[Maternal smoking during pregnancy and socioeconomic factors as predictors of low birth weight in term pregnancies in Nis]

Social Determinants of Cigarette Smoking among American Women during Pregnancy

Educational attainment is among the most substantial protective factors against cigarette smoking, including during pregnancy. Although Minorities’ Diminished Returns (MDRs) of educational attainment, defined as weaker protective effect of education for racial and ethnic minority groups compared to Non-Hispanic Whites, has been demonstrated in previous studies; such MDRs are not tested for cigarette smoking during pregnancy. To better understand the relevance of MDRs to tobacco use during pregnancy, this study had three aims: firstly, to investigate the association between educational attainment and cigarette smoking in pregnant women; secondly, to compare racial and ethnic groups for the association between educational attainment and cigarette smoking; and thirdly, to explore the mediating effect of poverty status on such MDRs, among American adults during pregnancy. This cross-sectional study explored a nationally representative sample of pregnant American women (n = 338), which was taken from the Population Assessment of Tobacco and Health (PATH; 2013). Current smoking was the outcome. Educational attainment was the independent variable. Region and age were the covariates. Poverty status was the mediator. Race and ethnicity were the effect modifiers. Overall, a higher level of educational attainment (OR = 0.54, p < 0.05) was associated with lower odds of current smoking among pregnant women. Race (OR = 2.04, p < 0.05) and ethnicity (OR = 2.12, p < 0.05) both showed significant interactions with educational attainment on smoking, suggesting that the protective effect of educational attainment against smoking during pregnancy is smaller for Blacks and Hispanics than Non-Hispanic Whites. Poverty status fully mediated the above interactions. In the United States, highly educated pregnant Black and Hispanic women remain at higher risk of smoking cigarettes, possibly because they are more likely to live in poverty, compared to their White counterparts. The results suggest the role that labor market discrimination has in explaining lower returns of educational attainment in terms of less cigarette smoking by racial and ethnic minority pregnant women.

First-trimester smoking cessation in pregnancy did not increase the risk of preeclampsia/eclampsia: A Murmansk County Birth Registry study

Background

Although prior studies have shown that smoking reduces preeclampsia/eclampsia risk, the consequence of giving up this habit during pregnancy should be assessed. The aims of the current study were threefold: (i) describe maternal characteristics of women with preeclampsia/eclampsia; (ii) examine a possible association between the number of cigarettes smoked daily during pregnancy and the development of this affliction; and (iii) determine if first-trimester discontinuation of smoking during pregnancy influences the risk.

Methods

A registry-based study was conducted using data from the Murmansk County Birth Registry (MCBR). It included women without pre-existing hypertension, who delivered a singleton infant during 2006–2011 and had attended the first antenatal visit before 12 week of gestation. We adjusted for potential confounders using logistic regression.

Results

The prevalence of preeclampsia/eclampsia was 8.3% (95%CI: 8.0–8.6). Preeclampsia/eclampsia associated with maternal age, education, marital status, parity, excessive weight gain and body mass index at the first antenatal visit. There was a dose-response relationship between the number of smoked cigarettes per day during pregnancy and the risk of preeclampsia/eclampsia (adjusted OR_{1-5 cig/day} = 0.69 with 95%CI: 0.56–0.87; OR_{6-10 cig/day} = 0.65 with 95%CI: 0.51–0.82; and OR_{≥11 cig/day} = 0.49 with 95%CI: 0.30–0.81). There was no difference in this risk among women who smoked before and during pregnancy and those who did so before but not during pregnancy (adjusted OR = 1.10 with 95%CI: 0.91–1.32).

Conclusions

Preeclampsia/eclampsia was associated with maternal age, education, marital status, parity, excessive weight gain, and body mass index at the first antenatal visit. There was a negative dose-response relationship between the number of smoked cigarettes per day during pregnancy and the odds of preeclampsia/eclampsia. However, women who gave up smoking during the first trimester of gestation had the same risk of preeclampsia/eclampsia as those who smoked while pregnant. Consequently, antenatal clinic specialists are advised to take these various observations into account when counselling women on smoking cessation during pregnancy.

Prevalence of smoking before and during pregnancy and changes in this habit during pregnancy in Northwest Russia: a Murmansk county birth registry study

Background

Smoking during pregnancy leads to adverse maternal and birth outcomes. However, the prevalence of smoking among women in Russia has increased from < 5 % in the 1980s to > 20 % in the 2000s. We conducted a registry-based study in Murmansk County, Northwest Russia. Our aims were twofold: (i) assess the prevalence of smoking before and during pregnancy; and (ii) examine the socio-demographic factors associated with giving up smoking or reducing the number of cigarettes smoked once pregnancy was established.

Methods

This study employs data from the population-based Murmansk County Birth Registry (MCBR) collected during 2006–2011. We used logistic regression to investigate associations between women’s socio-demographic characteristics and changes in smoking habit during pregnancy. To avoid departure from uniform risk within specific delivery departments, we employed clustered robust standard errors.

Results

Of all births registered in the MCBR, 25.2 % of the mothers were smokers before pregnancy and 18.9 % continued smoking during pregnancy. Cessation of smoking during pregnancy was associated with education, marital status and parity but not with maternal age, place of residence, and ethnicity. Women aged ≤ 20–24 years had higher odds of reducing the absolute numbers of cigarettes smoked per day during pregnancy than those aged ≥ 30–34 years. Moreover, smoking nulliparae and pregnant women who had one child were more likely to reduce the absolute numbers of cigarettes smoked per day compared to women having ≥ 2 children.

Conclusions

About 25.0 % of smoking women in the Murmansk County in Northwest Russia quit smoking after awareness of the pregnancy, and one-third of them reduced the number cigarettes smoked during pregnancy. Our study demonstrates that women who have a higher education, husband, and are primiparous are more likely to quit smoking during pregnancy. Maternal age and number of children are indicators that influence reduction in smoking during pregnancy. Our findings are useful in identifying target groups for smoking intervention campaigns.

The influence of maternal smoking and exposure to residential ETS on pregnancy outcomes: a retrospective national study

In a nationwide study of Serbian births, in 2008, we estimated the influence of maternal prenatal smoking and environmental tobacco smoke (ETS) exposure on birth outcomes. Using stratified two-stage random cluster sampling, 2,721 women were interviewed in-person (response rates 98.1 %), and 2,613 singleton live births were included. Date of birth, gender, birthweight, birth height and head circumference were copied from the official hospital Birth Certificate. Six exposure categories were defined according to mother's smoking history and exposure to ETS. We calculated adjusted mean values and group differences by analysis of covariance, and adjusted odds ratios for the low birthweight (LBW < 2,500 g). Compared to the reference category (non-smoking, non-exposed to ETS) we observed birthweight reductions in infants whose mothers smoked continuously during the pregnancy and were exposed to ETS (-162.6 g) and whose mothers were not exposed to ETS (-173 g) (p = 0.000, and p = 0.003, respectively), as well as reduction in birth length (-1.01 and -1.06 cm; p = 0.003 and p = 0.000, respectively). Reduction in birthweight and birth length related to exposure categories was not linear. Adjusted OR for LBW was almost tripled for mothers who smoked over the entire pregnancy and were non-exposed to ETS (aOR 2.85; 95 % CI 1.46-5.08), and who were exposed to ETS (aOR 2.68; 95 % CI 1.15-6.25). Our results showed strong effects of smoking throughout the pregnancy on reduced birthweight, birth length and head circumference, and increased risk for LBW. We were not able to detect an effect for ETS exposure alone.

Prevalence and predictors of smoking and quitting during pregnancy in Serbia: results of a nationally representative survey

OBJECTIVES

Middle- and low-income countries rarely have national surveillance data on smoking in pregnancy. This nationwide population-representative survey investigated pre- and post-partum smoking and their predictors in Serbia.

METHODS

Using stratified two-stage random cluster sampling, 2,721 women in 66 health care centres were interviewed at 3 and 6 months post-partum.

RESULTS

37.2% of women smoked at some point in pregnancy (average 8.8 cigarettes/per day). Smoking at pregnancy onset and during pregnancy was associated with smoking by others in the home and lower education and family socio-economic status. Almost a quarter of women (23.2%) who quit smoking during pregnancy did not relapse 6 months post-partum. Older women, primiparae, university students and white-collar workers were more likely to successfully quit smoking. More than a half of women were exposed to SHS in their homes (57.6%) and 84.6% allowed smoking in their homes.

CONCLUSION

Smoking during pregnancy in Serbia was two- to threefold higher than in the most affluent western countries. Target groups for action are women with lower education and socio-economic status, as well as health professionals and family members who smoke.

Nutrigenomics: The science of the 21st century

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