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Sloan M, Campbell KA, Bowker K, Coleman T, Cooper S, Brafman-Price B, Naughton F. Pregnant Women's Experiences and Views on an "Opt-Out" Referral Pathway to Specialist Smoking Cessation Support: A Qualitative Evaluation. Nicotine Tob Res 2016; 18:900-5. [PMID: 26743356 DOI: 10.1093/ntr/ntv273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/04/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking in pregnancy remains an important and costly public health concern with policy makers worldwide researching methods to aid cessation. UK government guidelines recommend implementation of an "opt-out" (ie, whether requested or not) referral pathway for pregnant smokers to specialist smoking cessation support using carbon monoxide (CO) screening. This study explores the views of pregnant smokers who experienced this new pathway in one UK hospital trust. METHODS Eighteen semi-structured telephone interviews with women who experienced the opt-out pathway were undertaken. Data were analyzed thematically. RESULTS Three themes were identified relating to expectations, acceptability and impact of the pathway. Women were generally very accepting of the CO testing especially when it met their prior expectations and was perceived as being a routine component of antenatal care. They considered the visual feedback from the CO monitoring improved their motivation to quit. Views on the automatic referral for cessation support were divided with questions raised as to the removal of choice, with many women also expressing dissatisfaction about perceived lack of contact by Stop Smoking Services (SSS) following referral. CONCLUSION The opt-out pathway is potentially an acceptable addition to current practice. The women considered CO monitoring to be the most valuable element of the pathway. Women keen to engage with SSS desired a more efficient system of contact. IMPLICATIONS This study presents a unique insight into pregnant women's views on the implementation of opt-out referrals for smoking cessation. Introducing CO testing and opt-out referrals at the time of antenatal ultrasound examination can potentially increase motivation to stop smoking in pregnancy. The findings demonstrate that facilitating access to SSS was not always achieved, and further refinement is needed to ensure more effective contact procedures. Ensuring all women are fully informed prior to the CO testing may further improve both the impact of the opt-out referral pathway and the chance of successfully engaging with SSS.
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Affiliation(s)
- Melanie Sloan
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom;
| | | | - Katharine Bowker
- Division of Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Tim Coleman
- Division of Primary Care, D1411, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Barbara Brafman-Price
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Felix Naughton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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De Long NE, Barra NG, Hardy DB, Holloway AC. Is it safe to use smoking cessation therapeutics during pregnancy? Expert Opin Drug Saf 2014; 13:1721-31. [PMID: 25330815 DOI: 10.1517/14740338.2014.973846] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Worldwide, 10 to 35% of pregnant women smoke. It is clear that smoking cessation has positive impacts for both the mother and child, yet many women are still unable to quit due to the addictive properties of nicotine. There are limited data surrounding their safety and efficacy in pregnancy. AREAS COVERED This review highlights evidence from clinical studies and animal experiments regarding the effects of smoking cessation therapeutics on pregnancy, neonatal and long-term postnatal outcomes. EXPERT OPINION There are insufficient data at this time to recommend the use of varenicline and/or bupropion for smoking cessation during pregnancy. In addition, the efficacy and safety of nicotine replacement therapy use for smoking cessation in pregnant women has not been clearly demonstrated. Until further studies are completed, there will continue to be considerable uncertainty regarding the use of these drugs in pregnancy despite the well-documented benefits of smoking cessation.
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Affiliation(s)
- Nicole E De Long
- McMaster University, Department of Obstetrics and Gynecology , RM HSC-3N52, 1280 Main Street West, Hamilton, Ontario, L8S 4K1 , Canada +1 905 525 9140 ext. 22130 ; +1 905 524 2911 ;
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Ivorra C, García-Vicent C, Ponce F, Ortega-Evangelio G, Fernández-Formoso JA, Lurbe E. High cotinine levels are persistent during the first days of life in newborn second hand smokers. Drug Alcohol Depend 2014; 134:275-279. [PMID: 24268547 DOI: 10.1016/j.drugalcdep.2013.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/17/2013] [Accepted: 10/20/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Despite the adverse effects of maternal smoking during pregnancy on the newborn's health are well-known, in the pediatric population, a high prevalence exists that is very much affected by second hand smoke (SHS). This study aims to investigate the impact of maternal smoking habits during pregnancy on cotinine levels in newborns during the first days of life. The high association between cotinine concentration in maternal and umbilical cord blood (UCB) has been previously reported, but the levels of blood cotinine that remain in infants born to smokers is unknown. METHODS Cotinine concentration was measured in UCB, in maternal and newborn peripheral blood. Data from UCB sample dyads of ninety mothers and from seventy-one newborns were analyzed. RESULTS Cotinine levels were significantly different among non-smokers (9.9 ± 5.9 ng/ml), moderate (67.3 ± 7.4 ng/ml), and heavy smokers (137.7 ± 19.5 ng/ml) (p<0.0001). Significant correlations were found between maternal and UCB cotinine (r=0.748; p<0.001), and between UCB and newborn plasma cotinine at 48 h after birth (r=0.541; p<0.001). The smokers exposed their infants to cotinine with a median of 31.7 ± 8.6 ng/ml (moderate) or 59.1 ± 13.3 ng/ml (heavy smokers) until at least, 48 h after birth. Reduced birth weight and length were significantly related with UCB cotinine levels. CONCLUSIONS A positive association between UCB and plasmatic cotinine in newborns was found. The high cotinine levels detected in newborns from smoker mothers indicates that their infants are subjected to elevated SHS from birth. These results can help to reinforce the awareness of the adverse effects of smoking during pregnancy.
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Affiliation(s)
- Carmen Ivorra
- Cardiovascular Risk Unit, Hospital General, University of Valencia, Department of Pediatrics, Avenida Tres Cruces 2, Valencia, 46014, Spain; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, 28049, Spain.
| | - Consuelo García-Vicent
- Cardiovascular Risk Unit, Hospital General, University of Valencia, Department of Pediatrics, Avenida Tres Cruces 2, Valencia, 46014, Spain; CIBERER, Instituto de Salud Carlos III, Madrid, 28049, Spain.
| | - Francisco Ponce
- Cardiovascular Risk Unit, Hospital General, University of Valencia, Department of Pediatrics, Avenida Tres Cruces 2, Valencia, 46014, Spain; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, 28049, Spain.
| | - Graciela Ortega-Evangelio
- Cardiovascular Risk Unit, Hospital General, University of Valencia, Department of Pediatrics, Avenida Tres Cruces 2, Valencia, 46014, Spain.
| | | | - Empar Lurbe
- Cardiovascular Risk Unit, Hospital General, University of Valencia, Department of Pediatrics, Avenida Tres Cruces 2, Valencia, 46014, Spain; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, 28049, Spain.
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Maritz GS, Harding R. Life-long programming implications of exposure to tobacco smoking and nicotine before and soon after birth: evidence for altered lung development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:875-98. [PMID: 21556184 PMCID: PMC3083675 DOI: 10.3390/ijerph8030875] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 02/28/2011] [Accepted: 03/04/2011] [Indexed: 12/13/2022]
Abstract
Tobacco smoking during pregnancy remains common, especially in indigenous communities, and likely contributes to respiratory illness in exposed offspring. It is now well established that components of tobacco smoke, notably nicotine, can affect multiple organs in the fetus and newborn, potentially with life-long consequences. Recent studies have shown that nicotine can permanently affect the developing lung such that its final structure and function are adversely affected; these changes can increase the risk of respiratory illness and accelerate the decline in lung function with age. In this review we discuss the impact of maternal smoking on the lungs and consider the evidence that smoking can have life-long, programming consequences for exposed offspring. Exposure to maternal tobacco smoking and nicotine intake during pregnancy and lactation changes the genetic program that controls the development and aging of the lungs of the offspring. Changes in the conducting airways and alveoli reduce lung function in exposed offspring, rendering the lungs more susceptible to obstructive lung disease and accelerating lung aging. Although it is generally accepted that prevention of maternal smoking during pregnancy and lactation is essential, current knowledge of the effects of nicotine on lung development does not support the use of nicotine replacement therapy in this group.
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Affiliation(s)
- Gert S. Maritz
- Department of Medical Biosciences, University of the Western Cape, Bellville 7535, South Africa; E-Mail:
| | - Richard Harding
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +613-9902-9107; Fax: +613-9902-9223
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Al-Sahab B, Saqib M, Hauser G, Tamim H. Prevalence of smoking during pregnancy and associated risk factors among Canadian women: a national survey. BMC Pregnancy Childbirth 2010; 10:24. [PMID: 20497553 PMCID: PMC2885995 DOI: 10.1186/1471-2393-10-24] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 05/24/2010] [Indexed: 11/24/2022] Open
Abstract
Background Cigarette smoking carries a threat both to the expecting mother and her newborn. Data on the prevalence and predictors of smoking during pregnancy is limited in Canada. Canadian studies are mainly representative of specific cities and/or provinces. Therefore, the study aims to assess the prevalence of smoking during pregnancy and its associated risk factors throughout the Canadian provinces and territories. Methods The analysis was based on the Maternity Experience Survey targeting women aged ≥15 years who had singleton live births during 2005/06 in the Canadian provinces and territories. The outcome was ever smoking during the thirst trimester of pregnancy. Socio-economic factors, demographic factors, maternal characteristics, and pregnancy related factors that proved to be significant at the bivariate level were considered for a logistic regression analysis. Bootstrapping was performed to account for the complex sampling design. Results The sample size was 6,421 weighted to represent 76,508 Canadian women. The prevalence of smoking during pregnancy was 10.5%, whereby smoking mothers consumed on average 7 cigarettes a day (95% Confidence interval - CI: 6.5-7.4; SD = 5.7). Regression analysis revealed that mothers who smoked during pregnancy were more likely to be of low socio-economic status, non-immigrant, single and passive smokers during pregnancy. Not attending prenatal classes and experiencing stressful events before/during pregnancy also increased the mothers' odds of smoking during pregnancy. While the age of the mother's first pregnancy was negatively associated with smoking during pregnancy, the mother's current age was positively associated with it. Conclusion Smoking during pregnancy is still prevalent among Canadian women. The findings may be useful to enhance smoking prevention programs and integrated health promotion strategies to promote positive health behaviors among disadvantaged pregnancies.
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Affiliation(s)
- Ban Al-Sahab
- School of Kinesiology and Health Science, York University, Toronto, ON Canada M3J 1P3.
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Köhler E, Avenarius S, Rabsilber A, Gerloff C, Jorch G. Nicotine and its metabolites in amniotic fluid at birth--assessment of prenatal tobacco smoke exposure. Hum Exp Toxicol 2010; 29:385-91. [PMID: 20164157 DOI: 10.1177/0960327110363326] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Amniotic fluid was collected from 78 pregnant women at birth additionally with their urine prior to delivery as well as neonatal urine and meconium. The smoking markers, nicotine and its metabolites cotinine and trans-3'-hydroxycotinine (OH-cotinine), were determined using high-performance liquid chromatography (HPLC). The self-reported smoking status during pregnancy determined by means of a questionnaire was verified by measurement of maternal urine. In all smokers, nicotine metabolites were detected in amniotic fluid and in 80% of them nicotine as well. However, the sum of the nicotine metabolites (Sum(met)) was significantly lower (p < .001) in amniotic fluid (704 +/- 464 nmol/L) than in meconium (921 +/- 588 nmol/L), neonatal urine (1139 +/- 813 nmol/L) and maternal urine (4496 +/- 3535 nmol/L). Concentrations of nicotine metabolites in amniotic fluid correlated well (p < .001) with that in the other specimen types. After environmental tobacco smoke (ETS) exposure, no nicotine or nicotine metabolites were detectable in amniotic fluid but only in maternal and neonatal urine. Analysis of amniotic fluid at birth lends itself to verifying smoking habits during pregnancy and clearly discriminating from ETS exposure, but it is not a suitable approach to differentiating between ETS exposure and non-exposure.
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Affiliation(s)
- E Köhler
- Department of Paediatrics, Otto von Guericke University, Leipziger Strasse 44, Magdeburg, Germany.
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Orive JIDG, Esteban JJ. [The Archivos archive, 2006: an overview of research published in Archivos de Bronconeumología]. Arch Bronconeumol 2007; 43:399-410. [PMID: 17663893 DOI: 10.1016/s1579-2129(07)60092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Barrueco Ferrero M, Torrecilla García M, Hernández Mezquita MÁ, Jiménez Ruiz CA, Morales Sánchez A, Alonso Díaz A, Plaza Martín D. Deshabituación tabáquica. Valor del resultado en la fase de acción sobre el resultado en la fase de consolidación. Arch Bronconeumol 2007. [DOI: 10.1157/13099529] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ferrero MB, García MT, Mezquita MÁH, Jiménez Ruiz CA, Sánchez AM, Díaz AA, Martín DP. Tobacco Cessation: Action-Stage Result as a Predictor of Successful Long-Term Maintenance. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1579-2129(07)60037-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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