Secondhand smoke and adverse fetal outcomes in nonsmoking pregnant women: a meta-analysis

Knowledge, Attitude, and Perception of Passive Smoking Among Medical and Dental Students of Karachi: A Survey-Based Study

Background

Passive smoking, the involuntary inhalation of tobacco smoke, poses significant health risks; however, its prevalence and impact on medical and dental students in Karachi, Pakistan, remain understudied. Therefore, this research aims to understand the knowledge, attitudes, and practices (KAP) regarding passive smoking among medical and dental students and will help shed light on their awareness, perceptions, and behaviours regarding this public health concern.

Methods

A cross-sectional study was conducted over 3 months, involving 378 medical and dental students (303 medical and 75 dental students)from various universities in Karachi. Participants completed a questionnaire to gather information on demographics, awareness of passive smoking, perceptions of its health effects, and actions taken in response to exposure.

Results

The majority of participants demonstrated awareness of passive smoking 320 (84.7%) and believed that it was essentially linked to active smoking 320 (84.7%). Cigarette smoke was identified as the primary contributor to passive smoking 345 (91.3%). A significant proportion of participants believed that children and pregnant women exposed to passive smoking had elevated health risks. In areas where smoking is not permissible, less than half of the participants 173 (45.8%) reminded smokers about the smoking regulations, and a few even referred smokers for counselling 141 (37.3%). Males are usually indifferent to smokers around them, whereas females are found uncomfortable with smoking in their surroundings.

Conclusion

In conclusion, our study highlights the persistent prevalence of passive smoking among medical and dental students in Pakistan. Enforcing strict tobacco control policies, integrating passive smoking education into medical curricula, and improving communication strategies for smoking cessation interventions are crucial steps towards creating smoke-free environments and healthier lifestyles nationwide. Despite awareness among medical and dental students about the dangers of cigarette smoking, their reluctance to urge regular smokers to quit underscores the need for improved communication between smokers and non-smokers to foster a cleaner and hazard-free environment.

Multicomponent Behavioural Intervention during Pregnancy to Reduce Home Exposure to Second-Hand Smoke: A Pilot Randomised Controlled Trial in Bangladesh and India

BACKGROUND

Pregnant women exposed to second-hand smoke (SHS) are at increased risk of poor birth outcomes. We piloted multicomponent behavioural intervention and trial methods in Bangalore, India, and Comilla, Bangladesh.

METHODS

A pilot individual randomised controlled trial with economic and process evaluation components was conducted. Non-tobacco-using pregnant women exposed to SHS were recruited from clinics and randomly allocated to intervention or control (educational leaflet) arms. The process evaluation captured feedback on the trial methods and intervention components. The economic component piloted a service use questionnaire. The primary outcome was saliva cotinine 3 months post-intervention.

RESULTS

Most pregnant women and many husbands engaged with the intervention and rated the components highly, although the cotinine report elicited some anxiety. Forty-eight (Comilla) and fifty-four (Bangalore) women were recruited. The retention at 3 months was 100% (Comilla) and 78% (Bangalore). Primary outcome data were available for 98% (Comilla) and 77% (Bangalore).

CONCLUSIONS

The multicomponent behavioural intervention was feasible to deliver and was acceptable to the interventionists, pregnant women, and husbands. With the intervention, it was possible to recruit, randomise, and retain pregnant women in Bangladesh and India. The cotinine data will inform sample size calculations for a future definitive trial.

Prevalence and factors associated with second hand smoke exposure among a sample of pregnant women in Cairo, Egypt

PURPOSE

This study estimated the prevalence of and factors associated with secondhand smoke (SHS) exposure, and assessed attitudes and knowledge about SHS among pregnant women in Cairo, Egypt.

METHODS

Pregnant women in the third trimester were recruited to participate in a survey assessing tobacco smoking and SHS exposure during their current pregnancy. Participants were recruited from three antenatal clinics in Cairo, Egypt, from June 2015 to May 2016. We examined differences in sociodemographic characteristics and SHS exposure, attitudes, and knowledge by smoking/SHS status. We used multivariable ordinary least squares regression to examine the association between husbands' smoking and pregnant women's mean daily hours of SHS exposure, adjusting for women's smoking status, age group, education, and urban (vs. suburban/rural) residence.

RESULTS

Of two hundred pregnant women aged 16-37 years, about two-thirds (69%) had a husband who smoked tobacco. During their current pregnancy, most women reported being non-smokers (71%), and 38% of non-smokers reported being SHS-exposed. Non-smokers exposed to SHS tended to live in more rural areas and have husbands who smoked in the home. In adjusted analyses, having a husband who smoked was significantly associated with a greater mean number of hours of SHS exposure per day exposed, and this difference was driven by husbands who smoked in the home (p < 0.001). Women in the SHS-exposed group were less likely than other groups to agree that SHS exposure was harmful to their own or their future child's health; however, all groups agreed that SHS was harmful to newborn health.

CONCLUSION

Among our sample of pregnant women in Cairo, Egypt, there was a high rate of SHS exposure as well as misconceptions about the safety of SHS exposure to a developing fetus. Our findings suggest a need for targeted education and gender-sensitive messaging about SHS exposure, along with improved enforcement of existing tobacco control policies.

Sources of personal PM2.5 exposure during pregnancy in the MADRES cohort

BACKGROUND

Personal exposure to fine particulate matter (PM2.5) is impacted by different sources each with different chemical composition. Determining these sources is important for reducing personal exposure and its health risks especially during pregnancy.

OBJECTIVE

Identify main sources and their contributions to the personal PM2.5 exposure in 213 women in the 3rd trimester of pregnancy in Los Angeles, CA.

METHODS

We measured 48-hr integrated personal PM2.5 exposure and analyzed filters for PM2.5 mass, elemental composition, and optical carbon fractions. We used the EPA Positive Matrix Factorization (PMF) model to resolve and quantify the major sources of personal PM2.5 exposure. We then investigated bivariate relationships between sources, time-activity patterns, and environmental exposures in activity spaces and residential neighborhoods to further understand sources.

RESULTS

Mean personal PM2.5 mass concentration was 22.3 (SD = 16.6) μg/m3. Twenty-five species and PM2.5 mass were used in PMF with a final R2 of 0.48. We identified six sources (with major species in profiles and % contribution to PM2.5 mass) as follows: secondhand smoking (SHS) (brown carbon, environmental tobacco smoke; 65.3%), fuel oil (nickel, vanadium; 11.7%), crustal (aluminum, calcium, silicon; 11.5%), fresh sea salt (sodium, chlorine; 4.7%), aged sea salt (sodium, magnesium, sulfur; 4.3%), and traffic (black carbon, zinc; 2.6%). SHS was significantly greater in apartments compared to houses. Crustal source was correlated with more occupants in the household. Aged sea salt increased with temperature and outdoor ozone, while fresh sea salt was highest on days with westerly winds from the Pacific Ocean. Traffic was positively correlated with ambient NO2 and traffic-related NOx at residence. Overall, 76.8% of personal PM2.5 mass came from indoor or personal compared to outdoor sources.

IMPACT

We conducted source apportionment of personal PM2.5 samples in pregnancy in Los Angeles, CA. Among identified sources, secondhand smoking contributed the most to the personal exposure. In addition, traffic, crustal, fuel oil, fresh and aged sea salt sources were also identified as main sources. Traffic sources contained markers of combustion and non-exhaust wear emissions. Crustal source was correlated with more occupants in the household. Aged sea salt source increased with temperature and outdoor ozone and fresh sea salt source was highest on days with westerly winds from the Pacific Ocean.

Prenatal Exposure to Tobacco and Cannabis in Six Race/Ethnicity Groups during the First Three Years after Legalization of Cannabis for Recreational Use in California

There are known health concerns linked to prenatal tobacco and cannabis exposures. This study aims to objectively determine the level of exposure to tobacco and cannabis in pregnant individuals from six race/ethnicity groups (Black, Hispanic, Asian Indian, Native American, Vietnamese, and White) in the first three years following legalization of recreational marijuana use in 2018 in California. We used a cross-sectional sample of prenatal screening program participants (2018-2020) from southern and central California (N = 925). Exposures were estimated by a lab analysis of cotinine (tobacco) and 11-hydroxy-Δ9-tetrahydrocannabinol (OH-THC, cannabis) in banked serum. Disparities in tobacco exposure were evident, with Black subjects experiencing the highest smoking rate (16%) followed by Native American (10%) and White (8%) subjects, and ≤2% among Hispanic, Asian Indian, and Vietnamese subjects. Environmental tobacco exposure generally showed a similar pattern of exposure to tobacco smoking across race/ethnicity groups. Cannabis detection ranged from 5% among Hispanic subjects to 12% and 13% among White and Black subjects, respectively, and was higher among tobacco users and those exposed to environmental tobacco smoke than those with no cotinine detected. Tobacco and cannabis exposure were generally greatest in younger subjects and those with indices of a lower economic status; however, among Black subjects, cannabis exposure was greatest in older subjects and those with a higher socioeconomic status. Race/ethnicity, age, and socioeconomic factors can inform targeting of high-exposure groups for intervention.

Environmental tobacco smoke and children's health: a bibliometric and altmetric analysis of 100 most cited articles

BACKGROUND

Exposure to environmental tobacco smoke (ETS) is arguably the most ubiquitous and hazardous, even at very low levels, starting in early life. The objective of this study was to describe the state of research and future trends on ETS exposure and Children's Health (CH) topics with bibliometrics and altmetrics.

METHODS

An electronic search was performed in Scopus database on January 31, 2023. Consensus was arrived on 100 most-cited articles by two reviewers. These papers were then cross matched with citations harvested from Web of Science (WoS) and Google Scholar. Altmetric Attention Score (AAS) and Dimension counts were also collected. Analysis and network visualization of authors, countries, and keywords were generated using VOSviewer software.

RESULTS

Among a total of 1107 articles published on ETS and CH, the 100 top-cited articles appeared in 54 journals, with Pediatrics (n = 12) contributing a maximum number of articles. The time period between 2000 and 2009 accounted for 44% of all publications. With respect to the research design employed across these studies, cross-sectional design took precedence over others accounting for approximately 40%. Predominantly, articles focused on childhood asthma; however, current research trends have shifted towards emerging fields such as children's oral health and DNA methylation. Twitter, policy documents, and news outlets were the main platforms where outputs were discussed. The AAS was not associated with journal impact factor or access type. Weak correlations were observed between AAS and citation count in Scopus, WoS, and Google Scholar (r = 0.17 to 0.27) while a positive association existed between dimension count and the number of citations across all three databases (r = 0.84 to 0.98).

CONCLUSION

This study demonstrates the evolution, digital dissemination and research hotspots in the field of ETS and CH, predicting the possible future research directions. High-quality studies with more specific exposure classification are warranted to better understand the relationship between ETS and CH.

Investigating associations between maternal stress, smoking and adverse birth outcomes: evidence from the All Our Families cohort

BACKGROUND

Independently, active maternal and environmental tobacco smoke exposure and maternal stress have been linked to an increased risk of preterm birth and low birth weight. An understudied relationship is the potential for interactive effects between these risk factors.

METHODS

Data was obtained from the All Our Families cohort, a study of 3,388 pregnant women < 25 weeks gestation recruited from those receiving prenatal care in Calgary, Canada between May 2008 and December 2010. We investigated the joint effects of active maternal smoking, total smoke exposure (active maternal smoking plus environmental tobacco smoke) and prenatal stress (Perceived Stress Scale, Spielberger State-Trait Anxiety Inventory), measured at two time points (< 25 weeks and 34-36 weeks gestation), on preterm birth and low birth weight.

RESULTS

A marginally significant association was observed with the interaction active maternal smoking and Spielberger State-Trait Anxiety Inventory scores in relation to low birth weight, after imputation (aOR = 1.02, 95%CI: 1.00-1.03, p = 0.06). No significant joint effects of maternal stress and either active maternal smoking or total smoke exposure with preterm birth were observed. Active maternal smoking, total smoke exposure, Perceived Stress Scores, and Spielberger State-Trait Anxiety Inventory scores were independently associated with preterm birth and/or low birth weight.

CONCLUSIONS

Findings indicate the role of independent effects of smoking and stress in terms of preterm birth and low birthweight. However, the etiology of preterm birth and low birth weight is complex and multifactorial. Further investigations of potential interactive effects may be useful in helping to identify women experiencing vulnerability and inform the development of targeted interventions.

The Impact of Prenatal Environmental Tobacco Smoking (ETS) and Exposure on Chinese Children: A Systematic Review

Background: There is considerable evidence to support the association between exposure to environmental tobacco smoke (ETS) and children's burden of disease. However, the literature on the health outcomes of prenatal ETS exposure among Chinese children has not yet been comprehensively reviewed. Objective: This systematic review examines the currently available evidence and identifies gaps for further research on the health consequences of prenatal ETS exposure on Chinese children. Methods: Following the JBI systematic-scoping review methodological framework, we conducted a computer-aided search of three electronic databases-PubMed, EBSCOhost, and ProQuest to include studies from January 2011 to May 2023 that addressed the health outcomes of Chinese children whose mothers were exposed to ETS at any stage of pregnancy. Furthermore, a methodological quality assessment of the selected articles was conducted using JBI critical appraisal checklists. Results: A total of 30 articles were reviewed, including eleven high-quality studies and nineteen moderate-quality studies. Five main themes, including hypertension, fetal and children's development, behavioural disorders, respiratory outcomes, and "other health outcomes", were encompassed. The majority of the studies showed a positive link between prenatal ETS exposure and an increased risk of preterm birth, and moderate risk of fetal growth restriction. A few studies explored other potential adverse outcomes of ETS, including hypertension, respiratory morbidity, lung function, and asthma in children. Conclusions: The currently available evidence on prenatal ETS exposure in Chinese children has unveiled a wide range of health outcomes, including preterm birth, fetal development, behavioural disorders, and much more. However, Chinese studies in this area are still lacking and a gap still exists in relation to the strength of association between prenatal ETS exposure and some health risks. Efficient anti-smoking policies and smoking cessation programs should be developed to promote maternal and child health. Further research is also needed to provide better evidence in this field.

Environmental exposures and adverse pregnancy outcomes in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Maternal exposures to environmental hazards during pregnancy are key determinants of birth outcomes that affect health, cognitive and economic status later in life. In Ethiopia, various epidemiological evidences have suggested associations between environmental exposures such as household air pollution, cigarette smoking, and pesticide exposure and pregnancy outcomes such as low birth weight, preterm birth, and birth defects.

OBJECTIVE

This review aimed at generating summarized evidence on the association between maternal exposure to environmental factors (household air pollution, cigarette smoking, and pesticide) and pregnancy outcomes (birth weight, preterm birth, and birth defects) in Ethiopia.

METHOD

A systematic literature search was performed using PubMed, Google Scholar, and the Cochrane Library databases. All observational study designs were eligible for inclusion in the review. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) quality assessment tools adopted for case-control and cross-sectional studies. The random-effects model was applied in computing the pooled estimates and their corresponding 95% confidence interval (CI). Funnel and Doi plots were used for detecting the potential publication bias. All statistical analyses were performed using comprehensive meta-analysis (CMA 2.0) and MetaXL version 5.3 software.

RESULT

The pooled estimates revealed that prenatal biomass fuel use increased the risk of giving a low birth weight baby by twofold (OR = 2.10, 95% CI: 1.33-3.31), and has no separate kitchen increases the risk of having low birth weight baby nearly by two and half times (OR = 2.48, 95% CI: 1.25-4.92). Overall, using biomass fuel as the main energy source for cooking and /or having no separate kitchen from the main house is 2.37 times more likely to give low birth weight babies (OR = 2.37, 95% CI: 1.58-3.53). Active cigarette smoker women were 4 times (OR = 4.11, 95% CI: 2.82-5.89) more prone to have low birth weight babies than nonsmokers; and passive smoker women were 2.6 times (OR = 2.63, 95% CI: 1.09-6.35) more risked to give low birth weight babies. It was also estimated that active cigarette smoker women were nearly 4 times (OR = 3.90, 95% CI: 2.36-6.45) more likely to give preterm birth babies. Pesticide exposure during pregnancy also increases the risk of the birth defect 4 times (OR = 4.44, 95% CI: 2.61-7.57) compared with non-exposed pregnant women.

CONCLUSION

Household air pollution from biomass fuel use, active and passive cigarette smoking, and pesticide exposures are significantly associated environmental risk factors for low birth weight, preterm birth, and birth defects in Ethiopia. Therefore, Pregnant and lactating women should be aware of these environmental hazards during pregnancy. Promoting clean energy and improved and efficient stoves at the household level will help to reduce household air pollution-related adverse health effects.

TRIAL REGISTRATION

PROSPERO 2022: CRD42022337140.

Pregnancy, infection, and epigenetic regulation: A complex scenario

A unique immunological condition, pregnancy ensures fetus from maternal rejection, allows adequate fetal development, and protects against microorganisms. Infections during pregnancy may lead to devastating consequences for pregnant women and fetuses, resulting in the mother's death, miscarriage, premature childbirth, or neonate with congenital infection and severe diseases and defects. Epigenetic (heritable changes in gene expression) mechanisms like DNA methylation, chromatin modification, and gene expression modulation during gestation are linked with the number of defects in the fetus and adolescents. The feto-maternal crosstalk for fetal survival during the entire gestational stages are tightly regulated by various cellular pathways, including epigenetic mechanisms that respond to both internal as well outer environmental factors, which can influence the fetal development across the gestational stages. Due to the intense physiological, endocrinological, and immunological changes, pregnant women are more susceptible to bacterial, viral, parasitic, and fungal infections than the general population. Microbial infections with viruses (LCMV, SARS-CoV, MERS-CoV, and SARS-CoV-2) and bacteria (Clostridium perfringens, Coxiella burnetii, Listeria monocytogenes, Salmonella enteritidis) further increase the risk to maternal and fetal life and developmental outcome. If the infections remain untreated, the possibility of maternal and fetal death exists. This article focused on the severity and susceptibility to infections caused by Salmonella, Listeria, LCMV, and SARS-CoV-2 during pregnancy and their impact on maternal health and the fetus. How epigenetic regulation during pregnancy plays a vital role in deciding the fetus's developmental outcome under various conditions, including infection and other stress. A better understanding of the host-pathogen interaction, the characterization of the maternal immune system, and the epigenetic regulations during pregnancy may help protect the mother and fetus from infection-mediated outcomes.

Associations of Education and Income with Secondhand Smoke Exposure Among Non-smoking Pregnant Women in Japan: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

OBJECTIVES

There is accumulating evidence that lower socioeconomic groups are more exposed to secondhand smoke (SHS) than higher ones in the general population. The objective of the study was to examine the associations of education and income with SHS exposure among non-smoking pregnant women in Japan.

METHODS

We analyzed data from 11,615 non-smoking pregnant women in Japan who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study from 2013 to 2017. SHS exposure was defined as indoor exposure to someone else's cigarette smoke ≥ 1 day/week during pregnancy. Multiple logistic regression analyses were conducted to examine whether pregnant women's educational attainment or equivalent household income was associated with SHS exposure, adjusting for covariates. Stratified analyses by work status were also conducted.

RESULTS

The prevalence of SHS exposure during pregnancy was 32.6%; 27.6% among non-working women and 35.8% among working women. Lower educational attainment was associated with an increased risk of SHS exposure; the odds ratio of high school education or lower compared with university education or higher was 1.87 (95% confidence interval, 1.66-2.10). Lower equivalent household income was associated with an increased risk of SHS exposure; the odds ratio of the lowest compared with the highest level of income was 1.53 (95% confidence interval, 1.35-1.74). These associations did not differ between non-working women and working women.

CONCLUSIONS FOR PRACTICE

Associations of education and income with SHS exposure imply that educational interventions and financial incentives are needed for pregnant women and their household smokers.

Global, regional, and national deaths, disability-adjusted life years, years lived with disability, and years of life lost for the global disease burden attributable to second-hand smoke, 1990-2019: A systematic analysis for the Global Burden of Disease Study

BACKGROUND

Smoke-free policies have led to a decline in smoking prevalence. Nevertheless, as the global population grows, more non-smokers are exposed to second-hand smoke (SHS) hazards. Mitigating SHS hazards requires a systematic analysis of the global disease burden attributable to SHS.

METHODS

Data on SHS was extracted from the Global Burden of Disease Study 2019. First, we measured the disease burden of SHS by the number of cases and age-standardized rates of deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) from 1990 to 2019. Second, trends in the disease burden of SHS in different periods were estimated based on the annual percentage change (APC) by joinpoint regression analysis. Finally, using histogram plots, world maps, Pearson correlation analysis, and population attributable fraction (PAF), we conducted a stratified analysis of SHS exposure by sex, age, geographic location, sociodemographic index (SDI) level, and disease.

RESULTS

The number of deaths caused by SHS remained stable between 1990 and 2019, and the number of YLDs more than doubled in three decades. In contrast, the number of DALYs and YLLs caused by SHS decreased. The declining trend in deaths (APC = -1.42 % [95 % UI -1.79 %, -1.05 %]), DALYs (APC = -1.91 % [95 % UI -2.15 %, -1.67 %]), and YLLs (APC = -1.28 % [95 % UI -1.93 %, -0.64 %]) had slowed down in recent years, while SHS-related YLDs were still increasing (APC = 1.84 % [95 % UI 0.74 %, 2.96 %]). From 2010 to 2019, we found that SHS exposure increased the risk of tracheal, bronchus, and lung cancer (PAF increased by 11.75 %), breast cancer (PAF increased by 5.36 %), diabetes mellitus (PAF increased by 8.24 %), and ischemic heart disease (PAF increased by 4.46 %). In addition, the disease burden caused by SHS was highest in middle SDI and low-middle SDI countries.

CONCLUSION

The global disease burden attributable to SHS is still severe, and policymakers need to implement more effective measures to reduce the harm of SHS.

The Effect of Active and Passive Maternal Smoking During Pregnancy on the Uterine Artery Blood Flow and Obstetric Outcomes: A Prospective Study

BACKGROUND AND AIM

Maternal smoking is associated with an increased risk of obstetric and neonatal complications during pregnancy. We aimed to investigate the effects of active and passive smoking on fetal-maternal blood flow and fetal complications in mid-trimester pregnant women.

METHODS

This prospective study was conducted at Zekai Tahir Burak Women's Research and Training Hospital and included women who were 20 to 22 weeks old, with no fetal anomalies, and with a singleton pregnancy. The data used in the analysis were obtained from a total of 168 pregnant women (50 smokers, 50 passive smokers, and 68 non-smokers). Starting from their 20^th week of pregnancy, the women were examined at least once in each trimester. Fetal and maternal pregnancy results were evaluated. Fetal biometry, umbilical, and uterine artery Doppler ultrasonography were performed. To evaluate the flow in these veins, the pulsatility index, resistance index, and systole/diastole (S/D) ratio were performed.

RESULTS

The mean age of study patients was 25.06 ± 4.36 years and the mean gestational week was 20.03 ± 0.6 weeks. In terms of the umbilical artery pulsatility index (UMBAPI), umbilical artery systolic/diastolic ratio (UMBAS/D),uterine artery resistance index (UARI), uterine artery pulsatility index (UAPI), and uterine artery systolic/diastolic ratio (UAS/D) levels, the mean value of the smoker group was significantly higher compared to the non-smoker group (p<0.001, p=0.043, p=0.021, p=0.020, and p=0.037, respectively). The birth weight of the fetus was significantly lower in the active and passive smoker groups than in the non-smoker group (p=0.009 and p=0.006, respectively). The number of patients diagnosed with intrauterine growth restriction (IUGR) and oligohydramnios were significantly higher in the smoker group than in the passive smoker and non-smoker groups (p=0.003 and p<0.001, respectively). The risk of low birth weight (OR, (95% CI): 3.38 (2.05 - 5.57); p=0.024), oligohydramnios (OR (95% CI): 13.44 (5.22 - 34.57); p=0.001), IUGR (OR (95% CI): 9.33 (4.50 - 19.33); p=0.001), and preterm birth (OR (95% CI): 4.56 (1.25 - 17.32); p=0.001) increased significantly in the active and passive cigarette exposure groups, compared to the non-smokers.

CONCLUSION

During pregnancy, both smoking and passive exposure to cigarette smoke adversely affect the fetus and the newborn. Uterine and umbilical artery Doppler measurements in pregnant women who smoke are significantly higher than the pregnant women who do not smoke.

Maternal vitamin D status modifies the effects of early life tobacco exposure on child lung function

BACKGROUND

Prior studies suggest that vitamin D may modify the effects of environmental exposures; however, none have investigated gestational vitamin D and cumulative tobacco smoke exposure (TSE) throughout pregnancy and early life.

OBJECTIVES

This study investigated the effects of early life TSE on child lung function and the modulatory effects of gestational vitamin D on this association.

METHODS

The VDAART (Vitamin D Antenatal Asthma Reduction Trial) recruited nonsmoking pregnant women and followed the mother-child pairs to age 6 years. TSE was assessed with questionnaires and plasma cotinine measurements in the mothers (10-18 and 32-38 gestational weeks) and children (1, 3, and 6 years). Cumulative TSE was calculated from the repeated cotinine measurements. 25-hydroxyvitamin D (25[OH]D) levels were measured at 10-18 and 32-38 gestational weeks. Lung function was assessed at 6 years with spirometry and impulse oscillometry.

RESULTS

Of the 476 mother-child pairs, 205 (43%) had increased cotinine levels at ≥1 time point. Cumulative TSE was associated with decreased FEV1 (β = -0.043 L, P = .018) and increased respiratory resistance at 5 Hz (R5; β = 0.060 kPa/L/s, P = .002). This association persisted in subjects with insufficient (<30 ng/mL) 25(OH)D levels throughout pregnancy (β = 0.077 kPa/L/s, P = .016 for R5) but not among those with sufficient levels throughout pregnancy.

CONCLUSIONS

Cumulative TSE from pregnancy to childhood is associated with dose- and duration-dependent decreases in child lung function at 6 years even in the absence of reported maternal smoking. Gestational vitamin D may modulate this effect and have therapeutic potential for minimizing the adverse effect of TSE on lung throughout early life.

RANDOMIZED TRIAL

Maternal Vitamin D Supplementation to Prevent Childhood Asthma (VDAART); clinicaltrials.gov identifier: NCT00920621.

Early childhood exposure to maternal smoking and obesity: A nationwide longitudinal survey in Japan

Involuntary exposure to tobacco smoke is suspected to be one of the risks factors that are associated with obesity in children. The purpose of this study was to examine the relationship between early childhood exposure to tobacco smoke and the risk of obesity and overweight in Japan. This study utilized a nationwide, population-based longitudinal survey. The participants were restricted to 32 081 children who had available information on maternal smoking history as well as childhood height and weight. We conducted a binomial log-linear regression analysis with children of non-smoking mothers as the reference group. The children with mothers who were smokers had a higher risk of developing obesity or being overweight compared to the children with mothers who were nonsmokers. The risk ratios were 1.20 (95% confidence interval [CI]: 1.09-1.32) for overweight and 1.17 (95% CI: 0.95-1.44) for obesity. Early exposure to maternal smoking increases the risk of being overweight and having obesity during childhood. The increased risk is more pronounced among children with mothers, smoked heavily, or parents, who were smokers.

Evaluating association of smoking status during pregnancy with adverse birth outcomes using urinary cotinine concentration: The Japan environment and Children's study (JECS)

Urinary cotinine concentration (UCC) reflects smoking status. However, in pregnant women, its association with adverse birth outcomes related to fetal growth is not widely known. Thus, we aimed to explore this relationship by focusing on dose-response relationships. We investigated 86,638 pregnant women enrolled between 2011 and 2014 in a prospective cohort study in Japan and observed three birth outcomes (preterm birth, low birth weight, and small-for-gestational age). We measured UCC in the second or third trimester, and categorized the participants using cut-off values (negative cotinine concentration, passive cotinine concentration, and active cotinine concentration corresponding to non-smokers, passive smokers, and active smokers, respectively). Logistic regression analyses were conducted to evaluate the risks, and dose-response relationships were visualized using restricted cubic spline curves. Analyses based on self-reported smoking status were also performed. We found that in low active and highly active cotinine concentrations, the adjusted odds ratios (aORs) of birth outcomes were significantly increased (preterm birth, 1.24 [95% CI 1.06-1.46], 1.39 [95% CI 1.19-1.62]; low birth weight, 1.40 [95% CI 1.24-1.58], 2.27 [95% CI 2.05-2.53]; small-for-gestational age, 1.35 [95% CI 1.19-1.52], 2.39 [95% CI 2.16-2.65]). Restricted cubic spline curves demonstrated risk elevations in the active cotinine concentration range. Our research revealed dose-response relationships between UCC during pregnancy and the risks of preterm birth, low birth weight, and small-for-gestational age. Measurement of UCC to ascertain smoking status during pregnancy may be a useful approach for predicting the risks of these birth outcomes.

Association between maternal smoke exposure and congenital heart defects from a case-control study in China

There is a gap in knowledge how maternal exposure to environmental tobacco smoke (ETS) is associated with offspring congenital heart defects (CHDs). In this case-control study, we collected data on 749 fetuses with CHDs and 880 fetuses without any congenital anomalies to examine the association of maternal ETS with fetal CHDs and the potentially moderating effect by maternal hazardous and noxious substances (HNS), periconceptional folate intake and paternal smoking. Maternal exposure to ETS in first trimester was associated with increased risk of CHDs in a dose-response gradient, with the AORs (95% CI) were1.38 (1.00-1.92), 1.60 (1.07-2.41), and 4.94 (2.43-10.05) for ETS < 1 h/day, 1-2 h/day, and ≥ 2 h/day, respectively. With the doubly unexposed group as reference categories, AORs for maternal ETS exposure ≥ 2 h/day in the absence of folate intake, in the presence of HNS exposure or paternal smoking, were 7.21, 11.43, and 8.83, respectively. Significant additive interaction between ETS exposure and maternal folate intake on CHDs was detected. Maternal ETS exposure during first trimester may increase the risk of offspring CHDs in a dose-response shape, and such effect may be modified by maternal folate intake or other potential factors.

Fetal growth restriction, low birth weight, and preterm birth: Effects of active or passive smoking evaluated by maternal expired CO at delivery, impacts of cessation at different trimesters

INTRODUCTION

The objectives of this study were to evaluate the effect of cessation of active smoking during the 1st, 2nd, and 3rd trimesters of pregnancy on the risk of reduced birth weight and prematurity using an exhaled carbon monoxide biomarker with a cut-off value ≥3 ppm as well as the effects of passive smoking.

METHODS

This was a multicenter prospective cohort study involving pregnant smokers and non-smokers. Pregnant smokers were identified at the first prenatal visit before 15 weeks of amenorrhea by the number of cigarettes smoked per day and by the carbon monoxide breath test. Women were classified into 6 groups: non-smokers, passive smokers, first trimester cessation, second trimester cessation, third trimester cessation, and smoking throughout pregnancy. Smoking cessation was defined if the pregnant woman reported quitting smoking and if she achieved an exhaled CO level of <3 ppm. The association between smoking cessation and fetal growth restriction or prematurity was assessed by multivariate logistic regression. Passive smoking was defined for non-smoking women on declarative smoking status and exhaled CO ≥3 ppm. The association between passive smoking and fetal growth restriction or prematurity was assessed by multivariate logistic regression.

RESULTS

The number of patients included was 5244. The incidence of fetal growth restriction below the 10th percentile was 10.6%, 12.1%, 8.5%, 9.1%, 21.1%, and 22.9%, respectively, for the non-smoking, passive smoking, first, second, third trimester cessation, and full-pregnancy smoking, groups. The risk of FGR compared to non-smokers was OR=2.3 (95% CI: 1.18–4.30, p=0.014) for patients who quit smoking in the third trimester, OR=2.5 (95% CI: 2.03–3.12, p<0.001) for women who smoked throughout pregnancy. After logistic regression, FGR (AOR=1.9; 95% CI: 0.96–3.82) for women who quit smoking in the 3rd trimester (AOR=1.8; 95% CI: 1.38–2.31, p<0.001). The risk of FGR <5th percentile was AOR=1.96 (95% CI: 1.36–2.48, p<0.001).

CONCLUSIONS

Active or passive smoking during pregnancy is associated with an increased risk of intrauterine growth restriction and low birth weight. Cessation in the 1st and 2nd trimester reduces the risk of intrauterine growth restriction or low birth weight. Passive smoking has a deleterious impact on fetal development, intermediate to that of active smoking.

Impact of Tobacco and Marijuana on Infertility and Early Reproductive Wastage

Reducing exposure to tobacco and marijuana during preconception and early pregnancy is a critical area of intervention for obstetricians, gynecologists, and other reproductive health care professionals. Beyond the deleterious personal health effects, both substances have been extensively associated with short-term and long-term detrimental effects to gametogenesis, fecundity, as well as tissue level effects in the reproductive tracts. When tobacco and marijuana do not impair the ability to achieve pregnancy, an increasing body of literature suggests either may be associated with increased risk of early pregnancy loss and reproductive wastage. In this review, we will discuss what is known about how tobacco and marijuana affect the male and female reproductive systems and highlight how these consequences may impair attempts at successful conception and pregnancy continuation beyond the first trimester.

Tobacco use during pregnancy

The use of tobacco during pregnancy is the leading preventable cause of pregnancy complications and adverse birth outcomes. In high-income countries, around one in 10 pregnant women smokes tobacco, while smokeless tobacco is the primary form of tobacco used in many low- and middle-income countries. Although the risk of tobacco-related harms can be reduced substantially if mothers cease smoking in the first trimester of pregnancy, the proportion of women who successfully quit smoking during pregnancy remains modest. Psychosocial interventions are first-line treatment, with some high-quality evidence showing that counselling is effective in promoting smoking cessation among pregnant women. There is insufficient evidence regarding the efficacy and safety of smoking cessation pharmacotherapies when used during pregnancy, although in some countries nicotine replacement therapy is recommended for pregnant women who have been unable to quit without pharmacological assistance. E-cigarettes are increasingly being used as a smoking cessation aid in the general population of smokers, but more research is needed to determine if e-cigarettes are a safe and effective treatment option for pregnant women.

Risk of Gestational Diabetes Due to Maternal and Partner Smoking

Pregnant women are among the most vulnerable to environmental exposure to tobacco smoke (EET); which has been linked to problems in the mothers’ health; one of the most frequent is gestational diabetes (GD). For this reason, there are specific interventions and prevention strategies designed to reduce this exposure risk. However, currently, they are mostly aimed only at aiding the pregnant women with smoking cessation during pregnancy and do not assess or address the risk from passive exposure due to partner smoking. The aim of this work is to study the exposure to EET of pregnant women considering active and passive smoking and to evaluate its effect on the development of GD. This is an observational case-control study within a retrospective cohort of pregnant women. Information on smoking habits was obtained from both personal interviews and recorded medical history. In total, 16.2% of mothers and 28.3% of partners declared having been active smokers during pregnancy; 36.5% of the women presented EET during pregnancy when both active and passive smoking were considered. After adjustments, the association with the EET and GD of the mother was (aOR 1.10 95% CI: 0.64–1.92); for the EET of the partner, it was (aOR 1.66 95% CI: 1.01–2.77); for both partners, it was (aOR 1.82 95% CI: 1.15–2.89), adjusted by the mother’s age and body mass index. There is a lack of education regarding the effects of passive exposure to tobacco smoke. It is essential that pregnant women and their partners are educated on the risks of active and passive smoking; this could improve the effectiveness of other GD prevention strategies.

Propensity score analysis of the association between maternal exposure to second-hand tobacco smoke and birth defects in Northwestern China

Previous studies have suggested that maternal active smoking can increase the risk of birth defects, but evidence on second-hand tobacco smoke (SHS) is limited. We aimed to assess the association between maternal exposure to SHS and birth defects in a Chinese population. The data were based on a large-scale cross-sectional survey conducted in Shaanxi Province, China. Considering the characteristics of survey design and the potential impact of confounding factors, we adopted propensity score matching (PSM) to match the SHS exposure group and the non-exposure group to attain a balance of the confounders between the two groups. Subsequently, conditional logistic regression was employed to estimate the effect of SHS exposure on birth defects. Furthermore, sensitivity analyses were conducted to verify the key findings. After nearest neighbor matching of PSM with a ratio of 2 and a caliper width of 0.03, there were 6,205 and 12,410 participants in the exposure and control group, respectively. Pregnant women exposed to SHS were estimated to be 58% more likely to have infants with overall birth defects (OR = 1.58, 95% CI: 1.30-1.91) and 75% more likely to have infants with circulatory system defects (OR = 1.75, 95% CI: 1.26-2.44). We also observed that the risk effect of overall birth defects had an increasing trend as the frequency of exposure increased. Additionally, sensitivity analyses suggested that our results had good robustness. These results indicate that maternal exposure to SHS likely increases the risk of overall birth defects, especially circulatory system defects, in Chinese offspring.

High-resolution metabolomics of exposure to tobacco smoke during pregnancy and adverse birth outcomes in the Atlanta African American maternal-child cohort

Exposure to tobacco smoke during pregnancy has been associated with a series of adverse reproductive outcomes; however, the underlying molecular mechanisms are not well-established. We conducted an untargeted metabolome-wide association study to identify the metabolic perturbations and molecular mechanisms underlying the association between cotinine, a widely used biomarker of tobacco exposure, and adverse birth outcomes. We collected early and late pregnancy urine samples for cotinine measurement and serum samples for high-resolution metabolomics (HRM) profiling from 105 pregnant women from the Atlanta African American Maternal-Child cohort (2014-2016). Maternal metabolome perturbations mediating prenatal tobacco smoke exposure and adverse birth outcomes were assessed by an untargeted HRM workflow using generalized linear models, followed by pathway enrichment analysis and chemical annotation, with a meet-in-the-middle approach. The median maternal urinary cotinine concentrations were 5.93 μg/g creatinine and 3.69 μg/g creatinine in early and late pregnancy, respectively. In total, 16,481 and 13,043 metabolic features were identified in serum samples at each visit from positive and negative electrospray ionization modes, respectively. Twelve metabolic pathways were found to be associated with both cotinine concentrations and adverse birth outcomes during early and late pregnancy, including tryptophan, histidine, urea cycle, arginine, and proline metabolism. We confirmed 47 metabolites associated with cotinine levels, preterm birth, and shorter gestational age, including glutamate, serine, choline, and taurine, which are closely involved in endogenous inflammation, vascular reactivity, and lipid peroxidation processes. The metabolic perturbations associated with cotinine levels were related to inflammation, oxidative stress, placental vascularization, and insulin action, which could contribute to shorter gestations. The findings will support the further understanding of potential internal responses in association with tobacco smoke exposures, especially among African American women who are disproportionately exposed to high tobacco smoke and experience higher rates of adverse birth outcomes.

European progress in working towards a tobacco-free generation

Children have the right to grow up free from the hazards associated with tobacco smoking. Tobacco smoke exposure can have detrimental effects on children's health and development, from before birth and beyond. As a result of effective tobacco control policies, European smoking rates are steadily decreasing among adults, as is the proportion of adolescents taking up smoking. Substantial variation however exists between countries, both in terms of smoking rates and regarding implementation, comprehensiveness and enforcement of policies to address smoking and second-hand smoke exposure. This is important because comprehensive tobacco control policies such as smoke-free legislation and tobacco taxation have extensively been shown to carry clear health benefits for both adults and children. Additional policies such as increasing the legal age to buy tobacco, reducing the number of outlets selling tobacco, banning tobacco display and advertising at the point-of-sale, and introducing plain packaging for tobacco products can help reduce smoking initiation by youth. At societal level, health professionals can play an important role in advocating for stronger policy measures, whereas they also clearly have a duty to address smoking and tobacco smoke exposure at the patient level. This includes providing cessation advise and referring to effective cessation services.Conclusion: Framing of tobacco exposure as a child right's issue and of comprehensive tobacco control as a tool to work towards the ultimate goal of reaching a tobacco-free generation can help accelerate European progress to curb the tobacco epidemic. What is Known: • Tobacco exposure is associated with a range of adverse health effects among babies and children. • Comprehensive tobacco control policies helped bring down smoking rates in Europe and benefit child health. What is New: • Protecting the rights and health of children provides a strong starting point for tobacco control advocacy. • The tobacco-free generation concept helps policy-makers set clear goals for protecting future generations from tobacco-associated harms.

Child marriage and exposure to secondhand smoke among women of childbearing age: evidence from a nationally representative study in India

Women in low-and-middle income countries (LMICs) are disproportionately exposed to secondhand smoke (SHS), particularly in the home environment. Girls married before the age of 18 are more likely to remain at home and may be at higher risk of SHS exposure. This paper investigates whether women who were married as child brides had a higher risk of SHS exposure than their peers who were married as adults in India, where both burden of smoking and child marriage are critical public health concerns. Data were obtained from the 2015-2016 wave of the nationally representative India National Family Health Survey and included 306,788 married women ages 18 to 35 years. We estimated bivariate and multivariate logistic regressions to obtain odds ratios in favor of SHS exposure. The prevalence of SHS exposure for those who were married as adults was 50.3% while that was 55.2% for those who were married before age 18. After controlling for sociodemographic characteristics, the adjusted odds of SHS exposure for those who were married as child were 1.06 (95% CI: 1.03, 1.09) times that of those who were married as adults. Findings of this study inform policies for coordinated efforts to eliminate child marriage and strengthen tobacco control.

Change in exposure of children to second-hand smoke with impact on children's health and change in parental smoking habits after smoking ban in Bavaria - a multiple cross-sectional study

BACKGROUND

Concerns about smoking displacement from public places to private amenities aroused following smoking ban implementation in Bavaria in 2008. We analysed children's exposure to second-hand smoke (SHS) before and after the ban, its effect on children's health and prevalence of active smoking in adults.

METHODS

Six cross-sectional surveys (n = 32,443) on pre-school children in Bavaria were analysed, two surveys before the smoking ban in years 2004 and 2005 (S1 and S2) and four after the ban in 2008, 2012, 2014 and 2016 (S4, S6, S7 and S8). Using multivariable logistic regression, we analysed change in children's intra- and extrauterine SHS exposure and its adverse health effects (Asthma, wheezing, bronchitis and neurodermatitis) as well as change in parental active smoking.

RESULTS

The response rates were 78% for S1, 73% for S2, 61% for S4, 62% for S6, 56% for S7 and 54% for S8. Odds of parents never smoked at home in presence of children increased significantly from before to after the ban with odds ratios (OR) 1.17 (CI_95% 1.01-1.35), 1.65 (CI_95% 1.39-1.95), 2.85 (CI_95% 2.32-3.51), 2.24 (CI_95% 1.84-2.72) and 3.66 (CI_95% 2.89-4.63) for S2, S4, S6, S7 and S8, respectively with S1 as reference. Compared to S4, odds of parents who were not actively smoking is significantly higher in S7 (OR = 1.13 (CI_95% 1.03-1.24)) and S8 (OR = 1.24 (CI_95% 1.13-1.36)). The odds of mothers who never smoked during pregnancy increased over time with OR = 1.22 (CI_95% 1.06-1.40) for S2 and 1.57 (CI_95% 1.33-1.86) for S8 compared to S1. Adverse health effects related to children's exposure to SHS are significantly less in S8 compared to S1.

CONCLUSION

After 11 years of smoking ban in Bavaria, smoking displacement to homes was disproved. Exposure of children to SHS intrauterine and at home is decreasing. Number of parents who are not actively smoking is increasing over time. Prevalence of health problems in children related to exposure to SHS is decreasing.

Association between Self-Reported Survey Measures and Biomarkers of Second-Hand Tobacco Smoke Exposure in Non-Smoking Pregnant Women

Second-hand tobacco smoke (SHS) causes adverse health outcomes in adults. Further studies are needed to evaluate psychosocial SHS exposure measures in comparison to SHS exposure biomarkers, particularly in pregnant women. This study aimed to compare self-reported SHS exposure to urinary cotinine levels in pregnant women. A cross-sectional correlation design was conducted using a convenience sample of 70 non-smoking pregnant women. Measures included self-reported questionnaires and laboratory confirmation of cotinine levels in the urinary samples. Multiple regression analysis was used to assess the correlation after controlling for potential confounding variables. The average level of urinary cotinine among non-smoking pregnant women was 6.77 ng/mL. Medium-strength correlations were found among psychosocial SHS exposure measures and urine cotinine levels. Questions regarding ‘instances of smoking in front of the individual’ and ‘subjective perceived frequency of SHS exposure in past 7 days’ are feasible items for pregnant women in clinics (particularly the first question). Hence, we suggest that these simple questions should be used to assist pregnant women in reducing the harm associated with SHS exposure.

Development of a prenatal smoking cessation counseling scale for public health nurses in Japan

INTRODUCTION

This study aimed to develop a scale to measure prenatal smoking cessation counseling for Japanese public health nurses (PHNs).

METHODS

A cross-sectional study was conducted via an anonymous, self-administered questionnaire. The sample included 1933 PHNs working in 424 municipal health centers nationwide, which were randomly selected. We created the draft scale based on semi-structured interviews, previous studies, and preliminary survey. Additionally, we conducted back translation for English version of the draft scale to be applicable in English countries. The analytic strategy consisted of item analysis, exploratory factor analysis, and differentiation by 'known groups'.

RESULTS

A total of 550 responses (28.5%) were included in the analysis. Most of the respondents were female (98.2%) and the mean age was 37.5±9.37 years. In the exploratory factor analysis, two factors were extracted and the factor loadings for all items were greater than 0.40. The first factor with eleven items was named as 'basic counseling' and the second factor with seven items was named as 'advanced counseling'. The Cronbach's alpha of the scale was 0.918, and the cumulative contribution was 44.908%. Multiple comparisons by experience years working as a PHN revealed significant differences in the scale and two factors.

CONCLUSIONS

In this study, we initially developed the prenatal smoking cessation counseling scale for Japanese PHNs, and the reliability and validity of the scale were considered to be acceptable.

Brief Advice, Nicotine Replacement Therapy Sampling, and Active Referral for Expectant Fathers Who Smoke Cigarettes: A Randomized Clinical Trial

IMPORTANCE

Pregnancy presents an opportunity to engage expectant fathers in smoking cessation, but evidence from randomized clinical trials is scarce.

OBJECTIVE

To evaluate the effectiveness of a proactive, combined intervention for smoking cessation in expectant fathers.

DESIGN, SETTING, AND PARTICIPANTS

This pragmatic randomized clinical trial in prenatal clinics in 7 public hospitals in Hong Kong proactively recruited and enrolled 1053 participants from October 10, 2018, to February 8, 2020. Included male adults were 18 years or older, smoked cigarettes daily in the past 3 months, had partners who were pregnant and nonsmoking in the past 30 days, and had a landline or mobile telephone number for follow-up. These participants were randomized to either the intervention group or the control group. The primary analyses used an intention-to-treat approach.

INTERVENTIONS

The intervention group received brief cessation advice, a 1-week free sample of nicotine replacement therapy (NRT), and active referral to a community-based smoking cessation service. The control group received only brief cessation advice with a leaflet on the hazards of perinatal exposure to tobacco smoke and the toll-free quitline telephone number.

MAIN OUTCOMES AND MEASURES

The primary outcome was biochemically validated tobacco abstinence at 6 months after intervention initiation defined by an exhaled carbon monoxide level of 3 parts per million or lower. The secondary outcomes included self-reported 24-week continuous abstinence at 6 months after intervention initiation as well as 7-day point prevalence abstinence, use of any NRT, and use of a smoking cessation service at 3 and 6 months after intervention initiation.

RESULTS

All 1053 randomized participants were male adults with a mean (SD) age of 33.8 (6.9) years. The retention rate at 6-month follow-up was 80.7%. The primary outcome of biochemically validated tobacco abstinence at 6 months after intervention initiation was significantly higher in the intervention group than in the control group (6.8% [36 of 527 participants] vs 3.6% [19 of 526]; odds ratio [OR], 1.96; 95% CI, 1.11-3.46; P = .02). The main secondary outcomes of self-reported 24-week continuous abstinence at 6 months (OR, 1.87; 95% CI, 1.08-3.23; P = .03) and 7-day point prevalence abstinence at 3 months (OR, 1.48; 95% CI, 1.05-2.09; P = .03) and 6 months (OR, 1.74; 95% CI, 1.29-2.34; P < .001) were also significantly higher in the intervention group. The intervention group had a significantly higher increase in perceived family harmony (score range, 0-10, with a higher score indicating a higher level of harmony) from baseline to 6 months (B = 0.28; 95% CI, 0.063-0.50; P = .01).

CONCLUSIONS AND RELEVANCE

This trial found that combining brief advice with a 1-week sample of NRT and referral to smoking cessation programs nearly doubled the odds that expectant fathers who smoked would achieve validated abstinence compared with providing brief advice alone. The intervention was also effective in promoting family harmony.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03671707.

Maternal tobacco exposure and health-related quality of life during pregnancy: a national-based study of pregnant women in China

BACKGROUND

With the increase of the number of smokers, tobacco exposure among pregnant women is becoming more and more common. Pregnant women exposed to first-hand smoke and second-hand smoke are susceptible to physiological and psychological health issues has been proved in previous studies. Nevertheless, there are no enough studies focus on the impact of third-hand smoke during pregnancy. This study aimed to assess and compare health-related quality of life for pregnant women with exposure to first-hand smoke, second-hand smoke, third-hand smoke and non-exposure to tobacco in mainland China.

METHODS

National-based cross-sectional study is based on a questionnaire survey which collects information including demographics, smoking behaviors and self-evaluation. All questionnaires were delivered and collected from August to September 2019. EuroQol group's visual analog scale and EuroQoL Five-dimension Questionnaire were used to collect data in mainland China.

RESULTS

Totally, 15,682 pregnant women were included in this study, among which non-exposure to smoke were 7564 (48.2%), exposed to first-hand smoke, second-hand smoke and third-hand smoke were 89 (0.6%), 2349 (15.0%), and 5680 (36.2%) respectively. Pregnant women without tobacco exposure had the highest EuroQol group's visual analog scale score (mean value = 85.4[SD = 14.0]), while those with first-hand smoke had the lowest score (mean value = 77.4[SD = 22.2]). Among all five dimensions of EuroQoL Five-dimension Questionnaire, there were significant differences of EQ-index among groups with different tobacco exposure in usual activity and anxiety or depression dimensions (p < 0.001).

CONCLUSIONS

Third-hand smoke exposure had close relationship with low health-related quality of life in pregnant women. Moreover, second-hand smoke exposure significantly led more problems on mental dimension of pregnant women.

Active and Passive Exposure to Tobacco and e-Cigarettes During Pregnancy

OBJECTIVES

Active and passive exposure to tobacco cigarettes during pregnancy is associated with multiple negative health outcomes for the fetus. In addition, exposure to e-cigarettes has been progressively discussed as a new threat to fetal health. Until now, there has been a lack of studies examining active and passive exposure to tobacco and e-cigarettes among pregnant women. The objective of our current STudy on E-cigarettes and Pregnancy (STEP) was to advance and complement the current knowledge regarding active and passive exposure to tobacco and e-cigarettes before pregnancy and during early and late pregnancy.

METHODS

One element of the STEP study was a quantitative cross-sectional design: A sample of 540 pregnant women recruited at an obstetrician clinic in Hamburg from April 2018 to January 2019 were surveyed once via a standardized questionnaire and provided complete information regarding their consumption of tobacco and e-cigarettes. We performed a descriptive analysis of tobacco and e-cigarette use before pregnancy and during early and late pregnancy, as well as bivariate analysis of these variables with sociodemographic determinants. Passive exposure was assessed by asking the participating pregnant women about the consumption of tobacco and e-cigarettes by their partners, in general, and in their homes.

RESULTS

Before pregnancy, 20.0% of the participants used tobacco cigarettes exclusively, 1.3% used e-cigarettes exclusively, and 6.5% were dual users. Educational level was significantly associated with tobacco cigarette use (p < 0.001) and dual use (p = 0.047) before pregnancy. During early (late) pregnancy, 8.7% (2.8%) used tobacco cigarettes and 0.4% (0.0%) used e-cigarettes exclusively. Twenty-point nine percent of women's partners consumed tobacco cigarettes exclusively, 2.7% consumed e-cigarettes exclusively, and 2.7% consumed both. A total of 8.5% (16.7%) of the partners who consumed tobacco cigarettes exclusively (e-cigarettes exclusively) did so in the women's homes.

CONCLUSIONS FOR PRACTICE

Among pregnant women, the use of tobacco cigarettes remains prominent before and during pregnancy, while e-cigarette use predominately occurs before pregnancy. Our study shows that pregnant women are frequently exposed to their partners' tobacco and e-cigarette use within their homes. Strategies to reduce such exposure should be further intensified.

A behaviour change intervention to reduce home exposure to second hand smoke during pregnancy in India and Bangladesh: a theory and evidence-based approach to development

BACKGROUND

Home exposure to secondhand smoke (SHS) is highly prevalent amongst pregnant women in low- and middle-income countries like India and Bangladesh. The literature on the efficacy of behaviour change interventions to reduce home exposure to SHS in pregnancy is scarce.

METHODS

We employed a theory and evidence-based approach to develop an intervention using pregnant women as agents of change for their husband's smoking behaviours at home. A systematic review of SHS behaviour change interventions led us to focus on developing a multicomponent intervention and informed selection of behaviour change techniques (BCTs) for review in a modified Delphi survey. The modified Delphi survey provided expert consensus on the most effective BCTs in reducing home exposure to SHS. Finally, a qualitative interview study provided context and detailed understanding of knowledge, attitudes and practices around SHS. This insight informed the content and delivery of the proposed intervention components.

RESULTS

The final intervention consisted of four components: a report on saliva cotinine levels of the pregnant woman, a picture booklet containing information about SHS and its impact on health as well strategies to negotiate a smoke-free home, a letter from the future baby to their father encouraging him to provide a smoke-free home, and automated voice reminder and motivational messages delivered to husbands on their mobile phone. Intervention delivery was in a single face-to-face session with a research assistant who explained the cotinine report, discussed key strategies for ensuring a smoke-free environment at home and practised with pregnant women how they would share the booklet and letter with their husband and supportive family members.

CONCLUSION

A theory and evidence-based approach informed the development of a multicomponent behaviour change intervention, described here. The acceptability and feasibility of the intervention which was subsequently tested in a pilot RCT in India and Bangladesh will be published later.

A single-center, prospective, observational study on maternal smoking during pregnancy in Greece: The HELENA study

INTRODUCTION

The unequivocal association between exposure to smoke and numerous complications of pregnancy, demonstrated in the last decades, has led to a significant decrease of smoking rates in pregnancy. The aim of the present study was to determine the prevalence of maternal smoking and to elucidate factors predisposing to it among pregnant women in Athens, Greece.

METHODS

A population of 1700 pregnant women (mean age: 31.2±5.5 years) who visited consecutively the Cardiology Department of Helena Venizelou Maternity Hospital in Athens, Greece, between September 2016 and August 2017, was prospectively analyzed. Data regarding changes in the future mother’s smoking habit as well as different sociodemographic factors potentially related to these changes were recorded.

RESULTS

Of the 1700 participants, 704 (41.4%) were smokers, and of those 52.4% quit smoking after knowledge of their pregnancy status. The overall prevalence of smoking in pregnancy was 19.7%. Prevalence was higher in women who were aged <20 years (p=0.038), were multipara (p=0.032), had ≤12 years of education (p=0.044) and had a partner who was a smoker (p=0.047). Women aged ≤20 years were more likely to be persistent smokers at the beginning of pregnancy and demonstrated a higher prevalence of smoking during pregnancy (42.2% vs 19.7% in the overall study population).

CONCLUSIONS

Our data demonstrate that maternal smoking during pregnancy still remains a major public health issue in Greece with a prevalence higher than most other industrialized countries.

Novel risk factors for craniofacial microsomia and assessment of their utility in clinic diagnosis

Craniofacial microsomia (CFM, OMIM%164 210) is one of the most common congenital facial abnormalities worldwide, but it's genetic risk factors and environmental threats are poorly investigated, as well as their interaction, making the diagnosis and prenatal screening of CFM impossible. We perform a comprehensive association study on the largest CFM cohort of 6074 samples. We identify 15 significant (P < 5 × 10-8) associated genomic loci (including eight previously reported) and decipher 107 candidates based on multi-omics data. Gene Ontology term enrichment found that these candidates are mainly enriched in neural crest cell (NCC) development and hypoxic environment. Single-cell RNA-seq data of mouse embryo demonstrate that nine of them show dramatic expression change during early cranial NCC development whose dysplasia is involved in pathogeny of CFM. Furthermore, we construct a well-performed CFM risk-predicting model based on polygenic risk score (PRS) method and estimate seven environmental risk factors that interacting with PRS. Single-nucleotide polymorphism-based PRS is significantly associated with CFM [P = 7.22 × 10-58, odds ratio = 3.15, 95% confidence interval (CI) 2.74-3.63], and the top fifth percentile has a 6.8-fold CFM risk comparing with the 10th percentile. Father's smoking increases CFM risk as evidenced by interaction parameter of -0.324 (95% CI -0.578 to -0.070, P = 0.011) with PRS. In conclusion, the newly identified risk loci will significantly improve our understandings of genetics contribution to CFM. The risk prediction model is promising for CFM prediction, and father's smoking is a key environmental risk factor for CFM through interacting with genetic factors.

Low gestational vitamin D level and childhood asthma are related to impaired lung function in high-risk children

BACKGROUND

Lung function impairment in early life often persists into adulthood. Therefore, identifying risk factors for low childhood lung function is crucial.

OBJECTIVE

We examined the effect of 25-hydroxyvitamin D (25[OH]D) level and childhood asthma phenotype on childhood lung function in the Vitamin D Antenatal Asthma Reduction Trial (VDAART).

METHODS

The 25(OH)D level was measured at set time points in mothers during pregnancy and in children during early life. On the basis of parental reports, children were categorized into 3 clinical phenotypes: asymptomatic/infrequent wheeze, early transient wheeze, and asthma at age 6 years. Lung function was assessed with impulse oscillometry at ages 4, 5, and 6 years and with spirometry at ages 5 and 6 years.

RESULTS

A total of 570 mother-child pairs were included in this post hoc analysis. Mean gestational 25(OH)D-level quartiles were negatively associated with child respiratory resistance at 5 Hz (R5) from age 4 to 6 years (β, -0.021 kPa/L/s; 95% CI, -0.035 to -0.007; P = .003) and positively associated with FEV₁ (β, 0.018 L; 95% CI, 0.005-0.031; P = .008) and forced vital capacity (β, 0.022 L; 95% CI, 0.009-0.036; P = .002) from age 5 to 6 years. Children with asthma at age 6 years had lower lung function from age 4 to 6 years than the asymptomatic/infrequent wheeze group (β, 0.065 kPa/L/s; 95% CI, 0.028 to 0.102; P < .001 for R5 and β, -0.063 L; 95% CI, -0.099 to -0.028; P < .001 for FEV₁).

CONCLUSIONS

Low gestational 25(OH)D level and childhood asthma are important risk factors for decreased lung function in early childhood.

The association between maternal exposure to secondhand smoke during pregnancy and their children's cerebral palsy, Shandong, China

INTRODUCTION

Tobacco use poses a threat to the health of pregnant women and their children. Our study assessed the association between maternal exposure to secondhand smoke (SHS) during pregnancy and children's cerebral palsy (CP) in Shandong, China.

METHODS

In our observational study, 5067 mother-child pairs were included from Shandong Province, China. Mothers filled in questionnaires about exposure to SHS during pregnancy. Statistical analysis and logistic regression models were built in R program to estimate the association in adjusted odds ratio (AOR) between SHS exposure during pregnancy and risk of children's CP, after adjustment for potential confounders including delivery mode and baby's birthweight.

RESULTS

Exposure to SHS was noted among 3663 (72.3%) of the 5067 non-smoking mothers during their pregnancy. Of the 239 CP children within the study, 192 (80.3%) were exposed to SHS during pregnancy. Children born to mothers exposed to SHS during pregnancy had a higher risk of CP (AOR=1.44; 95% CI: 1.02-2.04) than those born to non-exposed mothers, the risk increased by exposure time in the logistic regression model. The association between SHS exposure during pregnancy and CP children remained significant when adjusting for delivery mode and infant's birthweight due to their significant association with CP, with an AOR of 1.46 (95% CI: 1.13-1.91) for 1-4 days/week and 1.63 (95% CI: 1.22-2.01) for 5-7 days/week exposure to SHS.

CONCLUSIONS

Our study suggests that maternal exposure to secondhand smoke during pregnancy is associated with children's CP. Future preventive interventions of CP should include strategies that target the antenatal women who are exposed to SHS.

Effects of past environmental tobacco smoke exposure on the menstrual cycle and menstrual phase-related symptoms: A cross-sectional study

AIM

This study examined the effects of current and past environmental tobacco smoke exposure on the menstrual cycle and menstrual phase-related symptoms in nonsmoking Japanese women of child-bearing age.

METHODS

Of 5000 women who agreed to participate, 3935 were analyzed (932 smokers, 2326 nonsmokers, and 677 past smokers). Nonsmokers were divided into three groups based on smoking status and environmental tobacco smoke exposure: nonsmokers without exposure (n = 352), nonsmokers with past exposure (n = 1196) and nonsmokers with current exposure (n = 778). Participants completed a questionnaire on background characteristics, environmental tobacco smoke exposure (location and relationship to smokers), abnormal menstrual cycle, days of menstrual cycle and menstrual cycle-related symptoms experienced in the past 3 months (assessed by the Menstrual Distress Questionnaire).

RESULTS

Mean age was 29.7 ± 7.0 (20-44) years. Compared with nonsmokers without environmental tobacco smoke exposure, current smokers had the highest risk of an abnormal menstrual cycle (adjusted odds ratio [OR], 1.74 [1.194-2.545]), followed by nonsmokers with past exposure (adjusted OR, 1.70 [1.171-2.464]), past smokers (adjusted OR, 1.60 [1.081-2.366]) and nonsmokers with current environmental tobacco smoke exposure (adjusted OR, 1.49 [0.901-1.212]). Irrespective of environmental tobacco smoke exposure, current smokers reported significantly more severe premenstrual and menstrual symptoms than nonsmokers, and nonsmokers with past environmental tobacco smoke exposure had significantly more severe premenstrual and menstrual symptoms than nonsmokers without environmental tobacco smoke exposure.

CONCLUSION

Past environmental tobacco smoke exposure, especially during childhood or adolescence, might harm women's reproductive health when they reach reproductive age.

Prediction of stillbirth: an umbrella review of evaluation of prognostic variables

BACKGROUND

Stillbirth accounts for over 2 million deaths a year worldwide and rates remains stubbornly high. Multivariable prediction models may be key to individualised monitoring, intervention or early birth in pregnancy to prevent stillbirth.

OBJECTIVES

To collate and evaluate systematic reviews of factors associated with stillbirth in order to identify variables relevant to prediction model development.

SEARCH STRATEGY

MEDLINE, Embase, DARE and Cochrane Library databases and reference lists were searched up to November 2019.

SELECTION CRITERIA

We included systematic reviews of association of individual variables with stillbirth without language restriction.

DATA COLLECTION AND ANALYSIS

Abstract screening and data extraction were conducted in duplicate. Methodological quality was assessed using AMSTAR and QUIPS criteria. The evidence supporting association with each variable was graded.

RESULTS

The search identified 1198 citations. Sixty-nine systematic reviews reporting 64 variables were included. The most frequently reported were maternal age (n = 5), body mass index (n = 6) and maternal diabetes (n = 5). Uterine artery Doppler appeared to have the best performance of any single test for stillbirth. The strongest evidence of association was for nulliparity and pre-existing hypertension.

CONCLUSION

We have identified variables relevant to the development of prediction models for stillbirth. Age, parity and prior adverse pregnancy outcomes had a more convincing association than the best performing tests, which were PAPP-A, PlGF and UtAD. The evidence was limited by high heterogeneity and lack of data on intervention bias.

TWEETABLE ABSTRACT

Review shows key predictors for use in developing models predicting stillbirth include age, prior pregnancy outcome and PAPP-A, PLGF and Uterine artery Doppler.

Low birthweight of children is positively associated with mother's prenatal tobacco smoke exposure in Shanghai: a cross-sectional study

INTRODUCTION

Low birthweight (LBW) is a significant public health issue, and maternal smoking is the most prevalent preventable cause of LBW. But there is limited evidence on association of LBW among children and cigarette smoke exposure in mothers in China. In this cross-sectional study, we try to explore if the LBW in children is positively associated with mothers' prenatal cigarette smoke exposure.

METHODS

We selected 8, 586 mothers and their singleton children in 2018 in Songjiang district, Shanghai. Birthweight of children and gestational weeks of mother was identified by birth records in the hospital, we classified mothers' prenatal cigarette smoke status into the first-hand smoke (FHS) exposure and the second-hand smoke (SHS) exposure. We use SAS 9.1.3 software to calculate the prevalence of children's LBW and the prevalence of mothers' prenatal cigarette smoke exposure including FHS and SHS. Chi-square test and logistic regression were used to analyze the difference.

RESULTS

In 8, 586 women, The prenatal FHS and SHS exposure prevalence was 0.9 and 20.8%, respectively. The mean birthweight of children was 3315.5 g with a standard deviation of 497.2 g, the mean birthweight was 167.7 g and 66.1 g lower in children born to mothers with prenatally FHS and SHS exposure compared with those children whose mother were not exposed, respectively. The children's LBW prevalence was 4.7% in this study. By comparing with children whose mother were not exposed, the LBW prevalence was higher among children whose mother were prenatally exposed to FHS [OR (Odds Ratios) = 2.91, 95% confidence interval (CI) (1.49, 5.68)], and SHS [OR = 2.35, 95% CI (1.90, 2.89)].

CONCLUSIONS

Children's LBW is positively associated with mothers' prenatal tobacco smoke exposure both for FHS and SHS. So implementing tobacco control measures is crucial to lower smoking prevalence among women, and decrease smoking prevalence of their family members as well as work fellows.

Social predictors of continued and indoor smoking among partners of non-smoking pregnant women: the TMM BirThree Cohort Study

BACKGROUND

Secondhand smoke (SHS) from partners is a major source of exposure for non-smoking women. However, epidemiological studies have rarely examined social factors associated with continued and indoor smoking among pregnant women's partners.

METHODS

We analyzed data on 6091 partners of non-smoking pregnant women in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Partners' age, education, income, workplace SHS exposure (almost never or sometimes, almost every day), and pregnant women's smoking history (never, quit before pregnancy awareness, quit after pregnancy awareness) were used as social factors. Multivariate logistic regression analyses were conducted to examine the associations of social factors with partners' continued smoking and indoor smoking.

RESULTS

Among 2432 smoking partners, 2237 continued to smoke after pregnancy awareness. Workplace SHS exposure was associated with increased risk of partners' continued smoking: the odds ratio of workplace SHS exposure almost every day compared with almost never or sometimes was 2.08 (95% confidence interval, 1.52-2.83). Women's quitting smoking after-but not before-pregnancy awareness was associated with decreased risk of partners' continued smoking: the odds ratio of women's quitting after pregnancy awareness compared with never smoking was 0.57 (95% confidence interval, 0.40-0.80). About one-third of partners who continued to smoke did so indoors. Older age, lower education, workplace SHS exposure, and women's quitting smoking after pregnancy awareness were associated with increased risk of partners' indoor smoking.

CONCLUSIONS

Workplace SHS exposure and pregnant women's smoking history were associated with continued smoking and indoor smoking among partners of non-smoking pregnant women.

Factors Associated with Prenatal Smoking Cessation Interventions among Public Health Nurses in Japan

This study aimed to identify the factors associated with prenatal smoking cessation interventions based on the 5As model among public health nurses (PHNs) in Japan. A nationwide cross-sectional study was conducted from December 2019 to February 2020 via a self-administered questionnaire. The study subjects were 1988 PHNs working in 431 health centers of municipalities and special wards across the country. Of the 1988 questionnaires mailed, 521 responses (26.2%) were included in the analysis. Of the 521 responses, most of the respondents were female (98.1%) and the mean age was 37.5 years. There were statistically significant differences on age, work regions, experience years working as a PHN and smoking cessation training after becoming a PHN in implementing the 5As. Self-efficacy, professional development competency, research utilization competency, age and experience years working as a PHN were positively associated with the 5As. Social nicotine dependence was negatively associated with the 5As. Furthermore, self-efficacy mediated the relationship between the 5As and professional development competency, research utilization competency, social nicotine dependence, age and experience years working as a PHN. In the future, smoking cessation intervention training should be widely implemented to improve self-efficacy and prenatal smoking cessation interventions among Japanese PHNs.

[Passive Smoking and Pregnancy - CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy]

OBJECTIVE

The objective of this chapter is to evaluate the risks of second-hand-smoke during pregnancy and to assess the benefits of antenatal care.

METHODS

Bibliographical research in French and English using the Medline and Cochrane databases and the recommendations of international societies.

RESULTS

Exposure to second-hand smoke appears to be higher at home and in the car, with potential consequences for pregnancy, especially prematurity (NP3). Complete avoidance of smoking at home significantly reduces exposure to passive smoking compared to incomplete avoidance (NP4). The more numerous the sources, the higher the intoxication is (NP4). The major risk factor associated with passive smoking is the presence of a spouse who smokes. Other associated factors are the presence of a smoker at home or in the car, young population (<25 years), low level of education, old smoking (NP4). Passive smoking is associated with an increased risk of fetal death in utero, fetal malformations, prematurity and birth weight under 2500g (NP2). No specific management is recommended for all pregnant women. Nevertheless, in a specific population of pregnant women with vulnerabilities, a behavioral approach aimed at teaching them to negotiate with their entourage may be beneficial in order to reduce the effects of passive smoking on pregnancy (NP2).

CONCLUSION

It is recommended to advise women and their family (especially spouses) to create a smoke-free environment, especially at home and in the car (professional consensus). It is recommended to provide a minimum amount of smoking cessation advice to pregnant women's entourage (professional consensus).

Brief cessation advice, nicotine replacement therapy sampling and active referral (BANSAR) for smoking expectant fathers: Study protocol for a multicentre, pragmatic randomised controlled trial

BACKGROUND

Pregnancy presents a teachable moment to engage male smokers whose partners are pregnant in smoking cessation. Evidence on how to approach and help these smokers quit smoking in antenatal settings has remained scarce. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a brief intervention model for promoting smoking cessation in expectant fathers.

METHODS

BANSAR is a pragmatic randomised controlled trial conducted in antenatal clinic in seven public hospitals in Hong Kong, China. An estimated 1148 fathers who smoke at least one cigarette daily and whose partners are pregnant and non-smoking will be randomised (1:1) to receive brief advice combined with 1-week sample of nicotine replacement therapy (NRT) and active referral to smoking cessation services, or brief advice only (usual care). Outcome will be assessed at 3 and 6 months after treatment initiation. The primary outcome is carbon monoxide-verified (<4 part per million) abstinence at 6 months post-treatment initiation. Secondary outcomes include self-reported 7-day point-prevalence abstinence and 24-week continuous abstinence, use of smoking cessation service and NRT and quit attempt, and smoking reduction, change in nicotine dependence and intention to quit in continuing smokers.

COMMENT

This trial will provide real-world evidence on the effectiveness of a combined brief intervention model for smoking cessation in expectant fathers, an understudied population. The findings may be particularly relevant to low and middle-income countries, where male-to-female smoking ratios and birth rates tend to be higher than higher-income countries.

TRIAL REGISTRATION

ClinicalTrials.gov, number NCT03671707.

Reducing Secondhand Smoke Exposure Among Nonsmoking Pregnant Women: A Systematic Review

Introduction

Exposure to secondhand smoke (SHS) in pregnancy leads to an increased risk of stillbirths, congenital malformations, and low birth weight. There is a lack of evidence about how best to achieve reductions in SHS exposure among nonsmoking pregnant women. This work systematically reviews individual or household interventions to reduce pregnant women’s exposure to SHS.

Methods

MEDLINE, EMBASE, and CINAHL databases were searched from their dates of inception to April 17, 2019. Studies were included if: participants were nonsmoking pregnant women; involved an intervention to reduce SHS exposure or encourage partner quitting; and measured SHS exposure of pregnant women and/or recorded quit rates among partners. The UK National Institute for Health & Care Excellence (NICE) Quality Appraisal checklist was used to determine internal and external validity.

Results

Nine studies met the inclusion criteria. Educational interventions were primarily targeted at the pregnant woman to change her or others’ behavior, with only two studies involving the partner who smoked. Intervention delivery was mixed, spanning brief discussions through to more involving sessions with role play. The effective interventions involved multiple follow-ups. There was no standardized method of assessing exposure to SHS. Many of the included studies had moderate to high risk of bias.

Conclusion

There is mixed evidence for interventions aimed at reducing pregnant women’s exposure to SHS, though multi-component interventions seem to be more effective. The effectiveness of family-centered approaches involving creating smoke-free homes alongside partner smoking cessation, perhaps involving pharmacological support and/or financial incentives, should be explored.

Implications

• Measures to protect nonsmoking pregnant women from SHS tend to place the responsibility for “avoidance” on the woman.

• There is little work that seeks to involve the smoking partner or other smokers in protecting pregnant women from SHS.

• Interventions to create smoke-free homes and/or smoking partner cessation need to be developed: pharmacological and financial support should be explored.

Mothers' prenatal tobacco smoke exposure is positively associated with the occurrence of developmental coordination disorder among children aged 3-6 years: A cross-sectional study in a rural area of Shanghai, China

INTRODUCTION

Prenatal tobacco smoke exposure is a potential risk factor for developmental coordination disorder (DCD) in children, but evidence on the relationship between DCD in children and tobacco smoke exposure in women is limited in China. We conducted a cross-sectional study to understand the prevalence of prenatal tobacco smoke exposure among mothers and the prevalence of DCD among children and to explore if mothers’ prenatal tobacco smoke exposure is positively associated with the occurrence of DCD among children.

METHODS

During 2018, we sampled 8586 children aged 3–6 years and their mothers in Songjiang district, Shanghai. DCD in children was identified by MABC-2 screening combined with pediatrician confirmation. Prenatal tobacco smoke exposure among mothers was classified into firsthand smoke (FHS) and secondhand smoke (SHS) exposure. SAS 9.2 software was applied to calculate the prevalence of DCD in children, the prevalence of prenatal FHS and SHS exposure in mothers and to analyze the differences by chi-squared test and logistic regression.

RESULTS

Among the 8586 women, the prevalence of prenatal FHS and SHS exposure was 0.94% and 20.79%, respectively. The prevalence of DCD in children was 6.65%, which was significantly higher in boys (7.64%) than in girls (5.51%), and children aged 3 years (9.77%) had a higher prevalence of DCD than children aged 4, 5 or 6 years (7.44%, 5.27% and 4.28%, respectively). In comparison with children whose mother was not exposed to prenatal FHS or SHS, the odds of having DCD was higher in children whose mother was exposed to prenatal FHS (OR=4.42; 95% CI: 2.62–7.44) and SHS (OR=1.77; 95% CI: 1.47–2.14), even after adjustment for potential confounders.

CONCLUSIONS

The occurrence of DCD among children is positively associated with prenatal tobacco smoke exposure among the mothers. It is crucial to implement tobacco control measures to decrease the prevalence of smoking among pregnant women and SHS exposure at home as well as in the work environment.

ABBREVIATIONS

DCD: developmental coordination disorder, ADHD: attention deficit hyperactivity disorder, FHS: firsthand smoke, SHS: secondhand smoke, MABC-2: movement assessment battery for children-2nd edition, GATS: global adult tobacco survey, SD: standard deviation, OR: odds ratio, CI: confidence interval, DAGs: directed acyclic graphs.

Exposure to Wood Smoke and Associated Health Effects in Sub-Saharan Africa: A Systematic Review

Background

Observational studies suggest that exposure to wood smoke is associated with a variety of adverse health effects in humans.

Objective

We aimed to summarise evidence from sub-Saharan Africa on levels of exposure to pollutants in wood smoke and the association between such exposures and adverse health outcomes.

Methods

PubMed and Google scholar databases were searched for original articles reporting personal exposure levels to pollutants or health outcomes associated with wood smoke exposure in Sub-Saharan African population.

Results

Mean personal PM_2.5 and carbon monoxide levels in the studies ranged from 26.3 ± 1.48 μg/m³ to 1574 ± 287μg/m³ and from 0.64 ± 2.12 ppm to 22 ± 2.4 ppm, respectively. All the reported personal PM_2.5 exposure levels were higher than the World Health Organization's Air Quality Guideline (AQG) for 24-hour mean exposure. Use of wood fuels in domestic cooking is the major source of wood smoke exposure in this population. Occupational exposure to wood smoke included the use of wood fuels in bakery, fish drying, cassava processing and charcoal production. Females were exposed to higher levels of these pollutants than males of the same age range. Major determinants for higher exposure to wood smoke in SSA included use of unprocessed firewood, female gender and occupational exposure. We recorded strong and consistent associations between exposure to wood smoke and respiratory diseases including acute respiratory illness and impaired lung function. Positive associations were reported for increased blood pressure, low birth weight, oesophageal cancer, sick building syndrome, non-syndromic cleft lip and/or cleft palate and under-five mortality.

Conclusion

There is high level of exposure to wood smoke in SSA and this exposure is associated with a number of adverse health effects. There is urgent need for aggressive programs to reduce wood smoke exposure in this population.

Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting

The aim of this review of reviews was to collate the latest evidence from systematic reviews about the maternal and child health outcomes of being exposed to tobacco and nicotine during pregnancy; the effectiveness of interventions designed to reduce these exposures, and barriers to and facilitators of smoking cessation during pregnancy. Two databases were searched to obtain systematic reviews published from 2010 to 2019. Pertinent data from 76 articles were summarized using a narrative synthesis (PROSPERO reference: CRD42018085896). Exposure to smoke or tobacco in other forms during pregnancy is associated with an increased risk of obstetric complications and adverse health outcomes for children exposed in-utero. Counselling interventions are modestly effective, while incentive-based interventions appear to substantially increase smoking cessation. Nicotine replacement therapy is effective during pregnancy but the evidence is not conclusive. Predictors and barriers to smoking cessation in pregnancy are also discussed. Smoking during pregnancy poses substantial risk to mother's and child's health. Psychosocial interventions and nicotine replacement therapy (NRT) appear to be effective in helping pregnant women quit smoking. Barriers to smoking cessation must be identified and steps taken to eradicate them in order to reduce smoking among pregnant women. More research is needed on smoking cessation medications and e-cigarettes.

The association between secondhand smoke exposure and growth outcomes of children: A systematic literature review

INTRODUCTION

The strong relation between maternal smoking and maternal secondhand smoke (SHS) exposure and the growth of newborn infants has been proven. However, the effect of SHS on growth outcomes of older children is not well defined. Through a systematic literature review, we sought to determine whether a relationship exists between SHS exposure and growth outcomes of children up to 8 years of age.

METHODS

A systematic review was performed, including articles published between 2004–2019, related to SHS exposure (prenatal and postnatal) and children’s growth (weight, length/height, and head circumference). The relevant articles were identified from Science Direct, ProQuest, Sage Publication, Scopus, Wiley Online Library, CINAHL Plus with Full Text (via EBSCOhost) and Google search.

RESULTS

Seventeen articles were identified, of which three categories of growth measurements were extracted, comprising weight (weight, WAZ, WHZ, and BMI), height (height/length and HAZ) and head circumference. SHS exposure both pre or postnatally was inversely associated with weight (deficit in weight, risk of underweight, risk of wasting) and height (lower length and risk of stunting) and elevated BMI of children. Furthermore, prenatal SHS exposure was associated with a lower head circumference.

CONCLUSIONS

The current review identified that exposure to SHS may be associated with adverse growth outcomes in children. It is crucial that active smokers, specifically those who live with children or with a pregnant partner, are made aware of the potential effects of SHS exposure on non-smokers. Further assessment of the association between exposure to SHS and other growth outcomes in other age groups is needed.