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Sun J, Liu X, Zhao M, Magnussen CG, Xi B. Dose-response association between maternal smoking during pregnancy and the risk of infant death: a nationwide, population-based, retrospective cohort study. EClinicalMedicine 2023; 57:101858. [PMID: 36879656 PMCID: PMC9984774 DOI: 10.1016/j.eclinm.2023.101858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 02/27/2023] Open
Abstract
Background Association of timing and intensity of maternal smoking during pregnancy with all-cause and cause-specific infant death remains inconclusive. We aimed to examine the dose-response association of maternal smoking during each of the three trimesters of pregnancy with all-cause and cause-specific infant death. Methods In this nationwide, population-based, retrospective cohort study, data were extracted from the U.S. National Vital Statistics System, 2015-2019. We included mother-infant pairs after excluding twin or multiple births, newborns with gestation age <37 weeks and those with low birthweight, mothers aged <18 years or ≥50 years, mothers with pre-existing hypertension or diabetes, and those with missing values for variables of interest. Poisson regression models were used to examine the association of different intensities and doses of maternal smoking during each of the three trimesters of pregnancy with all-cause and cause-specific infant death attributed to congenital anomalies, preterm birth, other perinatal conditions, sudden unexpected infant death, and infection. Findings A total of 13,524,204 mother-infant pairs were included in our analyses. Maternal smoking during the entire pregnancy was associated with infant all-cause death (relative risk [RR] 1.88, 95% confidence interval [95% CI] 1.79-1.97), cause-specific death due to preterm birth (1.57, 1.25-1.98), perinatal conditions excluding preterm birth (1.35, 1.10-1.65), sudden unexpected infant death (2.56, 2.40-2.73), and infection (1.51, 1.20-1.88). The risk of infant all-cause death (RR values from 1.80 to 2.15) and cause-specific infant death by preterm birth (RR values from 1.42 to 1.74), perinatal conditions excluding preterm birth (RR values from 1.46 to 1.53), sudden unexpected infant death (RR values from 2.37 to 3.04), and infection (RR values from 1.48 to 2.69) increased with the intensity of maternal cigarette use during the entire pregnancy from 1-5 to ≥11 cigarettes. Compared with mothers who smoked during their entire pregnancy, those who smoked in the first trimester and then quit smoking in the second or third trimesters of pregnancy had a reduced risk of infant all-cause death (0.71, 0.65-0.78) and sudden unexpected infant death (0.64, 0.57-0.72). Interpretation There was a dose-response association of maternal cigarette use during each of the three trimesters of pregnancy with all-cause and cause-specific infant death. In addition, mothers who are smokers in the first trimester and then quit smoking in the subsequent two trimesters are at decreased risk of infant all-cause mortality and sudden unexpected infant death compared with those who smoked during the entire pregnancy. These findings suggest that there is no safe level of maternal smoking in any trimester of pregnancy and maternal smokers should stop smoking during pregnancy to improve the survival of infants. Funding Youth Team of Humanistic and Social Science and the Innovation Team of the "Climbing" Program of Shandong University (20820IFYT1902).
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Affiliation(s)
- Jiahong Sun
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xue Liu
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Costan G. Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Choi SKY, Tran DT, Kemp-Casey A, Preen DB, Randall D, Einarsdottir K, Jorm LR, Havard A. The Comparative Effectiveness of Varenicline and Nicotine Patches for Smoking Abstinence During Pregnancy: Evidence From a Population-based Cohort Study. Nicotine Tob Res 2021; 23:1664-1672. [PMID: 34398235 DOI: 10.1093/ntr/ntab063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/05/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In the general population, varenicline is consistently shown to be more efficacious for smoking cessation than nicotine replacement therapy (NRT). Current clinical guidelines for the management of smoking during pregnancy recommend against the use of varenicline, whilst supporting the use of NRT. However, little is known about the comparative effectiveness of these smoking cessation therapies among pregnant women. AIMS AND METHODS Routinely-collected records of all births in two Australian States during 2011 and 2012 were used to create a population-based cohort of women who smoked during the first half of pregnancy. Pharmaceutical dispensing data were used to identify varenicline and nicotine patch dispensings in the first half of pregnancy. Propensity score matching was used to account for the potentially different distribution of confounding factors between the treatment groups. The outcome was defined as smoking abstinence during the second half of pregnancy. RESULTS After propensity score-matching, our cohort comprised 60 women who used varenicline and 60 who used nicotine patches during the first half of pregnancy. More varenicline users (33.3%, 95% CI: 21.7%-46.7%) quit smoking than nicotine patch users (13.3%, 95% CI: 5.9%-24.6%). The adjusted rate difference was 24.2% (95% CI: 10.2%-38.2%) and the adjusted relative risk was 2.8 (95% CI: 1.4-5.7). CONCLUSIONS Varenicline was almost three times more effective than nicotine patches in assisting pregnant women to quit smoking. Further studies are needed to corroborate our results. Together with data on the safety of varenicline during pregnancy, evidence regarding the relative benefit of varenicline and NRT during pregnancy important for informing clinical decisions for pregnant smokers. IMPLICATIONS This study is the first to measure the comparative effectiveness of varenicline and nicotine patches during pregnancy - women using varenicline were almost three times as likely to quit smoking than those using nicotine patches. This study addressed a clinically important question using an observational study, noting that there is an absence of evidence from randomized controlled trials because of the ethical issues associated with including pregnant women in clinical trials of medicines of unknown safety.
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Affiliation(s)
- Stephanie K Y Choi
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Duong T Tran
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Anna Kemp-Casey
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Deborah Randall
- Northern Clinical School, Women and Babies Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kristjana Einarsdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Louisa R Jorm
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Komiyama M, Takahashi Y, Tateno H, Mori M, Nagayoshi N, Yonehara H, Nakasa N, Haruki Y, Hasegawa K. Support for Patients Who Have Difficulty Quitting Smoking: A Review. Intern Med 2019; 58:317-320. [PMID: 30210111 PMCID: PMC6395133 DOI: 10.2169/internalmedicine.1111-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Smoking cessation plays a crucial role in reducing preventable morbidity and mortality. However, some smokers find smoking cessation difficult, despite receiving treatment. This includes heavy smokers with chronic obstructive pulmonary disease, smokers with a psychiatric disorder, and female and underage smokers. This review article describes smoking cessation approaches for patients who find it difficult to quit smoking.
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Affiliation(s)
- Maki Komiyama
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Yuko Takahashi
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Hiroki Tateno
- Department of Internal Medicine, Saitama City Hospital, Japan
| | - Masahiro Mori
- Department of Surgery, National Hospital Organization Chiba Medical Center, Japan
| | | | | | - Naoko Nakasa
- Health Support Center, Matsue Memorial Hospital, Japan
| | - Yuko Haruki
- Health Support Center, Matsue Memorial Hospital, Japan
| | - Koji Hasegawa
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
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Ordean A, Wong S, Graves L. No. 349-Substance Use in Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 39:922-937.e2. [PMID: 28935057 DOI: 10.1016/j.jogc.2017.04.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To improve awareness and knowledge of problematic substance use in pregnancy and to provide evidence-based recommendations for the management of this challenging clinical issue for all health care providers. OPTIONS This guideline reviews the use of screening tools, general approach to care, and recommendations for the clinical management of problematic substance use in pregnancy. OUTCOMES Evidence-based recommendations for screening and management of problematic substance use during pregnancy and lactation. EVIDENCE Updates in the literature were retrieved through searches of Medline, PubMed, and The Cochrane Library published from 1996 to 2016 using the following key words: pregnancy, electronic cigarettes, tobacco use cessation products, buprenorphine, and methadone. Results were initially restricted to systematic reviews and RCTs/controlled clinical trials. A subsequent search for observational studies was also conducted because there are few RCTs in this field of study. Articles were restricted to human studies published in English. Additional articles were located by hand searching through article reference lists. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report. BENEFITS, HARMS, AND COSTS This guideline is intended to increase the knowledge and comfort level of health care providers caring for pregnant women who have substance use disorders. Improved access to health care and assistance with appropriate addiction care lead to reduced health care costs and decreased maternal and neonatal morbidity and mortality. RECOMMENDATIONS
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N o 349 - Consommation de substances psychoactives pendant la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:938-956.e3. [PMID: 28935058 DOI: 10.1016/j.jogc.2017.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIFS Accroître la sensibilisation à la consommation problématique de substances psychoactives pendant la grossesse et les connaissances à ce sujet, et formuler des recommandations factuelles relatives à la prise en charge de cet épineux problème clinique à l'intention de l'ensemble des fournisseurs de soins. OPTIONS La présente directive clinique analyse l'utilisation d'outils de dépistage, l'approche générale de soins et les recommandations pour la prise en charge clinique de la consommation problématique de substances psychoactives pendant la grossesse. ISSUES Recommandations factuelles pour le dépistage et la prise en charge de la consommation problématique de substances psychoactives pendant la grossesse et l'allaitement. RECHERCHE DOCUMENTAIRE La littérature à jour a été obtenue au moyen de recherches dans Medline, PubMed et la Bibliothèque Cochrane visant les articles publiés entre 1996 et 2016, avec les mots clés suivants : « pregnancy », « electronic cigarettes », « tobacco use cessation products », « buprenorphine » et « methadone ». Les résultats ont d'abord été restreints aux analyses systématiques, aux ECR et aux essais cliniques contrôlés. Ensuite, en raison de la rareté des ECR sur le sujet, des recherches d'études observationnelles ont également été menées. Les articles sélectionnés ont été limités aux études chez l'humain publiées en anglais, puis d'autres articles ont été trouvés manuellement, par l'analyse des listes de références. VALEURS La qualité des données a été évaluée au moyen des critères énoncés dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs. Les recommandations visant la pratique ont été classées conformément à la méthode décrite dans ce rapport. AVANTAGES, DéSAVANTAGES ET COûTS: La présente directive clinique a pour but d'améliorer les connaissances et le degré d'aisance des fournisseurs qui dispensent des soins aux femmes enceintes ayant un trouble de l'usage d'une substance. L'amélioration de l'accès aux soins de santé et de l'aide pour obtenir un traitement adéquat de la dépendance fait diminuer les coûts de santé et les taux de morbidité et de mortalité chez la mère et l'enfant. RECOMMANDATIONS.
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Provision of smoking cessation services in Australian community pharmacies: a simulated patient study. Int J Clin Pharm 2014; 36:604-14. [PMID: 24718946 DOI: 10.1007/s11096-014-9944-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND With the rising interest in expanding pharmacists' role in smoking cessation, it is pertinent that community pharmacists be equipped with up-to-date knowledge and competence to provide optimal therapeutic services that meet the demands of various presenting subsets of smokers. OBJECTIVE To investigate and evaluate responses to requests of quitting smoking from 'high risk' smokers seeking assistance and treatment within the pharmacy venue. SETTING Community pharmacies located within Sydney greater metropolitan area, New South Wales, Australia. METHOD A simulated patient methodology was utilised. Two scenarios were developed and enacted by two trained simulated patients in 100 randomly selected pharmacies. Scenario 1 involved a 28-year-old pregnant female who presents with a request for help in quitting smoking. Scenario 2 involved a 22-year-old female requesting a quit smoking product for her 55-year-old father who has cardiovascular problems. A standardised scoring key was designed to assess the performance of pharmacists during each encounter. MAIN OUTCOME MEASURE The primary outcome measure was the supply/non-supply of nicotine replacement products and the corresponding provision of counselling and advice to facilitate smoking cessation. RESULTS A product(s) was supplied in 42 % of the 100 encounters, while a product was adequately suggested pending doctor's referral in 45 %. In 13 % of the cases, a product was not supplied based on inappropriate notions of nicotine replacement therapy not being safe in the presented scenario. Pharmacists performed better in dispensing scores (counselling about product use) as compared to pre-dispensing scores (eliciting patient history). ANOVA followed by regression analysis indicated that the estimated age and gender of the pharmacist/staff were significant predictors affecting total scores. CONCLUSION Whilst pharmacists' counselling about smoking cessation aids seems satisfactory, further education is required to improve practice standards in terms of matching a patient's history and smoking status to an appropriate product.
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Kaur K, Kaushal S, Chopra SC. Varenicline for smoking cessation: A review of the literature. Curr Ther Res Clin Exp 2014; 70:35-54. [PMID: 24692831 DOI: 10.1016/j.curtheres.2009.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Smoking is the leading preventable risk to human health. Various agents have been used to promote smoking cessation, but none has had long-term efficacy. Varenicline, a new nicotinic ligand based on the structure of cytosine, was approved by the US Food amd Drug Administration for use as a smoking cessation aid. OBJECTIVES The aims of this review were to provide an overview on the mechanism of action and preclinical and clinical data of the new drug, varenicline, and to discuss the current and future impact of varenicline as a treatment for smoking cessation. METHODS MEDLINE, BIOSIS, and Google scholar databases were searched (March 1, 2007-July 1, 2008) using the terms varenicline, smoking cessation, and nicotinic receptors. Full-text articles in English were selected for reference, and articles presenting the mechanism of action, pharmacokinetics, and data from preclinical and clinical trials were included. RESULTS The initial literature search yielded 70 papers. A total of 20 articles fulfilled the inclusion criteria. Varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, inhibits dopaminergic activation produced by smoking and decreases the craving and withdrawal syndrome that accompanies cessation attempts. In Phase III clinical trials, the carbon monoxide-confirmed 4-week continuous abstinence rates were significantly higher with varenicline than with buproprion sustained release or placebo for weeks 9 through 12. Varenicline has been found to be well tolerated, with nausea being the most commonly reported (28.1%) adverse event. CONCLUSIONS Varenicline is the first drug for smoking cessation that has been found to have significant effectiveness in long-term relapse prevention (up to 52 weeks). Varenicline, with its unique profile of agonist and antagonist properties, increased cessation rates (both short- and long-term) compared with both placebo and bupropion sustained release.
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Affiliation(s)
- Kirandeep Kaur
- Department of Pharmacology, Old Dayanand Medical College and Hospital, Ludhiana, India
| | - Sandeep Kaushal
- Department of Pharmacology, Old Dayanand Medical College and Hospital, Ludhiana, India
| | - Sarvesh C Chopra
- Department of Pharmacology, Old Dayanand Medical College and Hospital, Ludhiana, India
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Havard A, Jorm LR, Preen D, Daube M, Kemp A, Einarsdóttir K, Randall D, Tran DT. The Smoking MUMS (Maternal Use of Medications and Safety) Study: protocol for a population-based cohort study using linked administrative data. BMJ Open 2013; 3:e003692. [PMID: 24056492 PMCID: PMC3780331 DOI: 10.1136/bmjopen-2013-003692] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Approximately 14% of Australian women smoke during pregnancy. Although the risk of adverse outcomes is reduced by smoking cessation, less than 35% of Australian women quit smoking spontaneously during pregnancy. Evidence for the efficacy of bupropion, varenicline or nicotine replacement therapy as smoking cessation aids in the non-pregnant population suggest that pharmacotherapy for smoking cessation is worth exploring in women of childbearing age. Currently, little is known about the utilisation, effectiveness and safety of pharmacotherapies for smoking cessation during pregnancy; neither the extent to which they are used prior to pregnancy nor whether their use has changed in response to related policy reforms. The Smoking MUMS (Maternal Use of Medications and Safety) Study will explore these issues using linked person-level data for a population-based cohort of Australian mothers. METHODS AND ANALYSIS The cohort will be assembled by linking administrative health records for all women who gave birth in New South Wales or Western Australia since 2003 and their children, including records relating to childbirth, use of pharmaceuticals, hospital admissions, emergency department presentations and deaths. These longitudinal linked data will be used to identify utilisation of smoking cessation pharmacotherapies during and between pregnancies and to explore the associated smoking cessation rates and maternal and child health outcomes. Subgroup and temporal analyses will identify potential differences between population groups including indigenous mothers and social security recipients and track changes associated with policy reforms that have made alternative smoking cessation pharmacotherapies available. ETHICS AND DISSEMINATION Ethical approval has been obtained for this study. To enhance the translation of the project's findings into policy and practice, policy and clinical stakeholders will be engaged through a reference group and a policy forum will be held. Outputs from the project will include scientific papers and summary reports designed for policy audiences.
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Affiliation(s)
- Alys Havard
- Centre for Health Research, University of Western Sydney, Penrith, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Health Research, University of Western Sydney, Penrith, New South Wales, Australia
- The Sax Institute, Haymarket, New South Wales, Australia
| | - David Preen
- Centre for Health Services Research, University of Western Australia, Crawley, Western Australia, Australia
| | - Michael Daube
- Public Health Advocacy Institute of WA, Curtin University, Perth, Western Australia, Australia
| | - Anna Kemp
- Centre for Health Services Research, University of Western Australia, Crawley, Western Australia, Australia
| | - Kristjana Einarsdóttir
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Perth, Western Australia, Australia
| | - Deborah Randall
- Centre for Health Research, University of Western Sydney, Penrith, New South Wales, Australia
| | - Duong Thuy Tran
- Centre for Health Research, University of Western Sydney, Penrith, New South Wales, Australia
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Reduced Nicotine Content Cigarette Knowledge, Attitudes, and Practices of Patients at a Perinatal Substance Abuse Treatment Center. ADDICTIVE DISORDERS & THEIR TREATMENT 2013. [DOI: 10.1097/adt.0b013e31825afda6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hughes JR. An updated algorithm for choosing among smoking cessation treatments. J Subst Abuse Treat 2013; 45:215-21. [PMID: 23518288 DOI: 10.1016/j.jsat.2013.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/03/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
Although meta-analyses have documented the efficacy of treatments for smoking cessation, and guidelines have outlined treatment elements, few algorithms for choosing among treatments have been described. The current algorithm updates the author's prior algorithm. The major decisions in the algorithm are (a) use a motivational treatment if the smoker is not currently interested in quitting, (b) assess factors that influence choice of treatment, (c) consider both gradual and abrupt cessation, (d) use combined patch+gum/inhaler/lozenge or varenicline as first line medications, (e) use individual, group, Internet, and phone counseling as first line psychosocial treatments, and (f) continue treatment after a lapse or relapse. Further research is needed to determine whether algorithms improve treatment outcomes.
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Affiliation(s)
- John R Hughes
- Department of Psychiatry, University of Vermont, Burlington, VT, USA.
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Parrish DE, von Sternberg K, Velasquez MM, Cochran J, Sampson M, Mullen PD. Characteristics and factors associated with the risk of a nicotine exposed pregnancy: expanding the CHOICES preconception counseling model to tobacco. Matern Child Health J 2012; 16:1224-31. [PMID: 21735139 DOI: 10.1007/s10995-011-0848-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The preconception counseling model tested in the CDC funded Project CHOICES efficacy trial to reduce the risk of an alcohol-exposed pregnancy (AEP) could be extended to smokers to prevent a nicotine-exposed pregnancy (NEP), when pharmacotherapy can be provided safely and disclosure of these risk behaviors is more likely. The CHOICES model, which incorporates motivational interviewing, encourages reduction of AEP risk by decreasing risky drinking or using effective contraception; in the efficacy trial, most women chose both options. We conducted a secondary analysis of the CHOICES epidemiologic survey data (N = 2,672) (Project CHOICES Research Group in Am J Prev Med 23(3), 166-173, 2002) to identify the prevalence of risk of NEP and the factors associated with this risk using logistic regression modeling procedures. Conducted in six settings with women at risk for AEP, the percentage of AEP was 12.5% (333/2,672) among women of childbearing age (18-44). A total of 464 of the 2,672 (17.4%) were at risk for NEP. Among women at-risk of an unplanned pregnancy (n = 1,532), the co-occurrence of AEP and NEP risk was more prevalent (16.3%) than AEP risk alone (5.5%) or NEP risk alone (14.0%). In the multivariable model, statistically significant correlates for NEP risk included lifetime drug use, prior alcohol/drug treatment, drug use in the last 6 months, being married or living with a partner, having multiple sexual partners in the last 6 months, physical abuse in the last year, and lower levels of education. These findings suggest that preconception counseling for NEP could be combined with a program targeting AEP.
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Affiliation(s)
- Danielle E Parrish
- Health Behavior Research and Training Institute, University of Texas at Austin, School of Social Work, Austin, TX, USA.
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[The Fetal Tobacco Syndrome - A statement of the Austrian Societies for General- and Family Medicine (ÖGAM), Gynecology and Obstetrics (ÖGGG), Hygiene, Microbiology and Preventive Medicine (ÖGHMP), Pediatrics and Adolescence Medicine (ÖGKJ) as well as Pneumology (ÖGP)]. Wien Klin Wochenschr 2011; 124:129-45. [PMID: 22189489 DOI: 10.1007/s00508-011-0106-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 11/13/2011] [Indexed: 10/14/2022]
Abstract
Over more than 50 years, the nocuous effects of smoking in pregnancy on the fetus are well known. In the first years of science the focus was primarily on restricted fetal growth while in more recent years over 10.000 studies investigated the incomparably big sum of detrimental effects for the unborn's health. In this statement we want to present the recent scientific findings on this topic. The statement is aimed to show all doctors who treat pregnant women the present situation and evidence. In the beginning we give a short overview about the epidemiological situation in Europe. Then we present step by step the health effects with regards to pathophysiology and clinics. Furthermore the reader will learn about possibilities for smoking cessation in pregnancy. The problem of passive-smoking in pregnancy will be dealt with in a separate chapter. At present there is strong evidence that pregnant smoking has a detrimental effect on birth-weight, placenta-associated disease, stillbirth, sudden infant death syndrome (SIDS), childhood overweight, clefts, lung function, asthma, cardiovascular diseases and mental developmental disorders. These factors can be summarized by the term Fetal Tobacco Syndrome. There is supply for more studies for less investigated health effects. Pregnancy is a chance to stop smoking as most women show a high motivation in this period. Hence doctors of all disciplines should inform pregnant women about the detrimental effects of smoking on their unborn child and show them possibilities for smoking cessation.
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Wong S, Ordean A, Kahan M. SOGC clinical practice guidelines: Substance use in pregnancy: no. 256, April 2011. Int J Gynaecol Obstet 2011; 114:190-202. [PMID: 21870360 DOI: 10.1016/j.ijgo.2011.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To improve awareness and knowledge of problematic substance use in pregnancy and to provide evidence-based recommendations for the management of this challenging clinical issue for all health care providers. OPTIONS This guideline reviews the use of screening tools, general approach to care, and recommendations for clinical management of problematic substance use in pregnancy. OUTCOMES Evidence-based recommendations for screening and management of problematic substance use during pregnancy and lactation. EVIDENCE Medline, PubMed, CINAHL, and The Cochrane Library were searched for articles published from 1950 using the following key words: substance-related disorders, mass screening, pregnancy complications, pregnancy, prenatal care, cocaine, cannabis, methadone, opioid, tobacco, nicotine, solvents, hallucinogens, and amphetamines. Results were initially restricted to systematic reviews and randomized control trials/controlled clinical trials. A subsequent search for observational studies was also conducted because there are few RCTs in this field of study. Articles were restricted to human studies published in English. Additional articles were located by hand searching through article reference lists. Searches were updated on a regular basis and incorporated in the guideline up to December 2009. Grey (unpublished) literature was also identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table 1). BENEFITS, HARMS, AND COSTS This guideline is intended to increase the knowledge and comfort level of health care providers caring for pregnant women who have substance use disorders. Improved access to health care and assistance with appropriate addiction care leads to reduced health care costs and decreased maternal and neonatal morbidity and mortality.
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Clark SM, Nakad R. Pharmacotherapeutic management of nicotine dependence in pregnancy. Obstet Gynecol Clin North Am 2011; 38:297-311, x. [PMID: 21575802 DOI: 10.1016/j.ogc.2011.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Smoking in pregnancy can cause serious adverse antenatal and postnatal morbidities, and a significant number of women continue to smoke in pregnancy despite these consequences. Early intervention in the form counseling from their physicians, pregnancy-specific self-help materials, counseling sessions with a health educator, and/or continued follow-up can result in better pregnancy outcomes and possibly long-term cessation. If a woman cannot quit despite these measures, pharmacotherapy can be considered. Currently, nicotine replacement therapy (NRT), transdermal patches, and bupropion are used in pregnancy, but data on the safety and efficacy are largely lacking.
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Affiliation(s)
- Shannon M Clark
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 77555, USA.
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Filion KB, Abenhaim HA, Mottillo S, Joseph L, Gervais A, O'Loughlin J, Paradis G, Pihl R, Pilote L, Rinfret S, Tremblay M, Eisenberg MJ. The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials. BJOG 2011; 118:1422-8. [PMID: 21880109 DOI: 10.1111/j.1471-0528.2011.03065.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pregnant smokers are often prescribed counselling as part of multicomponent cessation interventions. However, the isolated effect of counselling in this population remains unclear, and individual randomised controlled trials (RCTs) are inconclusive. OBJECTIVE To conduct a meta-analysis of RCTs examining counselling in pregnant smokers. SEARCH STRATEGY We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline and PsycINFO databases for RCTs evaluating smoking cessation counselling. SELECTION CRITERIA We included RCTs conducted in pregnant women in which the effect of counselling could be isolated and those that reported biochemically validated abstinence at 6 or 12 months after the target quit date. DATA COLLECTION AND ANALYSIS Overall estimates were derived using random effects meta-analysis models. MAIN RESULTS Our search identified eight RCTs (n = 3290 women), all of which examined abstinence at 6 months. The proportion of women that remained abstinent at the end of follow up was modest, ranging from 4 to 24% among those randomised to counselling and from 2 to 21% among control women. The absolute difference in abstinence reached a maximum of only 4%. Summary estimates are inconclusive because of wide confidence intervals, albeit with little evidence to suggest that counselling is efficacious at promoting abstinence (odds ratio 1.08, 95% confidence interval 0.84-1.40). There was no evidence to suggest that efficacy differed by counselling type. CONCLUSIONS Available data from RCTs examining the isolated effect of smoking cessation counselling in pregnant women are limited but sufficient to rule out large treatment effects. Future RCTs should examine pharmacological therapies in this population.
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Affiliation(s)
- K B Filion
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA
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Abstract
OBJECTIVE To improve awareness and knowledge of problematic substance use in pregnancy and to provide evidence-based recommendations for the management of this challenging clinical issue for all health care providers. OPTIONS This guideline reviews the use of screening tools, general approach to care, and recommendations for clinical management of problematic substance use in pregnancy. OUTCOMES Evidence-based recommendations for screening and management of problematic substance use during pregnancy and lactation. EVIDENCE Medline, PubMed, CINAHL, and The Cochrane Library were searched for articles published from 1950 using the following key words: substance-related disorders, mass screening, pregnancy complications, pregnancy, prenatal care, cocaine, cannabis, methadone, opioid, tobacco, nicotine, solvents, hallucinogens, and amphetamines. Results were initially restricted to systematic reviews and randomized control trials/controlled clinical trials. A subsequent search for observational studies was also conducted because there are few RCTs in this field of study. Articles were restricted to human studies published in English. Additional articles were located by hand searching through article reference lists. Searches were updated on a regular basis and incorporated in the guideline up to December 2009. Grey (unpublished) literature was also identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table 1). BENEFITS, HARMS, AND COSTS This guideline is intended to increase the knowledge and comfort level of health care providers caring for pregnant women who have substance use disorders. Improved access to health care and assistance with appropriate addiction care leads to reduced health care costs and decreased maternal and neonatal morbidity and mortality. RECOMMENDATIONS 1. All pregnant women and women of childbearing age should be screened periodically for alcohol, tobacco, and prescription and illicit drug use. (III-A) 2. When testing for substance use is clinically indicated, urine drug screening is the preferred method. (II-2A) Informed consent should be obtained from the woman before maternal drug toxicology testing is ordered. (III-B) 3. Policies and legal requirements with respect to drug testing of newborns may vary by jurisdiction, and caregivers should be familiar with the regulations in their region. (III-A) 4. Health care providers should employ a flexible approach to the care of women who have substance use problems, and they should encourage the use of all available community resources. (II-2B) 5. Women should be counselled about the risks of periconception, antepartum, and postpartum drug use. (III-B) 6. Smoking cessation counselling should be considered as a first-line intervention for pregnant smokers. (I-A) Nicotine replacement therapy and/or pharmacotherapy can be considered if counselling is not successful. (I-A) 7. Methadone maintenance treatment should be standard of care for opioid-dependent women during pregnancy. (II-IA) Other slow-release opioid preparations may be considered if methadone is not available. (II-2B) 8. Opioid detoxification should be reserved for selected women because of the high risk of relapse to opioids. (II-2B) 9. Opiate-dependent women should be informed that neonates exposed to heroin, prescription opioids, methadone, or buprenorphine during pregnancy are monitored closely for symptoms and signs of neonatal withdrawal (neonatal abstinence syndrome). (II-2B) Hospitals providing obstetric care should develop a protocol for assessment and management of neonates exposed to opiates during pregnancy. (III-B) 10. Antenatal planning for intrapartum and postpartum analgesia may be offered for all women in consultation with appropriate health care providers. (III-B) 11. The risks and benefits of breastfeeding should be weighed on an individual basis because methadone maintenance therapy is not a contraindication to breastfeeding. (II-3B).
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Wong S, Ordean A, Kahan M, Gagnon R, Hudon L, Basso M, Bos H, Crane J, Davies G, Delisle MF, Farine D, Menticoglou S, Mundle W, Murphy-Kaulbeck L, Ouellet A, Pressey T, Roggensack A, Sanderson F, Ehman W, Biringer A, Gagnon A, Graves L, Hey J, Konkin J, Léger F, Marshall C, Robertson D, Bell D, Carson G, Gilmour D, Hughes O, Le Jour C, Leduc D, Leyland N, Martyn P, Masse A, Abrahams R, Avdic S, Berger H, Franklyn M, Harper S, Hunt G, Mousmanis P, Murphy K, Payne S, Midmer D, de la Ronde S. Consommation de substances psychoactives pendant la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011. [DOI: 10.1016/s1701-2163(16)34856-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Smoking and women's health. Nurs Womens Health 2010; 14:427-9. [PMID: 20955537 DOI: 10.1111/j.1751-486x.2010.01571.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Warland J, McCutcheon H. The 'quit' smoker and stillbirth risk: a review of contemporary literature in the light of findings from a case-control study. Midwifery 2010; 27:607-11. [PMID: 20833459 DOI: 10.1016/j.midw.2010.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 03/29/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE to identify existing literature which addresses the topic of detecting, assessing and intervening when a pregnant woman who has quit smoking relapses. This literature review was conducted in the light of findings of a case-control study which suggest that a quit smoking status is associated with increased risk of late stillbirth (odds ratio 3.03, 95% confidence interval 1.27-7.24, p = 0.01). METHOD a structured review was conducted to identify literature related to quitting smoking in early pregnancy, prevalence and likelihood of relapse, possible methods for detecting smoking resumption, potential intervention strategies for the relapsed smoker and the societal burden of continuing to smoke in pregnancy. FINDINGS there is a wide variety of evidence for the effectiveness of intervention strategies aimed at assisting women to quit smoking during pregnancy. However, few studies have specifically aimed to identify strategies to assist those women who report quitting in early pregnancy to maintain that status throughout pregnancy. CONCLUSIONS in light of the results of the case-control study and this literature review, it is important that changes are made to prenatal care in order to enable midwives to better identify women who are struggling with abstinence or who resume smoking during pregnancy. IMPLICATIONS FOR PRACTICE midwives should discuss and monitor smoking status with women at every prenatal visit. If a midwife finds that a woman has relapsed into smoking, they can be offered a range of quit smoking intervention strategies, including referral to a dedicated cessation service, counselling support, alternative therapies and, perhaps, nicotine replacement therapy. Further research aimed at identifying the extent of relapse among these women and the impact this may have on pregnancy outcome is warranted. Research to ascertain the most appropriate interventions to prevent relapse is also needed.
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Affiliation(s)
- Jane Warland
- School of Nursing and Midwifery, University of South Australia, City East Campus, North Terrace, Adelaide 5000, Australia.
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Cummings KM, Mahoney MC. Strategies for smoking cessation: what is new and what works? Expert Rev Respir Med 2010; 2:201-13. [PMID: 20477249 DOI: 10.1586/17476348.2.2.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While the prevalence of smoking in the USA has declined over the past half century, there still remain over 40 million current smokers, ensuring that smoking will continue to be a major factor influencing premature morbidity and mortality rates for years to come. Most people begin smoking during their teenage years and struggle to quit as adults. Nicotine dependence should be considered a chronic health condition with exacerbations and remissions. Clinicians have an important role to play in helping their patients to stop smoking. The systematic identification of all smokers is the initial step in addressing smoking cessation. Providing both pharmacotherapy and counseling support for all quit attempts helps to optimize rates of cessation. First-line pharmacotherapy to support a quit attempt include nicotine replacement (gum, patch, lozenge, nasal spray or inhaler), bupropion or varenicline. Use of these agents can increase quit rates by 1.5- to threefold. Several studies have shown that combining the nicotine patch with either gum or nasal spray can increase quit rates over single modality therapy. Recent studies have also suggested that giving smokers stop-smoking medications for several weeks in advance of their quit date may help to boost long-term quit rates. New medications are under development, including a nicotine vaccine and faster delivery nicotine medications. However, from a public health perspective, a ban on the sale of nicotine-containing combustion tobacco products may represent the most straightforward means to minimize the harm caused by tobacco use.
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Affiliation(s)
- K Michael Cummings
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Alwan S, Reefhuis J, Botto LD, Rasmussen SA, Correa A, Friedman JM. Maternal use of bupropion and risk for congenital heart defects. Am J Obstet Gynecol 2010; 203:52.e1-6. [PMID: 20417496 DOI: 10.1016/j.ajog.2010.02.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 12/10/2009] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We sought to determine if maternal bupropion treatment in early pregnancy is associated with congenital heart defects in the infant. STUDY DESIGN We conducted a retrospective case-control study of birth defects risk factors. Data on 6853 infants with major heart defects were compared with 5869 control infants born in 1997-2004. Bupropion exposure was defined as any reported use between 1 month before and 3 months after conception. RESULTS Mothers of infants with left outflow tract heart defects were more likely to have reported taking bupropion than mothers of control infants (adjusted odds ratio, 2.6; 95% confidence interval, 1.2-5.7; P = .01). CONCLUSION We identified a positive association between early pregnancy bupropion use and left outflow tract heart defects; however, the magnitude of the observed increased risk was small. Nevertheless, further studies are needed to confirm these results.
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Abstract
Nicotine replacement therapy (NRT) is effective for smoking cessation, but much controversy surrounds its use during pregnancy. The importance of finding ways to help pregnant smokers quit is undisputed, since smoking during pregnancy causes harm to the mother and the fetus, with effects of smoke exposure extending into childhood. Researchers and providers are divided, however, with respect to opinions of safety and efficacy of NRT use in pregnant smokers. The research-based evidence on the topic is limited, but there are studies examining the efficacy of NRT in pregnancy. This article presents the evidence for this smoking cessation methodology in pregnancy.
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Blood-Siegfried J, Rende EK. The long-term effects of prenatal nicotine exposure on neurologic development. J Midwifery Womens Health 2010; 55:143-52. [PMID: 20189133 DOI: 10.1016/j.jmwh.2009.05.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 05/15/2009] [Accepted: 05/21/2009] [Indexed: 11/17/2022]
Abstract
A large body of documented evidence has found that smoking during pregnancy is harmful to both the mother and the fetus. Prenatal exposure to nicotine in various forms alters neurologic development in experimental animals and may increase the risk for neurologic conditions in humans. There is a positive association between maternal smoking and sudden infant death syndrome (SIDS); however, the connection between nicotine addiction, depression, attention disorders, and learning and behavior problems in humans is not straightforward. Nicotine's action on the production and function of neurotransmitters makes it a prime suspect in the pathology of these diseases. Nicotine accentuates neurotransmitter function in adults but desensitizes these functions in prenatally exposed infants and children. This desensitization causes an abnormal response throughout the lifespan. Furthermore, nicotine use by adolescents and adults can alleviate some of the symptoms caused by these neurotransmitter problems while they increase the risk for nicotine addiction. Although nicotine replacement drugs are used by pregnant women, there is no clear indication that they improve outcomes during pregnancy, and they may add to the damage that occurs to the developing neurologic system in the fetus. Understanding the effects of nicotine exposure is important in providing safe care for pregnant women, children, and families and for developing appropriate smoking cessation programs during pregnancy.
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García-Algar O, Jané Checa M. [Safety and efficacy of nicotine replacement treatment during pregnancy]. Arch Bronconeumol 2010; 46:453-4. [PMID: 20434822 DOI: 10.1016/j.arbres.2010.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 03/13/2010] [Indexed: 10/19/2022]
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Chisolm MS, Tuten M, Brigham EC, Strain EC, Jones HE. Relationship between cigarette use and mood/anxiety disorders among pregnant methadone-maintained patients. Am J Addict 2010; 18:422-9. [PMID: 19874163 DOI: 10.3109/10550490903077721] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study investigates the association between cigarette use and current mood/anxiety disorders among pregnant opioid-dependent patients. Pregnant methadone-maintained women (N = 122) completed the Addiction Severity Index and Structured Clinical Interview for DSM-IV. Participants were categorized based on past 30 days cigarette use: no (n = 15) and any smoking (n = 107); this latter group was then subdivided into light (one to ten cigarettes/day; n = 55), and heavy smokers (11+ cigarettes/day; n = 52). Any smoking was significantly associated with any current mood/anxiety disorder (p < 0.001), any current mood disorder (p = 0.007), and any current anxiety disorder (p < 0.001). No significant association was found between specific level of cigarette use and mood/anxiety disorders. This association between smoking and psychiatric disorders has implications for the mental and physical health of methadone-maintained women and their children, and may contribute to the understanding of the physiological mechanisms underlying smoking and nicotine dependence.
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Affiliation(s)
- Margaret S Chisolm
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Miscellaneous drugs, materials, medical devices, and techniques. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s0378-6080(10)32049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
Abstract The adverse effects of prenatal cigarette smoke exposure on human reproductive outcomes are a major scientific and public health concern. In the United States, approximately 25% of women of childbearing age currently smoke cigarettes, and only a small percentage of these individuals quit after learning of their pregnancy. Women interested in smoking cessation during pregnancy have a number of options, including behavioural and pharmacological aids, but nicotine replacement therapy (NRT) is by far the most common approach. While NRT avoids exposure to the myriad compounds present in tobacco smoke, nicotine itself causes damage to the developing nervous system. The purpose of this article is to review the detrimental effects of developmental tobacco smoke exposure on short- and long-term outcomes with particular emphasis on neurobehavioural consequences. In conclusion based on the clear, adverse effects of nicotine on brain development observed in human and animal studies, we suggest that safer alternatives for smoking cessation in pregnancy are badly needed.
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Affiliation(s)
- James R Pauly
- Department of Pharmaceutical Sciences, Spinal Cord and Brain Injury Research Center [corrected] College of Pharmacy, University of Kentucky, Lexington, KY [corrected] USA.
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