey consists of 4 sections: socio-demographic information, Fagerström Test of Nicotine Dependence, attitude towards water pipes, and perspective about smoking. Data were analyzed using the Statistical Package for Sciences version 25.0 (SPSS Inc., United States.). RESULTS Of the 622 participants, 429 (69%) were males with a mean age of 21.3 ± 3.1 years. The prevalence of tobacco smoking was 320 (51.4%), 208 (23.8%) for cigarettes, and 112 (18.0%) for water pipe. Smoking was significantly higher among male non-medical university students. The majority were low to moderate dependent when assessed by the Fagerström Test of Nicotine Dependence. CONCLUSIONS This study showed a very high prevalence of smoking indicating the need for smoking cessation programs, access to effective quitting treatments, and mass media campaigns to diminish smoking among the youth.
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Affiliation(s)
- Homam Alolabi
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | | | - Fatema Mohsen
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Mosa Shibani
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Hlma Ismail
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | | | - Bisher Sawaf
- Faculty of Medicine, Syrian Private University, Damascus, Syria
- Faculty of Medicine, American University of Beirut Medical Center Beirut, Lebanon
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Psotka MA, Rushakoff J, Glantz SA, De Marco T, Fleischmann KE. The Association Between Secondhand Smoke Exposure and Survival for Patients With Heart Failure. J Card Fail 2020; 26:745-750. [DOI: 10.1016/j.cardfail.2019.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022]
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