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Zaganjor I, Kramer RD, Kofie JN, Sawdey MD, Cullen KA. Trends in Smoking Before, During, and After Pregnancy in the United States from 2000 to 2020: Pregnancy Risk Assessment Monitoring System. J Womens Health (Larchmt) 2024; 33:283-293. [PMID: 38153374 DOI: 10.1089/jwh.2023.0641] [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: 12/29/2023] Open
Abstract
Objectives: This study used 2000-2020 Pregnancy Risk Assessment Monitoring System data to estimate trends in smoking before, during, and after pregnancy, as well as quitting smoking during pregnancy. Materials and Methods: Weighted prevalence and 95% confidence intervals (CIs) were calculated by year for each smoking-related measure. Annual percent change (APC) and average annual percent change (AAPC) in prevalence were estimated using Joinpoint regression to characterize trends over time. Results: Between 2000 and 2020, significant decreases in the prevalence of smoking before (23.0% to 14.0%; AAPC = -2.3% [95% CI = -2.9% to -1.7%]), during (13.2% to 6.5%; AAPC = -3.4% [95% CI = -4.0% to -2.7%]), and after pregnancy (18.9% to 8.8%; AAPC = -3.6% [95% CI = -4.3% to -2.9%]) were observed. For each measure, the fastest declines occurred largely throughout the 2010s (before: APC = -5.5% [2012-2020]; during: APC = -5.1% [2009-2020]; and after: APC = -6.4% [2012-2020]). The proportion of people who quit smoking during pregnancy significantly increased from 43.2% in 2000 to 53.7% in 2020 (AAPC = 1.0%; 95% CI = 0.2%-1.9%); however, Joinpoint regression detected relatively no change in quitting during pregnancy between 2010 and 2020 (APC = 0.0%; 95% CI = -0.4% to 0.5%). Conclusions: The prevalence of smoking before, during, and after pregnancy has reduced dramatically in the United States between 2000 and 2020, with the fastest declines occurring throughout the second decade of the twenty-first century. However, prevention and cessation efforts are still needed since approximately half of people who smoked before pregnancy continue to smoke during pregnancy.
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Affiliation(s)
- Ibrahim Zaganjor
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Renee D Kramer
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Justina N Kofie
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael D Sawdey
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Karen A Cullen
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Puga TB, Dai HD, Wang Y, Theye E. Maternal Tobacco Use During Pregnancy and Child Neurocognitive Development. JAMA Netw Open 2024; 7:e2355952. [PMID: 38349651 PMCID: PMC10865146 DOI: 10.1001/jamanetworkopen.2023.55952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/20/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Maternal tobacco use during pregnancy (MTDP) persists across the globe. Longitudinal assessment of the association of MTDP with neurocognitive development of offspring at late childhood is limited. Objectives To examine whether MTDP is associated with child neurocognitive development at ages 9 to 12 years. Design, Setting, and Participants This cohort study included children aged 9 and 10 years at wave 1 (October 2016 to October 2018) and aged 11 to 12 years at a 2-year follow-up (wave 2, August 2018 to January 2021) across 21 US sites in the Adolescent Brain Cognitive Development (ABCD) Study. Data were analyzed from June 2022 to December 2023. Exposure MTDP. Main Outcomes and Measures Outcomes of interest were neurocognition, measured by the National Institutes of Health (NIH) Toolbox Cognition Battery, and morphometric brain measures through the region of interest (ROI) analysis from structural magnetic resonance imaging (sMRI). Results Among 11 448 children at wave 1 (mean [SD] age, 9.9 [0.6] years; 5990 [52.3%] male), 1607 children were identified with MTDP. In the NIH Toolbox Cognition Battery, children with MTDP (vs no MTDP) exhibited lower scores on the oral reading recognition (mean [SE] B = -1.2 [0.2]; P < .001), picture sequence memory (mean [SE] B = -2.3 [0.6]; P < .001), and picture vocabulary (mean [SE] B = -1.2 [0.3]; P < .001) tests and the crystallized cognition composite score (mean [SE] B = -1.3 [0.3]; P < .001) at wave 1. These differential patterns persisted at wave 2. In sMRI, children with MTDP (vs no MTDP) had smaller cortical areas in precentral (mean [SE] B = -104.2 [30.4] mm2; P = .001), inferior parietal (mean [SE] B = -153.9 [43.4] mm2; P < .001), and entorhinal (mean [SE] B = -25.1 [5.8] mm2; P < .001) regions and lower cortical volumes in precentral (mean [SE] B = -474.4 [98.2] mm3; P < .001), inferior parietal (mean [SE] B = -523.7 [136.7] mm3; P < .001), entorhinal (mean [SE] B = -94.1 [24.5] mm3; P < .001), and parahippocampal (mean [SE] B = -82.6 [18.7] mm3; P < .001) regions at wave 1. Distinct cortical volume patterns continued to be significant at wave 2. Frontal, parietal, and temporal lobes exhibited differential ROI, while there were no notable distinctions in the occipital lobe and insula cortex. Conclusions and Relevance In this cohort study, MTDP was associated with enduring deficits in childhood neurocognition. Continued research on the association of MTDP with cognitive performance and brain structure related to language processing skills and episodic memory is needed.
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Affiliation(s)
- Troy B. Puga
- College of Public Health, University of Nebraska Medical Center, Omaha
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri
| | | | - Yingying Wang
- Neuroimaging for Language, Literacy & Learning Laboratory, University of Nebraska at Lincoln, Lincoln
| | - Elijah Theye
- College of Public Health, University of Nebraska Medical Center, Omaha
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Jiang W, Tang Y, Yang R, Long Y, Sun C, Han T, Wei W. Maternal smoking, nutritional factors at different life stage, and the risk of incident type 2 diabetes: a prospective study of the UK Biobank. BMC Med 2024; 22:50. [PMID: 38302923 PMCID: PMC10835913 DOI: 10.1186/s12916-024-03256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND This study aims to investigate potential interactions between maternal smoking around birth (MSAB) and type 2 diabetes (T2D) pathway-specific genetic risks in relation to the development of T2D in offspring. Additionally, it seeks to determine whether and how nutritional factors during different life stages may modify the association between MSAB and risk of T2D. METHODS This study included 460,234 participants aged 40 to 69 years, who were initially free of T2D from the UK Biobank. MSAB and breastfeeding were collected by questionnaire. The Alternative health eating index(AHEI) and dietary inflammation index(DII) were calculated. The polygenic risk scores(PRS) of T2D and pathway-specific were established, including β-cell function, proinsulin, obesity, lipodystrophy, liver function and glycated haemoglobin(HbA1c). Cox proportion hazards models were performed to evaluate the gene/diet-MSAB interaction on T2D. The relative excess risk due to additive interaction (RERI) were calculated. RESULTS During a median follow-up period of 12.7 years, we identified 27,342 cases of incident T2D. After adjustment for potential confounders, participants exposed to MSAB had an increased risk of T2D (HR=1.11, 95%CI:1.08-1.14), and this association remained significant among the participants with breastfeeding (HR= HR=1.10, 95%CI: 1.06-1.14). Moreover, among the participants in the highest quartile of AHEI or in the lowest quartile of DII, the association between MSAB and the increased risk of T2D become non-significant (HR=0.94, 95%CI: 0.79-1.13 for AHEI; HR=1.09, 95%CI:0.99-1.20 for DII). Additionally, the association between MSAB and risk of T2D became non-significant among the participants with lower genetic risk of lipodystrophy (HR=1.06, 95%CI:0.99-1.14), and exposed to MSAB with a higher genetic risk for β-cell dysfunction or lipodystrophy additively elevated the risk of T2D(RERI=0.18, 95%CI:0.06-0.30 for β-cell function; RERI=0.16, 95%CI:0.04-0.28 for lipodystrophy). CONCLUSIONS This study indicates that maintaining a high dietary quality or lower dietary inflammation in diet may reduce the risk of T2D associated with MSAB, and the combination of higher genetic risk of β-cell dysfunction or lipodystrophy and MSAB significantly elevate the risk of T2D in offspring.
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Affiliation(s)
- Wenbo Jiang
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R. China
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yiwei Tang
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Ruiming Yang
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Yujia Long
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Changhao Sun
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Tianshu Han
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R. China.
| | - Wei Wei
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R. China.
- Department of Pharmacology, College of Pharmacy Key Laboratory of Cardiovascular Research, Ministry of Education, Harbin Medical University, Harbin, P. R. China.
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Song J, Cai R. Interaction between smoking during pregnancy and gestational diabetes mellitus and the risk of cesarean delivery: evidence from the National Vital Statistics System 2019. J Matern Fetal Neonatal Med 2023; 36:2259048. [PMID: 37766417 DOI: 10.1080/14767058.2023.2259048] [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: 04/12/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To explore the interaction between smoking during pregnancy (SDP) and gestational diabetes mellitus (GDM) on the risk of cesarean delivery. METHODS This retrospective cohort study utilized data from the National Vital Statistics System (NVSS) 2019. The NVSS database provides data on births and deaths as well as maternal characteristics in the United States. The duration of follow-up was 38.74 ± 2.12 weeks. The outcome was the method of delivery, including vaginal and cesarean delivery. The multivariate logistic regression model was adopted to assess the associations of SDP and GDM with the method of delivery. The interaction between SDP and GDM was examined via calculating the relative excess risk of interaction (RERI), the attributable proportion of interaction (API) and the synergy index (S). Subgroup analyses were conducted based on age, race, prepregnancy body mass index (BMI), and primiparity. RESULTS The study included 3352615 puerperae. Compared with women who did not smoke during pregnancy, those who smoked during pregnancy had a significantly higher risk of cesarean delivery [odds ratio (OR)=1.07, 95% confidence intervals (CI): 1.05-1.10, p < 0.001]; women with GDM had a significantly greater risk of cesarean delivery than those without (OR = 1.31, 95%CI: 1.30-1.33, p < 0.001). In contrast to women who did not smoke during pregnancy and did not have GDM, those who smoked during pregnancy and had GDM exhibited an increased risk of a cesarean section (OR = 1.47, 95%CI: 1.40-1.54, p < 0.001). RERI was 0.08 (95%CI: 0.01-0.15), API was 0.06 (95%CI: 0.01-0.10), and S was 1.21 (95%CI: 1.04-1.40) suggested that there was an interaction between SDP and GDM, and it was a synergistic effect. There was a synergism between SDP and GDM in women of non-advanced age (RERI = 0.07, 95%CI: 0.001-0.15; API = 0.05, 95%CI: 0.003-0.10; S = 1.17, 95%CI: 1.001-1.36), in white women (RERI = 0.08, 95%CI: 0.004-0.16; API = 0.05, 95%CI: 0.01-0.10; S = 1.19, 95%CI: 1.02-1.39), in women who were overweight before pregnancy (RERI = 0.13, 95%CI: 0.05-0.21; API = 0.08, 95%CI: 0.04-0.13; S = 1.33, 95%CI: 1.14-1.55), and in primiparae (RERI = 0.20, 95%CI: 0.08-0.31; API = 0.12, 95%CI: 0.06-0.19; S = 1.50, 95%CI: 1.23-1.84). CONCLUSION SDP and GDM were associated with an increased risk of cesarean delivery, and a synergistic effect existed between SDP and GDM on the risk of cesarean delivery, especially in women of non-advanced age, white women, women who were overweight before pregnancy, and primiparae.
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Affiliation(s)
- Jie Song
- Department of Obstetrics and Gynecology, Ningxia People's Hospital, Yinchuan, Ningxia, P. R. China
| | - Ruiyu Cai
- Department of endocrinology, The Second Hospital of Jingzhou, Jingzhou, Hubei, P. R. China
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Shirwani A, Kuller JA, Dotters-Katz SK, Addae-Konadu K. Nicotine Use During Pregnancy: Cessation and Treatment Strategies. Obstet Gynecol Surv 2023; 78:589-597. [PMID: 37976314 DOI: 10.1097/ogx.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Abstract The use of tobacco and nicotine products during pregnancy is known to increase the risk of adverse effects on the fetus. Increased education and research have resulted in greater rates of smoking cessation during pregnancy, with a decline from 13.2% of pregnant individuals smoking in 2006 to 7.2% in 2016. However, smoking while pregnant still proves to be a prevalent issue that is associated with numerous adverse outcomes, including low birth weight, preterm birth, and developmental delays. Smoking cessation before or during pregnancy can help mitigate these effects, but the appropriate treatment can be challenging to ascertain. Accordingly, clinicians should look to provide individualized care composed of behavioral counseling in conjunction with pharmacotherapies when indicated, combined with ongoing support and education.
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Affiliation(s)
- Avan Shirwani
- Medical Student, Campbell University School of Osteopathic Medicine, Lillington, NC
| | - Jeffrey A Kuller
- Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Sarah K Dotters-Katz
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Kateena Addae-Konadu
- Private Practice, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Southeast Permanente Medical Group, Atlanta, GA
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Kobus M, Sitek A, Antoszewski B, Rożniecki JJ, Pełka J, Żądzińska E. The impact of exposure to tobacco smoking and maternal trauma in fetal life on risk of migraine. Front Neurosci 2023; 17:1191091. [PMID: 37456999 PMCID: PMC10338879 DOI: 10.3389/fnins.2023.1191091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/29/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Prenatal period is the key time in human development. Many prenatal factors are well-known and increase the risk of developing diseases' after birth. Few studies indicated the link between the prenatal period and the prevalence of migraine in childhood and adolescence so far. We decided to broaden current knowledge and investigate whether the prenatal factors influence the prevalence of migraine in adulthood. The objective of this study is to provide evidence of relationship between in utero environment and risk of migraine. Methods In total 266 females (136 in the migraine group, 130 in the control group) and 80 males (35 in the migraine group, 45 in the control group), aged 18-65 participated in the study. The quality of prenatal environment was characterized on the basis of mother's and father's education, tobacco smoke exposure, alcohol consumption, and traumatic event during pregnancy, which are considered as prenatal factors and affect on fetal development. Results Migraine occurrence in adulthood was significantly associated with maternal tobacco smoking during pregnancy (OR 3.42, 95% CI 1.54-7.61, p = 0.036) and traumatic event during pregnancy (OR 2.27, 95% CI 1.24-4.13, p = 0.020). Discussion Our study suggests that the fetal programming effect of tobacco smoking exposure and maternal trauma is not limited to prenatal life and is suggested as having a role in adulthood. Our findings support evidence that migraine adulthood can be partly influenced by early life conditions.
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Affiliation(s)
- Magdalena Kobus
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Aneta Sitek
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Esthetic Surgery, Institute of Surgery, Medical University of Lodz, Łódź, Poland
| | - Jacek J. Rożniecki
- Department of Neurology, Stroke and Neurorehabilitation, Medical University of Lodz, Lodz, Poland
| | - Jacek Pełka
- Department of Neurology, Norbert Barlicki Memory University Teaching Hospital, Lodz, Poland
| | - Elżbieta Żądzińska
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
- Biological Anthropology and Comparative Anatomy Research Unit, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
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Tahan C, Dobbins T, Hyslop F, Lingam R, Richmond R. Effect of digital health, biomarker feedback and nurse or midwife-led counselling interventions to assist pregnant smokers quit: a systematic review and meta-analysis. BMJ Open 2023; 13:e060549. [PMID: 36963792 PMCID: PMC10040078 DOI: 10.1136/bmjopen-2021-060549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/03/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To assess the effect of digital health (DH), biomarker feedback (BF) and nurse or midwife-led counselling (NoMC) interventions on abstinence in pregnant smokers during pregnancy and postpartum. SETTINGS Any healthcare setting servicing pregnant women, including any country globally. PARTICIPANTS Pregnant women of any social, ethnic or geographical background who smoke. METHODS We searched Embase, Medline, Web Of Science, Google Scholar, PsychINFO, CINAHL and PubMed between 2007 and November 2021. We included published original intervention studies in English with comparators (usual care or placebo). Two independent assessors screened and abstracted data. We performed a random-effects meta-analysis, assessed risk of bias with the Cochrane Tool and used Grading of Recommendations Assessment, Development and Evaluation to assess the quality of evidence. RESULTS We identified 57 studies and included 54 in the meta-analysis. Sixteen studies assessed DH (n=3961), 6 BF (n=1643), 32 NoMC (n=60 251), 1 assessed NoMC with BF (n=1120) and 2 NoMC with DH interventions (n=2107). DH interventions had moderate certainty evidence to achieve continuous abstinence (CA) at late pregnancy (4 studies; 2049 women; RR=1.98, 95% CI 1.08 to 3.64, p=0.03) and low certainty evidence to achieve point prevalence abstinence (PPA) postpartum (5 studies; 2238 women; RR=1.46, 95% CI 1.05 to 2.02, p=0.02). NoMC interventions had moderate certainty evidence to achieve PPA in late pregnancy (15 studies; 16 234 women; RR=1.54, 95% CI 1.16 to 2.06, p<0.01) and low certainty evidence to achieve PPA postpartum (13 studies; 5466 women; RR=1.79, 95% CI 1.14 to 2.83, p=0.01). Both DH and BF interventions did not achieve PPA at late pregnancy, nor NoMC interventions achieve CA postpartum. The certainty was reduced due to risk of bias, heterogeneity, inconsistency and/or imprecision. CONCLUSION NoMC interventions can assist pregnant smokers achieve PPA and DH interventions achieve CA in late pregnancy. These interventions may achieve other outcomes.
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Affiliation(s)
- Chadi Tahan
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Timothy Dobbins
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Fran Hyslop
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Paediatric Population Health, School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Richmond
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
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Racial differences in the impact of maternal smoking on sudden unexpected infant death. J Perinatol 2023; 43:345-349. [PMID: 36271297 PMCID: PMC9589613 DOI: 10.1038/s41372-022-01516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prenatal smoking increases the risk of Sudden Unexpected Infant Death (SUID). Whether exposure patterns and associations differ by race requires further study. OBJECTIVES Determine if patterns of exposure and associations between SUID and maternal smoking before and during pregnancy differ by race. METHODS Using U.S. National Center for Health Statistics linked birth/infant death files 2012-2013, we documented SUID by smoking duration and race. Maternal smoking history: never, pre-pregnancy only, and pre-pregnancy plus first, first, second, or all trimesters. RESULTS Smoking was more common in non-Hispanic White (NHW) than non-Hispanic Black (NHB) mothers and more evident for both in SUID cases. The most common exposure duration is from before and throughout pregnancy (SUID: 78.3% NHW, 66.9% NHB; Survivors: 60.22% and 53.96%, respectively). NHB vs. NHW SUID rates per 1000 live births were 1.07 vs. 0.34 for non-smokers and 3.06 and 1.79 for smokers, ORs trended upward for both with increasing smoking duration. CONCLUSION Fewer NHB mothers smoked, but both NHB and NHW groups exhibited a dose-response relationship between smoking duration and SUID. The most common duration was from before to the end of pregnancy, suggesting difficulty in quitting and a need for effective interventions.
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Smoking cessation Through Optimization of clinical care in Pregnancy: the STOP pragmatic randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:100763. [PMID: 36216314 DOI: 10.1016/j.ajogmf.2022.100763] [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: 07/15/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Smoking cessation improves pregnancy outcomes, yet there is uncertainty around the efficacy of models of antenatal intervention for smoking cessation in pregnancy. OBJECTIVE This study aimed to test the Smoking cessation Through Optimization of clinical care in Pregnancy (STOP) clinic as an antenatal care pathway for smoking cessation in pregnancy. The STOP intervention is a smoking cessation clinic staffed by a dedicated multidisciplinary team of obstetricians, midwives, and smoking cessation practitioners, who provide motivational and psychological support and intensive clinical monitoring of pregnancy. STUDY DESIGN This was a pragmatic randomized controlled trial of the STOP clinic compared with routine antenatal care at a tertiary urban maternity hospital delivering >8000 infants per year. The primary outcome measured was continuous abstinence from smoking before 28+0 weeks' gestation, sustained throughout the duration of the pregnancy, and validated using biological measures. The secondary outcomes included maternal and fetal morbidity, delivery and neonatal outcomes, smoking outcomes, and qualitative measures. RESULTS A total of 436 women were randomized, with 430 women included in the primary outcome analysis. Women attending the STOP antenatal clinic were more likely to quit smoking compared with those in routine care (odds ratio, 3.62; 95% confidence interval, 1.43-9.17). In addition, women who continued to smoke in the STOP clinic smoked fewer cigarettes daily at the time of delivery compared with controls: 5±4 in the STOP clinic and 7±5 in the control group (odds ratio, 0.28; 95% confidence interval, 0.13-0.59). However, this intervention did not alter postpartum relapse rates (4.3% intervention arm vs 1.5% control arm, not significant) at 4 to 6 months following delivery. The mean birthweight was similar in the intervention and control arms; however, quitters in both groups had infants with significantly higher birthweights compared with those of continued smokers. CONCLUSION The STOP antenatal model of care leads to higher smoking cessation rates among pregnant smokers and lower daily cigarette consumption at time of delivery. Currently, there is no defined or dedicated antenatal pathway for pregnant smokers, despite the high-risk nature of their pregnancies. Our findings suggest that improved smoking cessation rates in pregnancy may be achieved using the holistic approach of the STOP model of care.
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Saliaj A, Zahaj M, Vasilika P, Mechili EA. Long-term impact of tobacco exposure during pregnancy on children's psychomotor development. Pediatr Int 2023; 65:e15388. [PMID: 36251534 DOI: 10.1111/ped.15388] [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: 08/13/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Both active and second-hand smoking (SHS) can cause complications during pregnancy and after delivery. This study aimed to assess how tobacco exposure (active and passive) during the fetal period could impact the psychomotor development of children when they attain the age of 3-6 years. METHODS The study included 160 mothers and their 3-6 year-old children. Two research groups were set up of children born to active or SHS mothers during the period when they were pregnant and a control group of children of non-smoking mothers. The parameters of the psychomotor development of the children were measured using the Age & Stage Questionnaires 3® (ASQ-3). RESULTS Children, whose mothers were smokers themselves or who were exposed to SHS during the period of pregnancy had an average psychomotor development score of 221 points versus 243.5 points in the control group. Twenty-six percent had delays (near or under the cut-off scores) in one of the assessed psychomotor areas and 60% had two or more psychomotor delays; 36% of children whose mothers were not exposed to smoking during pregnancy had normal psychomotor development and only 34% presented multiple psychomotor delays. CONCLUSIONS Fetuses exposed to tobacco are more likely to achieve a psychomotor development in the 'monitor' and 'fail' areas compared to the non-exposed control group. The children exposed to smoking during their fetal development should be considered as a group at risk of developmental delays, therefore they should be closely monitored and supported by caregivers and developmental pediatricians.
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Affiliation(s)
- Aurela Saliaj
- Department of Health care, Faculty of Health, University 'Ismail Qemali' of Vlora, Vlora, Albania
| | - Majlinda Zahaj
- Department of Nursing, Faculty of Health, University 'Ismail Qemali' of Vlora, Vlora, Albania
| | - Prifti Vasilika
- Department of Nursing, Faculty of Health, University 'Ismail Qemali' of Vlora, Vlora, Albania
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Interventions Addressing Cannabis Use During Pregnancy: A Systematic Review. J Addict Med 2023; 17:47-53. [PMID: 36731108 DOI: 10.1097/adm.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The prevalence of cannabis use among pregnant women is increasing in the United States and places mothers and infants at risk of multiple adverse health outcomes. Given the uncertainty expressed by providers regarding how to approach cannabis use during pregnancy and the growing need for a systematic endeavor to curb use in this population, the aim of this study is to conduct a systematic review of interventions focused on reduction in cannabis use during pregnancy. METHODS We conducted a systematic search of MEDLINE, PsycINFO, CINAHL, Web of Science, SCOPUS, and Cochrane Library to identify studies of interventions that target individuals that engaged in cannabis use during pregnancy. We included studies if they were randomized controlled trials, controlled studies, feasibility studies, pilot studies, as well as observational studies. The primary diagnostic outcome of interest is reduction in cannabis use. RESULTS We identified 9 studies for inclusion with sample sizes ranging from 15 to 658 pregnant people. Interventions involved brief counseling, cognitive behavioral therapy (CBT), motivational interviewing (MI), motivational enhancement therapy + cognitive behavioral therapy (MET-CBT), computer-delivered psychotherapy, and psychoeducation. The interventions that were effective primarily used MI, CBT, and/or MET. There was just 1 study that implemented a home intervention and one that explored computer-based psychotherapy. CONCLUSIONS The studies uncovered through this systematic review suggest that interventions involving CBT and/or MI demonstrate promise for decreasing cannabis use during pregnancy. There is a tremendous need for high-quality studies focused on this population, and the potential for remote and computer-based interventions should be explored more fully.
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Agràs-Guàrdia M, Martínez-Torres S, Granado-Font E, Pallejà-Millán M, Villalobos F, Patricio D, Ruiz F, Marin-Gomez FX, Duch J, Rey-Reñones C, Martín-Luján F. Effectiveness of an App for tobacco cessation in pregnant smokers (TOBBGEST): study protocol. BMC Pregnancy Childbirth 2022; 22:933. [PMID: 36514020 PMCID: PMC9745963 DOI: 10.1186/s12884-022-05250-5] [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: 10/07/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tobacco consumption during pregnancy is one of the most modifiable causes of morbidity and mortality for both pregnant smokers and their foetus. Even though pregnant smokers are conscious about the negative effects of tobacco consumption, they also had barriers for smoking cessation and most of them continue smoking, being a major public health problem. The aim of this study is to determine the effectiveness of an application (App) for mobile devices, designed with a gamification strategy, in order to help pregnant smokers to quit smoking during pregnancy and in the long term. METHODS This study is a multicentre randomized community intervention trial. It will recruit pregnant smokers (200 participants/group), aged more than 18 years, with sporadically or daily smoking habit in the last 30 days and who follow-up their pregnancy in the Sexual and Reproductive Health Care Services of the Camp de Tarragona and Central Catalonia Primary Care Departments. All the participants will have the usual clinical practice intervention for smoking cessation, whereas the intervention group will also have access to the App. The outcome measure will be prolonged abstinence at 12 months after the intervention, as confirmed by expired-carbon monoxide and urinary cotinine tests. Results will be analysed based on intention to treat. Prolonged abstinence rates will be compared, and the determining factors will be evaluated using multivariate statistical analysis. DISCUSSION The results of this study will offer evidence about the effectiveness of an intervention using a mobile App in smoking cessation for pregnant smokers, to decrease comorbidity associated with long-term smoking. If this technology is proven effective, it could be readily incorporated into primary care intervention for all pregnant smokers. TRIAL REGISTRATION Clinicaltrials.gov ID NCT05222958 . Trial registered 3 February 2022.
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Affiliation(s)
- Maria Agràs-Guàrdia
- grid.22061.370000 0000 9127 6969Department of Primary Care Camp de Tarragona, Primary Care Center Llibertat (Reus – 3, Institut Català de La Salut, Reus, Spain ,grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
| | - Sara Martínez-Torres
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.36083.3e0000 0001 2171 6620Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Ester Granado-Font
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.22061.370000 0000 9127 6969Department of Primary Care Camp de Tarragona, Primary Care Center Horts de Miró (Reus – 4), Institut Català de La Salut, Reus, Spain
| | - Meritxell Pallejà-Millán
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.410367.70000 0001 2284 9230School of Medicine and Health Sciences, Universitat Rovira I Virgili, Reus, Spain
| | - Felipe Villalobos
- grid.36083.3e0000 0001 2171 6620Universitat Oberta de Catalunya (UOC), Barcelona, Spain ,grid.452479.9Fundació Institut Universitari Per a La Recerca a L’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - Demetria Patricio
- grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.22061.370000 0000 9127 6969Department of Primary Care Camp de Tarragona, Atenció a La Salut Sexual I Reproductive (ASSIR), Institut Català de La Salut, Reus, Spain
| | - Francisca Ruiz
- grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.410367.70000 0001 2284 9230School of Medicine and Health Sciences, Universitat Rovira I Virgili, Reus, Spain ,grid.22061.370000 0000 9127 6969Department of Primary Care Camp de Tarragona, Atenció a La Salut Sexual I Reproductive (ASSIR), Institut Català de La Salut, Reus, Spain
| | - Francesc X. Marin-Gomez
- grid.452479.9Primary Healthcare Research Support Unit Catalunya Central, Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain ,grid.22061.370000 0000 9127 6969Health Promotion in Rural Areas Research Group, Gerència Territorial de La Catalunya Central, Institut Català de La Salut, Sant Fruitós de Bages, Spain
| | - Jordi Duch
- grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.410367.70000 0001 2284 9230Department of Computer Engineering and Mathematics, Universitat Rovira I Virgili (URV), Tarragona, Spain
| | - Cristina Rey-Reñones
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.410367.70000 0001 2284 9230School of Medicine and Health Sciences, Universitat Rovira I Virgili, Reus, Spain
| | - Francisco Martín-Luján
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.410367.70000 0001 2284 9230School of Medicine and Health Sciences, Universitat Rovira I Virgili, Reus, Spain
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Singh PK, Singh L, Wehrmeister FC, Singh N, Kumar C, Singh A, Sinha DN, Bhutta ZA, Singh S. Prevalence of smoking and smokeless tobacco use during breastfeeding: A cross-sectional secondary data analysis based on 0.32 million sample women in 78 low-income and middle-income countries. EClinicalMedicine 2022; 53:101660. [PMID: 36159043 PMCID: PMC9489519 DOI: 10.1016/j.eclinm.2022.101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking and smokeless tobacco use during the postpartum period is well studied in high-income countries, whereas low-income and middle-income countries (LMICs) lack evidence. METHODS In this cross-sectional study we used data from the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted in 78 LMICs between January 2010 and December 2019 to study tobacco use among 0.32 million sample lactating women. Age-standardized prevalence of smoking and smokeless tobacco use was estimated and presented with a 95% Confidence Interval (CI) for 78 LMICs. Pooled estimates overall and by WHO regions were obtained using random-effects meta-analyses. Country-level and community-level variance to understand contextual factors was also quantified using multilevel modelling. FINDINGS Pooled prevalence of any tobacco use among breastfeeding women in LMICs was 3.61% (95% CI 3.53-3.70); with the lowest prevalence in regions of the Americas (1.44%, 1.26-1.63) and the highest in the Southeast Asia region (6.13%, 6.0-6.27). The pooled prevalence of tobacco smoking was reported to be 1.16% (1.11-1.21), with the highest prevalence in the Eastern Mediterranean region (4.27%, 3.88-4.67) and the lowest in the African region (0.81%, 0.76-0.86). The pooled prevalence of smokeless tobacco use was reported to be 2.56% (2.49-2.63), with the highest prevalence in the Southeast Asia region (4.92%, 4.80-5.04). Illiterate and poor women in LMICs bore the enormous burden of tobacco use. INTERPRETATION The prevalence of smoking and smokeless tobacco use among lactating women in LMICs varied considerably across different WHO regions. Considering the cross-sectional design of the study, caution is required while interpreting the results. To improve mothers' and children's health and nutrition outcomes and reduce health inequalities in LMICs, reducing tobacco use through evidence-based interventions is critical. FUNDING None.
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Affiliation(s)
- Prashant Kumar Singh
- Division of Preventive Oncology & Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, India
- Corresponding author at: Division of Preventive Oncology & Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, India.
| | - Lucky Singh
- ICMR - National Institute of Medical Statistics, New Delhi, India
| | - Fernando C. Wehrmeister
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Nishikant Singh
- Division of Preventive Oncology & Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Chandan Kumar
- Department of Policy & Management Studies, TERI School of Advanced Studies, New Delhi, India
| | - Ankur Singh
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | | | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Shalini Singh
- Division of Preventive Oncology & Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, India
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Mori M, Ishii K, Goto A, Nakano H, Suzuki K, Ota M, Yasumura S, Fujimori K. Factors Associated With Smoking Relapse Among Women in Japan From Pregnancy to Early Parenthood. J Obstet Gynecol Neonatal Nurs 2022; 51:428-440. [PMID: 35594955 DOI: 10.1016/j.jogn.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify factors, including mental health, associated with smoking relapse among women in Japan from pregnancy to early parenthood. DESIGN Secondary analysis of data from an ongoing cross-sectional study conducted between 2013 and 2016. SETTING We mailed questionnaires to all women who received a maternal and child health handbook from a municipality in Fukushima Prefecture or who underwent a maternal health checkup and gave birth in Fukushima Prefecture. PARTICIPANTS Of the 28,562 women who responded to the questionnaire, 6,747 who previously smoked and quit around the time they registered their pregnancies were included in the analysis. METHODS Participants were divided into groups according to smoking relapse status: a nonrelapse group, which included those who maintained smoking cessation, and a relapse group, which included those who quit smoking but later relapsed. We further classified the latter group into those who quit smoking before or after pregnancy registration. We used a logistic regression model with forced entry to calculate adjusted odds ratios. RESULTS Of the 6,747 participants who previously smoked, 881 (13.1%) relapsed. Regardless of the timing of smoking cessation, younger age and living in a specific region of Fukushima Prefecture were associated with smoking relapse. Relapse was associated with symptoms of depression in participants who quit smoking before registration and with multiparity in participants who quit smoking after registration of their pregnancies. CONCLUSIONS Support for women at risk of smoking relapse after pregnancy requires consideration of regional characteristics and incorporation of family and mental health support with a focus on younger women.
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15
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Bar-Zeev Y. Unclear role for e-cigarettes during pregnancy. Nat Med 2022; 28:900-901. [PMID: 35577965 DOI: 10.1038/s41591-022-01795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Health, Hebrew University of Jerusalem-Hadassah Medical Centre, Jerusalem, Israel.
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16
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Effects of Smoking Reduction and Cessation on Birth Outcomes in a Scheduled Gradual Reduction Cessation Trial. Matern Child Health J 2022; 26:963-969. [PMID: 35235142 PMCID: PMC9940452 DOI: 10.1007/s10995-022-03386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Smoking during pregnancy can affect infant birthweight. We tested whether an intervention that promoted scheduled gradual reduction improved birth outcomes among pregnant women who smoked. We also examined race differences in birth outcomes. METHODS We conducted a 2-arm randomized controlled trial where pregnant women who smoked received either SMS text-delivered scheduled gradual smoking reduction (SGR) program plus support texts or support messages only throughout their pregnancy. The outcomes for this paper were birth outcomes including birth weight and gestational age obtained from chart review. Analyses were conducted using chi-square and t-tests in SAS. RESULTS We approached 2201 pregnant women with smoking history. Of the 314 women recruited into the study, 290 completed a medical release form (92%). We did not find any significant differences in birth outcomes by arm or race. The majority of participants reduced smoking by the 80%. Women who reduced more than 50% of their baseline cigarettes per day had a birth weight increase of 335 g compared to those that did not (p = 0.05). The presence of alcohol/drug use in prenatal visit notes was associated with low infant birth weight (p = 0.05). DISCUSSION The scheduled gradual reduction intervention did not improve birth outcomes. Additional research is needed to help improve birth outcomes for pregnant women who engage in tobacco and illicit substance use. CLINICAL TRIAL #: NCT01995097.
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Joglekar R, Cauley M, Lipsich T, Corcoran DL, Patisaul HB, Levin ED, Meyer JN, McCarthy MM, Murphy SK. Developmental nicotine exposure and masculinization of the rat preoptic area. Neurotoxicology 2022; 89:41-54. [PMID: 35026373 PMCID: PMC8917982 DOI: 10.1016/j.neuro.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
Nicotine is a neuroteratogenic component of tobacco smoke, e-cigarettes, and other products and can exert sex-specific effects in the developing brain, likely mediated through sex hormones. Estradiol modulates expression of nicotinic acetylcholine receptors in rats, and plays critical roles in neurodevelopmental processes, including sexual differentiation of the brain. Here, we examined the effects of developmental nicotine exposure on the sexual differentiation of the preoptic area (POA), a brain region that normally displays robust structural sexual dimorphisms and controls adult mating behavior in rodents. Using a rat model of gestational exposure, developing pups were exposed to nicotine (2 mg/kg/day) via maternal osmotic minipump (subcutaneously, sc) throughout the critical window for brain sexual differentiation. At postnatal day (PND) 4, a subset of offspring was analyzed for epigenetic effects in the POA. At PND40, all offspring were gonadectomized, implanted with a testosterone-releasing capsule (sc), and assessed for male sexual behavior at PND60. Following sexual behavior assessment, the area of the sexually dimorphic nucleus of the POA (SDN-POA) was measured using immunofluorescent staining techniques. In adults, normal sex differences in male sexual behavior and in the SDN-POA area were eliminated in nicotine-treated animals. Using novel analytical approaches to evaluate overall masculinization of the adult POA, we identified significant masculinization of the nicotine-treated female POA. In neonates (PND4), nicotine exposure induced trending alterations in methylation-dependent masculinizing gene expression and DNA methylation levels at sexually-dimorphic differentially methylated regions, suggesting that developmental nicotine exposure is capable of triggering masculinization of the rat POA via epigenetic mechanisms.
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Affiliation(s)
- Rashmi Joglekar
- Duke University Nicholas School of the Environment, Durham, NC 27708 USA
| | - Marty Cauley
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC 27708 USA
| | - Taylor Lipsich
- Duke University Medical Center, Department of Obstetrics & Gynecology, Durham, NC 27708 USA
| | - David L. Corcoran
- Duke Center for Genomic and Computational Biology, Durham, NC 27708 USA
| | - Heather B. Patisaul
- North Carolina State University, Department of Biological Sciences, Raleigh, NC 27695 USA
| | - Edward D. Levin
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC 27708 USA
| | - Joel N. Meyer
- Duke University Nicholas School of the Environment, Durham, NC 27708 USA
| | - Margaret M. McCarthy
- University of Maryland School of Medicine, Department of Pharmacology, Baltimore, MD 21201 USA
| | - Susan K. Murphy
- Duke University Medical Center, Department of Obstetrics & Gynecology, Durham, NC 27708 USA
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Yang L, Wang H, Yang L, Zhao M, Guo Y, Bovet P, Xi B. Maternal cigarette smoking before or during pregnancy increases the risk of birth congenital anomalies: a population-based retrospective cohort study of 12 million mother-infant pairs. BMC Med 2022; 20:4. [PMID: 35012532 PMCID: PMC8750764 DOI: 10.1186/s12916-021-02196-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/22/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The associations of maternal cigarette smoking with congenital anomalies in offspring have been inconsistent. This study aimed to clarify the associations of the timing and intensity of maternal cigarette smoking with 12 subtypes of birth congenital anomalies based on a nationwide large birth cohort in the USA. METHODS We used nationwide birth certificate data from the US National Vital Statistics System during 2016-2019. Women reported the average daily number of cigarettes they consumed 3 months before pregnancy and in each subsequent trimester during pregnancy. Twelve subtypes of congenital anomalies were identified in medical records. Poisson regression analysis was used to estimate the risk ratios (RRs) with 95% confidence intervals (CIs) for 12 subtypes of congenital anomalies associated with the timing (i.e., before pregnancy, and during three different trimesters of pregnancy) and intensity (i.e., number of cigarettes consumed per day) of maternal cigarette smoking. RESULTS Among the 12,144,972 women included, 9.3% smoked before pregnancy and 7.0%, 6.0%, and 5.7% in the first, second, and third trimester, respectively. Maternal smoking before or during pregnancy significantly increased the risk of six subtypes of birth congenital anomalies (i.e., congenital diaphragmatic hernia, gastroschisis, limb reduction defect, cleft lip with or without cleft palate, cleft palate alone, and hypospadias), even as low as 1-5 cigarettes per day. The adjusted RRs (95% CIs) for overall birth congenital anomalies (defined as having any one of the congenital malformations above significantly associated with maternal cigarette smoking) among women who smoked 1-5, 6-10, and ≥ 11 cigarettes per day before pregnancy were 1.31 (1.22-1.41), 1.25 (1.17-1.33), and 1.35 (1.28-1.43), respectively. Corresponding values were 1.23 (1.14-1.33), 1.33 (1.24-1.42), 1.33 (1.23-1.43), respectively, for women who smoked cigarettes in the first trimester; 1.32 (1.21-1.44), 1.36 (1.26-1.47), and 1.38 (1.23-1.54), respectively, for women who smoked cigarettes in the second trimester; and 1.33 (1.22-1.44), 1.35 (1.24-1.47), and 1.35 (1.19-1.52), respectively, for women who smoked cigarettes in the third trimester. Compared with women who kept smoking before and throughout pregnancy, women who never smoked had significantly lower risk of congenital anomalies (RR 0.77, 95% CI 0.73-0.81), but women who smoked before pregnancy and quitted during each trimester of pregnancy had no reduced risk (all P > 0.05). CONCLUSIONS Maternal smoking before or during pregnancy increased the risk of several birth congenital anomalies, even as low as 1-5 cigarettes per day. Maternal smokers who stopped smoking in the subsequent trimesters of pregnancy were still at an increased risk of birth congenital anomalies. Our findings highlighted that smoking cessation interventions should be implemented before pregnancy.
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Affiliation(s)
| | | | - Liu Yang
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yajun Guo
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Pascal Bovet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Hirth JM, Valadez C, Gonzalez S, Kowalchuk A, Gutierrez JA, Zoorob R. Racial/ethnic variations in alcohol and cigarette use by pregnancy status among 20- to 44-year-old women, NHANES 2001–2018. WOMEN'S HEALTH 2022; 18:17455057221112188. [PMID: 35819070 PMCID: PMC9280819 DOI: 10.1177/17455057221112188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives: This study examines alcohol consumption and smoking behaviors by pregnancy status and race/ethnicity in order to inform improved interventions designed to assist women of all races to avoid alcohol and tobacco use during pregnancy for their health and to prevent potential fetal exposure. Methods: This retrospective secondary data analysis utilized nationally representative National Health and Nutrition Examination Survey data between 2001 and 2018. Smoking and alcohol use were evaluated by race/ethnicity and pregnancy risk. Sexual behavior, reproductive health, and prescription drug use determined pregnancy risk, categorized as low pregnancy risk, at risk of becoming pregnant, and pregnant. Binary and multinomial multivariable logistic regression were used to examine associations. Results: The final sample consisted of 10,019 women of which 11.8% were Mexican American, 7.7% other Hispanic, 65.5% white, and 15% black (weighted percentages). White low pregnancy risk and pregnancy risk smoked most frequently in respective pregnancy risk groups (p < 0.001). Among pregnant women, smoking prevalence was highest among black women (14.0%, p < 0.01). Pregnancy risk women were more likely to smoke and pregnant women were less likely to smoke compared with low pregnancy risk. Low pregnancy risk and pregnancy risk Hispanics had a lower prevalence of binge drinking, but prevalence decreased less among pregnant Hispanics than other racial/ethnic groups. In adjusted analyses, pregnancy risk black women had more than 2 times the odds of combined smoking and alcohol consumption compared with low pregnancy risk black women. Conclusion: Women who may become pregnant need interventions and improved policy to prevent alcohol use and smoking. Culturally appropriate alcohol and smoking cessation interventions before pregnancy and improved contraception access are needed.
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Affiliation(s)
- Jacqueline M Hirth
- Department of Family and Community Health, Baylor College of Medicine, Houston, TX, USA
| | | | - Sandra Gonzalez
- Department of Family and Community Health, Baylor College of Medicine, Houston, TX, USA
| | - Alicia Kowalchuk
- Department of Family and Community Health, Baylor College of Medicine, Houston, TX, USA
| | - Judith A Gutierrez
- Department of Family and Community Health, Baylor College of Medicine, Houston, TX, USA
| | - Roger Zoorob
- Department of Family and Community Health, Baylor College of Medicine, Houston, TX, USA
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20
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Noël A, Perveen Z, Xiao R, Hammond H, Le Donne V, Legendre K, Gartia MR, Sahu S, Paulsen DB, Penn AL. Mmp12 Is Upregulated by in utero Second-Hand Smoke Exposures and Is a Key Factor Contributing to Aggravated Lung Responses in Adult Emphysema, Asthma, and Lung Cancer Mouse Models. Front Physiol 2021; 12:704401. [PMID: 34912233 PMCID: PMC8667558 DOI: 10.3389/fphys.2021.704401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/19/2021] [Indexed: 12/18/2022] Open
Abstract
Matrix metalloproteinase-12 (Mmp12) is upregulated by cigarette smoke (CS) and plays a critical role in extracellular matrix remodeling, a key mechanism involved in physiological repair processes, and in the pathogenesis of emphysema, asthma, and lung cancer. While cigarette smoking is associated with the development of chronic obstructive pulmonary diseases (COPD) and lung cancer, in utero exposures to CS and second-hand smoke (SHS) are associated with asthma development in the offspring. SHS is an indoor air pollutant that causes known adverse health effects; however, the mechanisms by which in utero SHS exposures predispose to adult lung diseases, including COPD, asthma, and lung cancer, are poorly understood. In this study, we tested the hypothesis that in utero SHS exposure aggravates adult-induced emphysema, asthma, and lung cancer. Methods: Pregnant BALB/c mice were exposed from gestational days 6–19 to either 3 or 10mg/m3 of SHS or filtered air. At 10, 11, 16, or 17weeks of age, female offspring were treated with either saline for controls, elastase to induce emphysema, house-dust mite (HDM) to initiate asthma, or urethane to promote lung cancer. At sacrifice, specific disease-related lung responses including lung function, inflammation, gene, and protein expression were assessed. Results: In the elastase-induced emphysema model, in utero SHS-exposed mice had significantly enlarged airspaces and up-regulated expression of Mmp12 (10.3-fold compared to air-elastase controls). In the HDM-induced asthma model, in utero exposures to SHS produced eosinophilic lung inflammation and potentiated Mmp12 gene expression (5.7-fold compared to air-HDM controls). In the lung cancer model, in utero exposures to SHS significantly increased the number of intrapulmonary metastases at 58weeks of age and up-regulated Mmp12 (9.3-fold compared to air-urethane controls). In all lung disease models, Mmp12 upregulation was supported at the protein level. Conclusion: Our findings revealed that in utero SHS exposures exacerbate lung responses to adult-induced emphysema, asthma, and lung cancer. Our data show that MMP12 is up-regulated at the gene and protein levels in three distinct adult lung disease models following in utero SHS exposures, suggesting that MMP12 is central to in utero SHS-aggravated lung responses.
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Affiliation(s)
- Alexandra Noël
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Zakia Perveen
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Rui Xiao
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, United States
| | - Harriet Hammond
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | | | - Kelsey Legendre
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Manas Ranjan Gartia
- Department of Mechanical and Industrial Engineering, Louisiana State University, Baton Rouge, LA, United States
| | - Sushant Sahu
- Department of Chemistry, University of Louisiana at Lafayette, Lafayette, LA, United States
| | - Daniel B Paulsen
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Arthur L Penn
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
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21
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Behavioral Smoking Cessation Counseling During Pregnancy: A Cost-Effectiveness Analysis. Obstet Gynecol 2021; 137:703-712. [PMID: 33706341 DOI: 10.1097/aog.0000000000004327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the cost effectiveness of using behavioral smoking cessation counseling during pregnancy. METHODS We designed a decision-analytic model using TreeAge Pro 2020 software to compare the cost effectiveness and outcomes among women who received behavioral smoking cessation counseling compared with women who received usual care during pregnancy. We used a theoretical cohort of 285,000 women, the approximate number of pregnant women who smoke each year in the United States. Outcomes included maternal abstinence from smoking, fetal growth restriction, stillbirth, preterm delivery, neonatal death, and cerebral palsy, in addition to cost and quality-adjusted life-years (QALYs) for both the woman and the neonate. All model inputs were derived from the literature, and a willingness-to-pay threshold was set at $100,000 per QALY. Sensitivity analyses were performed to determine the robustness of baseline assumptions. RESULTS In our theoretical cohort, behavioral smoking cessation counseling compared with usual care was associated with 9,019 additional women stopping smoking during pregnancy (34,604 vs 25,585). Smoking cessation counseling also resulted in 911 fewer cases of fetal growth restriction, 20 fewer stillbirths, 250 fewer preterm deliveries, 11 fewer neonatal deaths, and one less case of cerebral palsy. Using behavioral smoking cessation counseling interventions during pregnancy led to better outcomes despite higher costs, with an incremental cost-effectiveness ratio of $71,658 per QALY, which was below our willingness-to-pay threshold of $100,000 per QALY, making the intervention cost effective. Sensitivity analyses demonstrated that the counseling intervention was cost effective at probabilities of smoking cessation greater than 11.6% (baseline input: 12.1%) or the cost of the behavioral intervention was less than $475.21 (baseline input: $368.78). CONCLUSION Behavioral smoking cessation counseling during pregnancy was associated with fewer adverse neonatal outcomes and was cost effective. Increasing utilization of such interventions and increasing insurance coverage of this care are important initiatives to improve outcomes in this at-risk population.
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22
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Kedia SK, Ahuja NA, Carswell A, Vander Weg MW, Scarinci IC, Ward KD. Smoking Cessation among Pregnant and Postpartum Women from Low-Income Groups in the United States. J Midwifery Womens Health 2021; 66:486-493. [PMID: 34260136 DOI: 10.1111/jmwh.13242] [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: 08/24/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pregnancy creates a unique window of opportunity for smoking cessation. However, pregnant women from underserved groups can face personal, social, and environmental challenges that impede quitting. This study draws upon the socioecological framework to explore perspectives on smoking cessation among pregnant and postpartum women from low-income groups in the mid-South of the United States. METHODS Semistructured interviews were conducted with 60 women who were pregnant or postpartum. Data were analyzed in Dedoose qualitative software using the directed content analysis approach. RESULTS Findings reveal that at the individual level, motivations for smoking cessation included the fact of being pregnant, risks associated with the infant's health, and desire to breastfeed. However, some pregnant women perceived that slowing down on smoking during pregnancy was adequate to prevent harm to their fetuses. Individual-level factors that made smoking cessation difficult included nicotine addiction and habit, boredom, stressful life circumstances, fear of weight gain, and perceived lack of willpower. At the interpersonal level, living in a smoke-free environment where loved ones do not smoke and emotional and practical support from social network members including partners and family members were thought to facilitate smoking cessation. At the organizational level, access to nicotine replacement therapies and counseling aided in their abilities to quit smoking. At the policy level, pregnant women viewed increase in cigarette prices, warning labels on the cigarette pack, and the potential for a ban on cigarette sales as having some effect in helping them quit smoking. DISCUSSION This study offers theoretical insights into factors that function as barriers or facilitators of smoking cessation among pregnant and postpartum women from low-income groups in the United States. Designing multilevel smoking cessation interventions while considering the interplay of individual, interpersonal, organizational, and policy level factors may lead to better cessation outcomes.
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Affiliation(s)
- Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Nikhil A Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
| | | | - Mark W Vander Weg
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa.,Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
| | - Isabel C Scarinci
- Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
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23
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Knowledge, Attitude and Smoking Patterns Among Pregnant Women: A Jordanian Perspective. Ann Glob Health 2021; 87:36. [PMID: 33868968 PMCID: PMC8034404 DOI: 10.5334/aogh.3279] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Smoking during pregnancy is one of the main modifiable factors associated with perinatal morbidity and mortality and maternal complications. Literature is scant regarding smoking habits of pregnant women in Jordan. Objectives: To investigate smoking patterns and attitudes of Jordanian pregnant women towards smoking. Methods: A cross-sectional survey of patterns and attitudes towards smoking among 436 mothers attending healthcare facilities in the Governorate of Irbid, Jordan, between August and September 2019. Results: Out of 436 pregnant women in the Governorate of Irbid, Jordan, 13 (2.9%) quit smoking once pregnancy was conformed, and 77 (17.6%) continued to smoke. Pregnant non-smokers believed that hookah and electronic cigarettes are as bad to health as cigarettes, while smokers believed that hookah and electronic cigarettes are less hazardous than cigarettes (5.19% versus 21.99%, p = 0.001, and 6.49% versus 19.37%, p = 0.009, respectively). Non-smokers were significantly more aware regarding the hazards of smoking on perinatal outcomes, such as abortion (31.94% versus 10.39%, p = 0.001), placental abruption (31.94% versus 10.39%, p = 0.001), intrauterine growth restriction and fetal malformations (36.65% versus 14.29%, p = 0.007), fetal death (30.89% versus 6.49, p < 0.001), neonatal pulmonary diseases (44.50% versus 24.68%, p = 0.024), neonatal asthma (47.12% versus 28.57%, p = 0.038), and ear diseases (42.41% versus 20.8%, p = 0.012). Conclusion: There is a high prevalence of smokers among pregnant women in Jordan. The level of awareness regarding long-term consequences of tobacco use remains low. Educational programs should include information about the hazards of all forms of smoking. Pregnancy provides a good opportunity for promoting smoking cessation.
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Maternal Prenatal Hair Cortisol Is Associated with Child Wheeze among Mothers and Infants with Tobacco Smoke Exposure and Who Face High Socioeconomic Adversity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052764. [PMID: 33803272 PMCID: PMC7967280 DOI: 10.3390/ijerph18052764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022]
Abstract
The association of co-occurring prenatal stress and tobacco exposures on childhood wheezing and asthma are not well established. In this study, we compared maternal prenatal hair cortisol concentration (HCC) to the maternal report of infant wheezing (y/n) in the first year of life among mother-infant dyads exposed to tobacco smoke and socioeconomic adversity. Data were obtained from the Vitamin C to Decrease Effects of Smoking in Pregnancy on Infant Lung Function study. Maternal adversity was defined by the level of education, household income, and health insurance provider. Hair was collected at delivery, representing average circulating third-trimester cortisol levels. HCC was log transformed and dichotomized into high/low cortisol groups that were placed into a multivariate model predicting wheeze. Subjects (n = 132) were primarily White with ≤high school education and receiving government-provided health insurance. Forty-five percent of infants wheezed. Average HCC was 3.39 pg/mg hair. Women with HCC > 3.55 pg/mg were more than twice as likely to report having a child who wheezed (odds ratio 2.56, 95% confidence interval 1.22-5.40; p = 0.01), adjusting for insurance provider and maternal asthma. Among this sample of dyads with prenatal smoke exposure, elevated maternal HCC was associated with child wheeze that was not diminished after consideration of covariates.
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Perez-Paramo YX, Lazarus P. Pharmacogenetics factors influencing smoking cessation success; the importance of nicotine metabolism. Expert Opin Drug Metab Toxicol 2021; 17:333-349. [PMID: 33322962 PMCID: PMC8049967 DOI: 10.1080/17425255.2021.1863948] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/10/2020] [Indexed: 01/12/2023]
Abstract
Introduction: Smoking remains a worldwide epidemic, and despite an increase in public acceptance of the harms of tobacco use, it remains the leading cause of preventable death. It is estimated that up to 70% of all smokers express a desire to quit, but only 3-5% of them are successful.Areas covered: The goal of this review was to evaluate the current status of smoking cessation treatments and the feasibility of implementing personalized-medicine approaches to these pharmacotherapies. We evaluated the genetics associated with higher levels of nicotine addiction and follow with an analysis of the genetic variants that affect the nicotine metabolic ratio (NMR) and the FDA approved treatments for smoking cessation. We also highlighted the gaps in the process of translating current laboratory understanding into clinical practice, and the benefits of personalized treatment approaches for a successful smoking cessation strategy.Expert opinion: Evidence supports the use of tailored therapies to ensure that the most efficient treatments are utilized in an individual's smoking cessation efforts. An understanding of the genetic effects on the efficacy of individualized smoking cessation pharmacotherapies is key to smoking cessation, ideally utilizing a polygenetic risk score that considers all genetic variation.
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Affiliation(s)
- Yadira X. Perez-Paramo
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Philip Lazarus
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
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26
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Higgins ST, Slade EP, Shepard DS. Decreasing smoking during pregnancy: Potential economic benefit of reducing sudden unexpected infant death. Prev Med 2020; 140:106238. [PMID: 32818512 PMCID: PMC7429512 DOI: 10.1016/j.ypmed.2020.106238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022]
Abstract
Sudden Unexpected Infant Death (SUID) remains the leading cause of death among U.S. infants age 1-12 months. Extensive epidemiological evidence documents maternal prenatal cigarette smoking as a major risk factor for SUID, but leaves unclear whether quitting reduces risk. This Commentary draws attention to a report by Anderson et al. (Pediatrics. 2019, 143[4]) that represents a breakthrough on this question and uses their data on SUID risk reduction to delineate potential economic benefits. Using a five-year (2007-11) U.S. CDC Birth Cohort Linked Birth/Infant Death dataset, Anderson et al. demonstrated that compared to those who continued smoking, women who quit or reduced smoking by third trimester decreased the adjusted odds of SUID risk by 23% (95% CI, 13%-33%) and 12% (95% CI, 2%-21%), respectively. We applied these reductions to the U.S. Department of Health and Human Services' recommended value of a statistical life in 2020 ($10.1 million). Compared to continued smoking during pregnancy, the economic benefits per woman of quitting or reducing smoking are $4700 (95% CI $2700-$6800) and $2500 (95% CI, $400-$4300), respectively. While the U.S. obtained aggregate annual economic benefits of $0.58 (95% CI, 0.35-0.82) billion from pregnant women who quit or reduced smoking, it missed an additional $1.16 (95%CI 0.71-1.60) billion from the women who continued smoking. Delineating the health and economic impacts of decreasing smoking during pregnancy using large epidemiological studies like Anderson et al. is critically important for conducting meaningful economic analyses of the benefits-costs of developing more effective interventions for decreasing smoking during pregnancy.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Psychological Science, University of Vermont, United States of America.
| | - Eric P Slade
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Johns Hopkins University School of Nursing, United States of America
| | - Donald S Shepard
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Heller School for Social Policy and Management, Brandeis University, United States of America
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27
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Kachroo P, Morrow JD, Kho AT, Vyhlidal CA, Silverman EK, Weiss ST, Tantisira KG, DeMeo DL. Co-methylation analysis in lung tissue identifies pathways for fetal origins of COPD. Eur Respir J 2020; 56:13993003.02347-2019. [PMID: 32482784 DOI: 10.1183/13993003.02347-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/21/2020] [Indexed: 12/21/2022]
Abstract
COPD likely has developmental origins; however, the underlying molecular mechanisms are not fully identified. Investigation of lung tissue-specific epigenetic modifications such as DNA methylation using network approaches might facilitate insights linking in utero smoke (IUS) exposure and risk for COPD in adulthood.We performed genome-wide methylation profiling for adult lung DNA from 160 surgical samples and 78 fetal lung DNA samples isolated from discarded tissue at 8-18 weeks of gestation. Co-methylation networks were constructed to identify preserved modules that shared methylation patterns in fetal and adult lung tissues and associations with fetal IUS exposure, gestational age and COPD.Weighted correlation networks highlighted preserved and co-methylated modules for both fetal and adult lung data associated with fetal IUS exposure, COPD and lower adult lung function. These modules were significantly enriched for genes involved in embryonic organ development and specific inflammation-related pathways, including Hippo, phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT), Wnt, mitogen-activated protein kinase and transforming growth factor-β signalling. Gestational age-associated modules were remarkably preserved for COPD and lung function, and were also annotated to genes enriched for the Wnt and PI3K/AKT pathways.Epigenetic network perturbations in fetal lung tissue exposed to IUS and of early lung development recapitulated in adult lung tissue from ex-smokers with COPD. Overlapping fetal and adult lung tissue network modules highlighted putative disease pathways supportive of exposure-related and age-associated developmental origins of COPD.
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Affiliation(s)
- Priyadarshini Kachroo
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jarrett D Morrow
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alvin T Kho
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Edwin K Silverman
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kelan G Tantisira
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA .,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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28
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Tabi S, Heitner SA, Shivale S, Minchenberg S, Faraone SV, Johnson B. Opioid Addiction/Pregnancy and Neonatal Abstinence Syndrome (NAS): A Preliminary Open-Label Study of Buprenorphine Maintenance and Drug Use Targeted Psychotherapy (DUST) on Cessation of Addictive Drug Use. Front Psychiatry 2020; 11:563409. [PMID: 33173512 PMCID: PMC7538830 DOI: 10.3389/fpsyt.2020.563409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/14/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Neonatal abstinence syndrome (NAS) is common, expensive, and hurts opioid addicted women and their families. Current treatments do not sufficiently address comorbid addictions, especially tobacco use, among pregnant buprenorphine-maintained women. METHODS 25 consecutive admissions of pregnant, opioid addicted women were treated with buprenorphine maintenance and a novel intervention for pregnant opioid addicted patients, Drug Use Targeted Therapy (DUST). DUST entails a combination of informing women about the impact of various drugs on their fetus, discussing the woman's thinking about these consequences of drug use, and varying the frequency of psychotherapy; increasing if addictive drugs are used and decreasing if the woman wishes when drug use is stopped. RESULTS 20/25 remained in treatment until delivery. All 20 women were using addictive drugs at admission. None were planned pregnancies. There was a high prevalence of emotional, physical or sexual abuse, criminal behavior, comorbid psychiatric disorders, and chronic pain. Nineteen stopped all addictive drugs. NAS was present for 5 out of 19 newborns with a duration of hospitalization from 4 to 6 days. CONCLUSIONS This preliminary open-label case series found that pregnant buprenorphine maintained women can stop tobacco. What has sometimes been termed "neonatal opioid abstinence syndrome" may most accurately be termed, "neonatal opioid/tobacco abstinence syndrome." If the treatment effectively addresses tobacco use, other addictive drugs are rarely used. DUST resulted in a 95% quit rate for addictive drugs. Pilot data on this new intervention is limited; a case series that does not have a corresponding control group.
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Affiliation(s)
- Sarah Tabi
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarah A. Heitner
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Swati Shivale
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, United States
- Department of Psychiatry, Bellevue Hospital Centre and New York University School of Medicine, New York, NY, United States
| | - Scott Minchenberg
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, United States
- Department of Medicine, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA, United States
| | - Stephen V. Faraone
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Brian Johnson
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, United States
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Chuang TD, Ansari A, Yu C, Sakurai R, Harb A, Liu J, Khorram O, Rehan VK. Mechanism underlying increased cardiac extracellular matrix deposition in perinatal nicotine-exposed offspring. Am J Physiol Heart Circ Physiol 2020; 319:H651-H660. [PMID: 32795172 DOI: 10.1152/ajpheart.00021.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although increased predisposition to cardiac fibrosis and cardiac dysfunction has been demonstrated in the perinatally nicotine-exposed heart, the underlying mechanisms remain unclear. With the use of a well-established rat model and cultured primary neonatal rat cardiac fibroblasts, the effect of perinatal nicotine exposure on offspring heart extracellular matrix deposition and the likely underlying mechanisms were investigated. Perinatal nicotine exposure resulted in increased collagen type I (COL1A1) and III (COL3A1) deposition along with a decrease in miR-29 family and an increase in long noncoding RNA myocardial infarction-associated transcript (MIAT) levels in offspring heart. Nicotine treatment of isolated primary neonatal rat cardiac fibroblasts suggested that these effects were mediated via nicotinic acetylcholine receptors including α7 and the induced collagens accumulation was reversed by a gain-of function of miR-29 family. Knockdown of MIAT resulted in increased miR-29 family and decreased COL1A1 and COL3A1 levels, suggesting nicotine-mediated MIAT induction as the underlying mechanism for nicotine-induced collagen deposition. Luciferase reporter assay and RNA immunoprecipitation studies showed an intense physical interaction between MIAT, miR-29 family, and argonaute 2, corroborating the mechanistic link between perinatal nicotine exposure and increased extracellular matrix deposition. Overall, perinatal nicotine exposure resulted in lower miR-29 family levels in offspring heart, while it elevated cardiac MIAT and collagen type I and III levels. These findings provide mechanistic basis for cardiac dysfunction in perinatal nicotine-exposed offspring and offer multiple novel potential therapeutic targets.NEW & NOTEWORTHY Using an established rat model and cultured primary neonatal cardiac fibroblasts, we show that nicotine mediated MIAT induction as the underlying mechanism for the excessive cardiac collagen deposition. These observations provide mechanistic basis for the increased predisposition to cardiac dysfunction following perinatal cigarette/nicotine exposure and offer novel potential therapeutic targets.
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Affiliation(s)
- Tsai-Der Chuang
- Department of and Obstetrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Aamir Ansari
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Celia Yu
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Reiko Sakurai
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Amir Harb
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Jie Liu
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Omid Khorram
- Department of and Obstetrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Virender K Rehan
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
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30
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Liu B, Xu G, Sun Y, Qiu X, Ryckman KK, Yu Y, Snetselaar LG, Bao W. Maternal cigarette smoking before and during pregnancy and the risk of preterm birth: A dose-response analysis of 25 million mother-infant pairs. PLoS Med 2020; 17:e1003158. [PMID: 32810187 PMCID: PMC7446793 DOI: 10.1371/journal.pmed.1003158] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/09/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Most of the women who smoke before pregnancy continue smoking during pregnancy, and some start to quit smoking after being pregnant, although existing guidelines for pregnancy recommend that women who smoke should quit smoking before pregnancy. Findings about the timing and intensity of maternal smoking, especially low-intensity smoking (1-9 cigarettes per day), and preterm birth are still inconsistent and ambiguous. This study aimed to examine the association of the timing of smoking and doses of smoking before pregnancy and during the first or second trimester of pregnancy with preterm birth in a large-scale population-based retrospective cohort study. METHODS AND FINDINGS We used nationwide birth certificate data from singleton mother-infant pairs in the United States National Vital Statistics System, 2011-2018. All adult women with live singleton births, without preexisting hypertension or diabetes, and with complete data on smoking and gestational age at delivery were included. Participants reported their smoking status (yes or no) and daily number of cigarettes consumed before and during each trimester of pregnancy. The outcome of interest was preterm birth, defined as a birth before 37 weeks of gestation. Logistic regression models were used to estimate the odds ratio (OR) with 95% confidence intervals (CIs) of preterm birth associated with smoking status and the number of cigarettes consumed, adjusting for maternal age, race/ethnicity, parity, education levels, prepregnancy BMI, previous history of preterm birth, marital status, infant sex, and initiation of prenatal care. This study included 25,623,479 women, with a mean age of 29 years (range 20-50 years); 13,742,486 (53.6%) participants were of non-Hispanic white ancestry, 5,971,598 (23.3%) of Hispanic ancestry, and 3,417,456 (13.34%) of non-Hispanic black ancestry. The prevalence of preterm birth was 9.3% (n = 2,378,398). We found that maternal smoking during pregnancy, even at a very low level of intensity, was associated with an increased risk of preterm delivery. The adjusted ORs (95% CI) of preterm birth for mothers who smoked 1-2, 3-5, 6-9, 10-19, and ≥20 cigarettes per day during the first trimester compared with mothers who did not smoke were 1.31 (1.29-1.33), 1.31 (1.30-1.32), 1.33 (1.31-1.35), 1.44 (1.43-1.45), and 1.53 (1.52-1.55), respectively (all P values < 0.001), whereas for those who smoked during the second trimester, the corresponding ORs were 1.37 (1.35-1.39), 1.36 (1.35-1.38), 1.36 (1.34-1.38), 1.48 (1.47-1.49), and 1.59 (1.58-1.61), respectively (all P values < 0.001). Furthermore, smokers who quit before pregnancy, regardless of smoking intensity, had a comparable risk of preterm birth with nonsmokers, although this was not the case when cessation occurred in the first or second trimester of pregnancy. The major limitation of this study is the self-reported information about smoking, which may be subject to information bias. In addition, we cannot rule out the possibility of residual confounding caused by unmeasured factors in an observational research design. CONCLUSIONS In this study, we observed that low-intensity cigarette consumption during either the first or second trimester of pregnancy, even as low as 1-2 cigarettes per day, was associated with an increased risk of preterm birth. These findings suggest that there is no safe level or safe trimester for maternal smoking during pregnancy. Women of reproductive age who smoke should be strongly encouraged and supported to quit smoking before pregnancy.
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Affiliation(s)
- Buyun Liu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail: (WB); (BL)
| | - Guifeng Xu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Yangbo Sun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Kelli K. Ryckman
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Yongfu Yu
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Linda G. Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail: (WB); (BL)
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Serapio S, Ahlsson F, Larsson A, Kunovac Kallak T. Second Trimester Maternal Leptin Levels Are Associated with Body Mass Index and Gestational Weight Gain but not Birth Weight of the Infant. Horm Res Paediatr 2020; 92:106-114. [PMID: 31655800 DOI: 10.1159/000503422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Obesity is increasing among the pregnant population. Leptin has an important role in the regulation of energy balance and hunger. The aim of this study was to investigate the association between maternal leptin levels with maternal obesity, gestational weight gain (GWG), single nucleotide polymorphisms (SNPs) within the leptin gene, and the age-adjusted birth weight of the child. MATERIAL AND METHODS Maternal leptin levels (n = 740) and SNPs (n = 504) were analyzed in blood samples taken within the Uppsala Biobank of Pregnant women at pregnancy weeks 16-19. RESULTS Maternal leptin levels differed significantly between body mass index (BMI) groups. Normal weight women had the lowest median leptin levels and levels increased with each BMI group. Leptin SNP genotype was not associated with leptin levels or BMI. There was also no association between maternal leptin levels and age-adjusted birth weight of the child except for a negative association between leptin levels and birth weight in the morbid obese group. DISCUSSION/CONCLUSION Maternal BMI was identified as the best positive explanatory factor for maternal leptin levels. Leptin was a strong positive explanatory factor for GWG. Birth weight of children of uncomplicated pregnancies was, however, dependent on maternal height, BMI, GWG, and parity but not leptin levels, except for in morbid obese women where a negative association between maternal leptin levels and birth weight was found. We speculate that this indicates altered placental function, not manifested in pregnancy complication. We conclude that maternal leptin levels do not affect the birth weight of the child more than BMI, GWG, and parity.
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Affiliation(s)
- Solveig Serapio
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Fredrik Ahlsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
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Effect of electronic cigarette aerosol exposure during gestation and lactation on learning and memory of adult male offspring rats. Physiol Behav 2020; 221:112911. [PMID: 32289318 DOI: 10.1016/j.physbeh.2020.112911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/14/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Electronic cigarette (ECIG) use has increased worldwide, including among pregnant and breastfeeding women. In this study, we examined the effect of ECIG aerosol exposure during gestation and lactation on learning and memory of adult male offspring rats. METHODS Rats were exposed to either fresh air or ECIG aerosol for one hour daily during gestational period as well as days 4-21 of lactation. Male offspring were followed through 19 weeks and then spatial learning and memory were tested by radial arm water maze (RAWM). The hippocampus was examined for biomarkers of harm, including oxidative stress, superoxide dismutase, catalase, glutathione peroxidase and thiobarbituric acid reactive substances and brain derived neurotrophic factor (BDNF). RESULTS Relative to exposure to fresh air, exposure to ECIG aerosol during gestation/lactation impaired long-term memory in adult offspring (P < 0.05). This impairment was associated with increased activity of superoxide dismutase in the hippocampus (P < 0.05). BDNF and the other tested oxidative stress biomarkers were not affected by ECIG aerosol exposure (p > 0.05). CONCLUSIONS In conclusion, ECIG aerosol exposure during gestation and lactation impaired long-term memory and increased the activity of superoxide dismutase in the hippocampus of offspring adult rats. These results support the development of strategies to enhance ECIG cessation during pregnancy and breastfeeding.
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Ruszkiewicz JA, Zhang Z, Gonçalves FM, Tizabi Y, Zelikoff JT, Aschner M. Neurotoxicity of e-cigarettes. Food Chem Toxicol 2020; 138:111245. [PMID: 32145355 PMCID: PMC7089837 DOI: 10.1016/j.fct.2020.111245] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
It appears that electronic cigarettes (EC) are a less harmful alternative to conventional cigarette (CC) smoking, as they generate substantially lower levels of harmful carcinogens and other toxic compounds. Thus, switching from CC to EC may be beneficial for smokers. However, recent accounts of EC- or vaping-associated lung injury (EVALI) has raised concerns regarding their adverse health effects. Additionally, the increasing popularity of EC among vulnerable populations, such as adolescents and pregnant women, calls for further EC safety evaluation. In this state-of-the-art review, we provide an update on recent findings regarding the neurological effects induced by EC exposure. Moreover, we discuss possible neurotoxic effects of nicotine and numerous other chemicals which are inherent both to e-liquids and EC aerosols. We conclude that in recognizing pertinent issues associated with EC usage, both government and scientific researchers must address this public health issue with utmost urgency.
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Affiliation(s)
- Joanna A Ruszkiewicz
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Konstanz, Germany
| | - Ziyan Zhang
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Filipe Marques Gonçalves
- Biochemistry Graduate Program, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington DC, United States
| | - Judith T Zelikoff
- Department of Environmental Medicine, New York University School of Medicine, Manhattan, NY, United States
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States.
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Andriani H, Putri S, Kosasih RI, Kuo HW. Parental Smoking and Under-Five Child Mortality in Southeast Asia: Evidence from Demographic and Health Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234756. [PMID: 31783665 PMCID: PMC6926522 DOI: 10.3390/ijerph16234756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022]
Abstract
Smoking remains the main cause of preventable early death. However, little is known about the association between parental smoking and child mortality in under-fives in developing countries. This study assesses the association between parental smoking status, smoking amount and smoking frequency with child mortality in under-fives in four Southeast Asian countries (Cambodia, Indonesia, Lao People’s Democratic Republic and Timor Leste). We used the Demographic and Health Survey dataset. The information from couples consisting of fathers and mothers (n = 19,301 couples) in the same household were collected. Under-five child mortality was significantly associated with paternal smoking only (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.14–1.38), maternal smoking only (OR = 2.40, 95% CI: 1.61–3.59) and both parents smoking (OR = 2.60, 2.08–3.26). Paternal, maternal, both parents’ smoking amount and frequency were also assessed. The estimated association decreased after adjusting for covariates but remained highly significant for smoking in both parents, mothers who smoked 1–10 cigarettes/day, when both parents smoked > 20 cigarettes/day, and in mothers who smoked every day. Future behavioural changes and smoking cessation programmes should engage parents as a catalyst for the reduction of child mortality risk in LMICs in the SEA region.
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Affiliation(s)
- Helen Andriani
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, 16424 Depok, Indonesia;
- Correspondence: or ; Tel.: +62-21-786-4974
| | - Septiara Putri
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, 16424 Depok, Indonesia;
| | | | - Hsien-Wen Kuo
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, 112 Taipei, Taiwan;
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Alaniz K, Christiansen B, Sullivan T, Khalil L, Fiore MC. Addressing Postpartum Smoking Relapse Among Low-Income Women: A Randomized Control Trial. J Patient Cent Res Rev 2019; 6:233-242. [PMID: 31768402 PMCID: PMC6827840 DOI: 10.17294/2330-0698.1702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Smoking during pregnancy can have dire consequences for both the baby and mother. Low-income pregnant women smoke at particularly high rates. Among women who quit during pregnancy, postpartum relapse is high. This randomized control trial tested the effect of adding postpartum assistance to an existing smoking cessation program (First Breath) designed for low-income women. METHODS Of 185 study participants, 94 women were randomly assigned to the standard First Breath program (control) and 91 to an enhanced program. First Breath consisted of evidence-based smoking cessation counseling provided at every prenatal visit. The enhanced program included all First Breath services plus 4 in-home counseling visits (3 postpartum), 3 postpartum counseling calls, support to others in the home, and incentives (gift cards) totaling $100. The primary outcome was biochemically verified abstinence at 6 months postpartum. RESULTS Among the 98 women who completed the study, the abstinence rate among the intervention participants (n=41) was significantly greater than among the control participants (n=57) (36.6% vs 12.3%, respectively; P<0.01). Analyzed on an intent-to-treat basis, with those lost to follow-up assumed to be smoking, the abstinence rate among intervention subjects (n=91) was 16.5% vs 7.4% among control participants (n=94); P=0.07. CONCLUSIONS Extending smoking cessation interventions into the postpartum period may help address postpartum relapse.
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Affiliation(s)
| | - Bruce Christiansen
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Michael C. Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Kuniyoshi KM, Rehan VK. The impact of perinatal nicotine exposure on fetal lung development and subsequent respiratory morbidity. Birth Defects Res 2019; 111:1270-1283. [PMID: 31580538 DOI: 10.1002/bdr2.1595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/13/2019] [Accepted: 09/05/2019] [Indexed: 01/18/2023]
Abstract
Maternal smoking during pregnancy remains as a significant public health crisis as it did decades ago. Although its prevalence is decreasing in high-income countries, it has worsened globally, along with a concerning emergence of electronic-cigarette usage within the last two decades. Extensive epidemiologic and experimental evidence exists from both human and animal studies, demonstrating the detrimental long-term pulmonary outcomes in the offspring of mothers who smoke during pregnancy. Even secondhand and thirdhand smoke exposure to the developing lung might be as or even more harmful than firsthand smoke exposure. Furthermore, these effects are not limited only to the exposed progeny, but can also be transmitted transgenerationally. There is compelling evidence to support that the majority of the effects of perinatal smoke exposure on the developing lung, including the transgenerational transmission of asthma, is mediated by nicotine. Nicotine exposure induces cell-specific molecular changes in lungs, which offers a unique opportunity to prevent, halt, and/or reverse the resultant damage through targeted molecular interventions. Experimentally, the proposed interventions, such as administration of peroxisome proliferator-activated receptor gamma (PPARγ) agonists can not only block but also potentially reverse the perinatal nicotine exposure-induced respiratory morbidity in the exposed offspring. However, the development of a safe and effective intervention is still many years away. In the meantime, electropuncture at specific acupoints appears to be emerging as a more practical and safe physiologic approach to block the harmful pulmonary consequences of perinatal nicotine exposure.
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Affiliation(s)
- Katherine M Kuniyoshi
- Department of Pediatrics, David Geffen School of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor, UCLA Medical Center, Torrance, California
| | - Virender K Rehan
- Department of Pediatrics, David Geffen School of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor, UCLA Medical Center, Torrance, California
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Kondracki AJ. Prevalence and patterns of cigarette smoking before and during early and late pregnancy according to maternal characteristics: the first national data based on the 2003 birth certificate revision, United States, 2016. Reprod Health 2019; 16:142. [PMID: 31519184 PMCID: PMC6743116 DOI: 10.1186/s12978-019-0807-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The objective of this study was to examine the prevalence of smoking by intensity status before pregnancy and during early (first and second trimester) and late (third trimester) pregnancy according to race/ethnicity, age, and educational attainment of women who gave birth in the United States in 2016. METHODS This cross-sectional study was based on the 2016 National Center for Health Statistics (NCHS) Natality File of 3,956,112 live births, the first year that it became 100% nationally representative. Self-reported smoking data were used to create new seven smoking intensity status categories to capture natural variability in smoking patterns during pregnancy and to identify maternal smokers by race/ethnicity, age, and educational attainment. The risk of smoking at low and high intensity in early pregnancy was estimated in multivariable logistic regression analyses. RESULTS Nearly 9.4% of women reported smoking before pregnancy and 7.1% during pregnancy, both at high and low intensity, and smoking rates were higher in the first trimester (7.1%) than in the second (6.1%) or the third (5.7%) trimester. Non-Hispanic White women, women 20-24 years old, and women with less than a high school education were the strongest predictors of smoking anytime during pregnancy. The odds of smoking in early pregnancy at high intensity were 88% lower (aOR 0.12, 95% CI: 0.11, 0.13) for Hispanic women, compared to non-Hispanic White women; 16% higher (aOR 1.16, 95% CI: 1.12, 1.21) for women 20-24 years old and 16% lower (aOR 0.84, 95% CI: 0.80, 0.89) for women ≥35 years old, compared to women 25-29 years old; as well as 13% higher (aOR 1.13, 95% CI: 1.09, 1.18) for women with less than a high school education and 92% lower (aOR 0.08, 95% CI: 0.08, 0.09) for women with a bachelor's degree or higher, compared to women with a high school diploma. CONCLUSIONS Despite the high prevalence of high intensity smoking before and during pregnancy, future intervention strategies need to focus on the proportion of low intensity quitters and reducers, who are ready to stop smoking. Continual monitoring of trends in smoking intensity patterns is necessary, including neonatal outcomes over time.
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Affiliation(s)
- Anthony J Kondracki
- University of Maryland, School of Public Health, Maternal and Child Health, 4200 Valley Drive, College Park, MD, 20742, USA.
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Reversal of neurobehavioral teratogenicity in animal models and human: Three decades of progress. Brain Res Bull 2019; 150:328-342. [DOI: 10.1016/j.brainresbull.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/09/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022]
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Cardenas VM, Fischbach LA, Chowdhury P. The use of electronic nicotine delivery systems during pregnancy and the reproductive outcomes: A systematic review of the literature. Tob Induc Dis 2019; 17:52. [PMID: 31582941 PMCID: PMC6770636 DOI: 10.18332/tid/104724] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 12/18/2018] [Accepted: 02/27/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Use of electronic nicotine delivery systems (ENDS) among pregnant women is of great concern. To our knowledge the current literature provides conflicting views regarding the uncertainties of the effects of ENDS use during pregnancy on the health of the fetus. METHODS We searched PubMed, CINAHL, and EMBASE, for the period 2007 to October 2017 for terms to identify publications on ENDS use during pregnancy and the reproductive outcomes. We updated the search for the period November 2017 to November 2018 using Ovid Medline. We obtained full text of articles and present a summary of the contents. RESULTS We found no studies of pregnant women exposed to ENDS use and its effect on their fetus or neonates. However, there is a growing body of experimental studies in animals that suggest that nicotine in ENDS alters DNA methylation, induces birth defects, reduces the birth weight, and affects the development of the heart and lungs of their offspring. A large population-based cohort study in the United States estimated that 5% of pregnant women were current ENDS users in 2014; most of them also smoked cigarettes. Surveys conducted among practitioners indicate that there is a need to screen and counsel pregnant women. Systematic reviews and meta-analysis of studies of women who used smokeless tobacco during pregnancy suggest that prenatal nicotine alone is a risk factor for low birth weight, premature delivery, and stillbirth. CONCLUSIONS There were no previous studies assessing the reproductive effects of ENDS use during pregnancy. However, prenatal exposure to nicotine is known to be harmful to the fetus and the pregnancy.
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Affiliation(s)
- Victor M Cardenas
- University of Arkansas for Medical Sciences, Little Rock, United States
| | - Lori A Fischbach
- University of Arkansas for Medical Sciences, Little Rock, United States
| | - Parimal Chowdhury
- University of Arkansas for Medical Sciences, Little Rock, United States
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Olson AL, Boardman MB, Johnson DJ. Smoke-Free Moms: Financial Rewards for Smoking Cessation by Low-Income Rural Pregnant Women. Am J Prev Med 2019; 56:852-859. [PMID: 31003804 PMCID: PMC6527358 DOI: 10.1016/j.amepre.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Maternal smoking places the child at risk during pregnancy and postpartum. Most women who quit smoking do so early when they first learn of pregnancy. Few low-income women quit once they enter prenatal care. The purpose of this study is to test in a clinical prenatal care setting the effectiveness of the Smoke-Free Moms intervention, which provides pregnant women a series of financial incentives for smoking cessation. STUDY DESIGN A prospective nonrandomized controlled trial that collected control population data of smoking-cessation rates at each clincal visit during pregnancy and postpartum with usual smoking counseling in 2013-2014. In 2015-2016, the same data were collected during the implementation of the Smoke-Free Moms intervention of financial incentives. Data analysis occurred in 2017. SETTING/PARTICIPANTS Women who were smoking at the first prenatal visit at four federally qualified health centers in rural New Hampshire. INTERVENTION All women received 5A's smoking counseling from clinic staff. At each clinic visit, with point-of-care confirmed negative urinary cotinine, intervention women received gift cards. MAIN OUTCOME MEASURES Cotinine confirmed smoking cessation without relapse: (1) during pregnancy and (2) smoking cessation in both pregnancy and postpartum. RESULTS Of 175 eligible pregnant women enrolled, 134 women were followed to the postpartum visit (Intervention n=66, Control n=68). The quit rates during pregnancy did not differ between groups (Intervention 36.4%, Control 29.4%, p=0.46). However, significantly more intervention mothers quit and continued as nonsmokers postpartum (Intervention 31.8%, Control 16.2%, p=0.04). In a logistic regression model including baseline sociodemographic, depressed mood, stress, and readiness to quit items, confidence in being able to quit predicted both cessation outcomes. The financial incentive intervention was an independent predictor of cessation in pregnancy through postpartum. CONCLUSIONS Financial incentives with existing smoking-cessation counseling by staff in low-income clinical prenatal programs led to cessation that continued during the postpartum period. Further study in larger populations is indicated.
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Affiliation(s)
- Ardis L Olson
- Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover, New Hampshire; Department of Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
| | - Maureen B Boardman
- Department of Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Deborah J Johnson
- Department of Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
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Houston-Ludlam AN, Bucholz KK, Grant JD, Waldron M, Madden PAF, Heath AC. The interaction of sociodemographic risk factors and measures of nicotine dependence in predicting maternal smoking during pregnancy. Drug Alcohol Depend 2019; 198:168-175. [PMID: 30939374 PMCID: PMC6467711 DOI: 10.1016/j.drugalcdep.2019.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/17/2019] [Accepted: 02/04/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Understanding differences in nicotine dependence assessments' ability to predict smoking cessation is complicated by variation in quit attempt contexts. Pregnancy reduces this variation, as each pregnant smoker receives the same strong cessation incentive. Cigarette smoking during pregnancy (SDP) provides a powerful paradigm for analyzing the interplay between nicotine dependence measures and sociodemographics in predicting cessation failure. METHODS Data from a female twin cohort (median birth year 1980), assessed in teens and early twenties, were merged with birth records to identify those with smoking history who experienced childbirth (N = 1657 births, N = 763 mothers). Logistic regression predicting SDP, as a function of birth record sociodemographic variables, generated a sociodemographic risk-score. Further analysis incorporated the risk-score with data from research interviews on DSM-IV-Nicotine Dependence symptom count, Heaviness of Smoking Index. RESULTS Low maternal educational level, younger age at childbirth, and being unmarried all contributed risk for SDP. In addition to sociodemographic risk-score, the best predictors of SDP included HSI-score (OR:1.51), their two-way interaction (OR:0.39; reduced impact of dependence at intermediate-high sociodemographic risk), history of ≥ two failed quit attempts (OR:1.38), and a dummy variable for prior pregnancy at time of assessment (OR:1.82). DSM-IV-Nicotine Dependence symptoms underperformed the Heaviness of Smoking Index and did not improve prediction when added to the best model. CONCLUSIONS The 2-item Heaviness of Smoking Index measure and report of ≥ two failed quit attempts performed best for predicting SDP. The contribution of either nicotine dependence measure to SDP risk was diminished at increased levels of sociodemographic risk.
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Affiliation(s)
- Alexandra N Houston-Ludlam
- Human and Statistical Genetics, Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, 660 S Euclid, CB 8134, St. Louis, MO 63110, USA; Medical Scientist Training Program, Washington University School of Medicine in St. Louis, 660 S Euclid, CB 8226, St. Louis, MO 63110, USA.
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 660 S Euclid, CB 8134, St. Louis, MO 63110, USA.
| | - Julia D Grant
- Department of Psychology, Maryville University of St. Louis, 650 Maryville University Drive, St. Louis, MO 63141, USA.
| | - Mary Waldron
- School of Education, Indiana University Bloomington, 201 N. Rose Ave, Bloomington, IN 47405, USA.
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 660 S Euclid, CB 8134, St. Louis, MO 63110, USA.
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 660 S Euclid, CB 8134, St. Louis, MO 63110, USA.
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Tolosa JE, Scherman A, Stamilio DM, McEvoy CT. Tobacco and nicotine exposure prevention in pregnancy: a priority to improve perinatal and maternal outcomes. Am J Obstet Gynecol MFM 2019; 1:19-23. [PMID: 33319752 PMCID: PMC8023387 DOI: 10.1016/j.ajogmf.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jorge E Tolosa
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, St. Luke's University Health Network, Bethlehem, PA; Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Oregon Health & Science University, Portland, OR; Global Network for Perinatal & Reproductive Health, FUNDARED-MATERNA, Bogotá, Colombia; Departamento de Obstetricia y Ginecología, NACER Salud Sexual y Reproductiva, Universidad de Antioquia, Medellín, Colombia.
| | - Ashley Scherman
- Oregon Health & Science University, Pediatrics, Portland, OR
| | - David M Stamilio
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, NC
| | - Cindy T McEvoy
- Department of Pediatrics, Division of Neonatology, Oregon Health & Science University, Portland, OR
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Saxena P, Pradhan D, Verma R, Kumar SN, Deval R, Kumar Jain A. Up-regulation of fibroblast growth factor receptor 1 due to prenatal tobacco exposure can lead to developmental defects in new born. J Matern Fetal Neonatal Med 2018; 33:1732-1743. [PMID: 30428736 DOI: 10.1080/14767058.2018.1529164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction: Tobacco-smoking is one of the most important risk factor for preterm delivery, pregnancy loss, low birth weight, and fetal growth restriction. It is estimated that approximately 30% of growth-restricted neonates could be independently associated with maternal smoking.Methods: In this study, gene expression profile, GSE11798, was chosen from GEO database with an aim to perceive change in gene expression signature in new born due to maternal smoking. Enrichment analysis was performed to annotate differentially expressed genes (DEGs) through gene ontology and pathway analysis using DAVID. Protein-protein interactions and module detection of these DEGs were carried out using cytoscape v3.6.0. Thirty umbilical cord tissue samples from 15 smokers and 15 non-smokers pregnant women were included in this analysis.Results: Twenty-six differentially expressed genes (DEGs) between two groups were selected using GEO2R tool. The DEGs were observed to be participating in biological processes/pathways related to growth releasing hormone, angiogenesis, embryonic skeletal, and cardiac development. Fibroblast growth factor receptor-1 (FGFR1) was identified to be the hub node with 348 interacting partners, which regulates transcription, cell growth, differentiation, and apoptosis. The up-regulation of FGFR1 in umbilical cord tissue may lead to reproductive and developmental complications such as encephalocraniocutaneous lipomatosis, osteoglophonic dysplasia, and Pfeiffer syndrome in new-borns.Conclusion: The findings manifests the possibility of overcoming these adverse health effects in new born through FGFR1 modulating treatments during pregnancy.
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Affiliation(s)
- Pallavi Saxena
- Department of Biotechnology, Invertis University, Bareilly, India.,Biomedical Informatics Centre, Indian Council of Medical Research, National Institute of Pathology, New Delhi, India
| | - Dibyabhaba Pradhan
- Biomedical Informatics Centre, Indian Council of Medical Research, National Institute of Pathology, New Delhi, India
| | - Rashi Verma
- Biomedical Informatics Centre, Indian Council of Medical Research, National Institute of Pathology, New Delhi, India
| | - Shashi Nandar Kumar
- Biomedical Informatics Centre, Indian Council of Medical Research, National Institute of Pathology, New Delhi, India
| | - Ravi Deval
- Department of Biotechnology, Invertis University, Bareilly, India
| | - Arun Kumar Jain
- Biomedical Informatics Centre, Indian Council of Medical Research, National Institute of Pathology, New Delhi, India
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