Patterns of tobacco exposure before and during pregnancy

Tobacco consumption from the 1st trimester of pregnancy to 7 months postpartum: Effects of previous tobacco consumption, and depression and anxiety symptoms

OBJECTIVE

Previous tobacco consumption, and depression and anxiety symptoms are major predictors of women's tobacco consumption during pregnancy and the postpartum period. However, the joint effect of these predictors is still unexplored. This study aimed to analyse the effects of previous tobacco consumption, and depression and anxiety symptoms on women's tobacco consumption status and quantity from the 1st trimester of pregnancy to 7 months postpartum.

METHOD

A sample of 803 Spanish women was assessed at the 1st and the 3rd trimester of pregnancy, and at 2 and 7 months postpartum. Previous tobacco consumption, and depression and anxiety symptoms were self-reported. Pregnancy and postpartum tobacco consumption were confirmed with biochemical tests.

RESULTS

Women with more previous tobacco consumption or more anxiety symptoms presented a steeper decrease in the number of cigarettes smoked per week from the 1st trimester of pregnancy to the childbirth, although smoking more cigarettes than women with less previous tobacco consumption or less anxiety symptoms. Women with more depression symptoms showed a higher tendency to relapse smoking during the first 2 months postpartum.

CONCLUSIONS

Previous tobacco consumption and anxiety symptoms were associated with higher smoking quantity during pregnancy, while depression symptoms were associated with consumption relapse during postpartum period.

Estimating causal and time-varying effects of maternal smoking on youth smoking

INTRODUCTION

Maternal smoking is a well-known risk factor for youth smoking, yet whether this relationship is causal remains unresolved. This study utilizes propensity score methods for causal inference to robustly account for shared risk factors between maternal and offspring smoking.

METHODS

An 8-year longitudinal cohort of 900 adolescents in the Chicago area were followed starting from approximately age 15.6. The effects of maternal lifetime smoking (MLS) and prenatal tobacco exposure (PTE) (among participants reporting MLS) on offspring's past 30-day smoking, daily smoking status and smoking frequency were examined using logistic regression and Poisson regression after nearest-neighbor propensity matching. Age dependency of this relationship was then examined across the age range of 15-25 using time-varying effect modeling.

RESULTS

Propensity matching yielded 438 and 132 pairs for MLS and PTE study samples, respectively. MLS demonstrated significant associations with past 30-day smoking (RR 1.09; 95% CI 1.04-1.14), daily smoking (RR 1.08; 95% CI 1.05-1.12), and smoking frequency of offspring (RR 1.32; 95% CI 1.15-1.52), with stable effects across age. Among participants reporting MLS, having PTE showed significant additional effects on daily smoking (RR 1.09; 95% CI 1.02-1.17) and age-dependency that showed significance during young adulthood but not adolescence.

CONCLUSION

The relationship between maternal and offspring smoking was not fully accounted for by shared risk factors, suggesting possible causation with PTE having a delayed effect across age. Targeted prevention efforts should be made on maternal smoking-exposed adolescents to mitigate their risks of developing heavy smoking habits in adulthood.

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.

Modeling Etiology of Smoking During Pregnancy in Swedish Twins, Full-, and Half-Siblings, Reared Together and Apart

INTRODUCTION

Using Swedish nationwide registry data, we investigated the contribution of genetic and environmental risk factors to the etiology of smoking status across stages of pregnancy with increasing degrees of social and psychological pressure to reduce or quit smoking, by twin and sibling modeling.

AIMS AND METHODS

Smoking status was available before, and during early and late pregnancy from the Medical Birth Register. Twin, full-, and half-sibling pairs, both reared together and apart, born between 1960 and 1990 were obtained from national twin and genealogical registers. Genetic structural equation modeling in OpenMx was applied to the population-based data to estimate shared genetic and/or environmental covariance across stages of pregnancy, accounting for maternal birth cohort and age at pregnancy.

RESULTS

Analyses of paired data on 258 749 individuals suggested that risk factors for smoking status changed across stages of pregnancy. Results predicted substantial heritability (60-70%) and moderate contributions of shared environmental factors (10-15%) for smoking status. Whilst the same shared environmental factors were amplified from before pregnancy to late pregnancy, new primarily unique environmental factors explained ~10% of the variance during early pregnancy which was carried forward to late pregnancy.

CONCLUSIONS

Using registry data on women across pregnancy, we replicated that smoking status is highly heritable. Furthermore, we found support for increased impact of shared environmental factors during pregnancy of factors already present prior to pregnancy, and an independent set of mostly new unique environmental factors that may be triggered by increased social pressure to reduce or quit smoking during pregnancy.

IMPLICATIONS

As new factors partially explain smoking status during pregnancy and the effects of familial factors increase across pregnancy, efforts to prevent or reduce smoking during pregnancy should receive continued attention, with a focus on both the individual and the family unit.

Association between maternal lifestyle factors and low birth weight in preterm and term births: a case-control study

Background

It has been reported that lifestyle factors may affect birth weight; however, few studies have explored the association between lifestyle factors and low birth weight in preterm and term births in China. The objective of this study was to explore the effect of lifestyle on low birth weight in preterm and term births.

Methods

This case-control study was conducted in fourteen hospitals in Jiangmen, Guangdong Province. Data were collected from August 2015 to May 2016 using a standard questionnaire. Data were analysed using logistic regression.

Results

Women who delivered preterm and were physically active (1–3 times per week and ≥ 4 times per week) had reduced odds of having low birth weight babies (aOR = 0.584, 95%CI = 0.394–0.867 and, aOR = 0.516, 95%CI = 0.355–0.752, respectively). Pregnant women who had insufficient gestational weight gain had increased odds of having low birth weight babies (aOR = 2.272, 95%CI = 1.626–3.176). Women exposed to passive smoking had an increased risk of delivering low birth weight infants (aOR = 1.404, 95%CI = 1.057–1.864). Insufficient gestational weight gain and excessive gestational weight gain were both significantly associated with low birth weight (aOR = 1.484, 95%CI = 1.103–1.998 and aOR = 0.369, 95%CI = 0.236–0.577, respectively) for term deliveries. In addition, parity, history of low birth weight, antenatal care and gestational hypertension were significantly associated with the likelihood of low birth weight.

Conclusion

Pregnant women without exercise contraindications should remain physically active. Pregnant women should be aware of the negative effects of smoke and be aware of strategies to protect themselves from passive smoke exposure. Hospitals should inform pregnant women of the importance appropriate gestational weight gain. These recommendations should be put into practice to decrease the prevalence of low birth weight infants.

Maternal Cotinine Levels and Red Blood Cell Folate Concentrations in the Periconceptual Period

OBJECTIVES

Studies have examined the association between tobacco use and folate levels in pregnancy, yet few have assessed this relation using objective and accurate measures of both smoking and folate. In this study, we evaluated the association between maternal cotinine levels and periconceptional red blood cell (RBC) folic acid reserves in a cohort of low-income pregnant mothers.

METHODS

Smoking information, based on salivary cotinine, a highly sensitive and specific tobacco smoke exposure biomarker, was used. Furthermore, folate was assessed using RBC folate, an indicator of long-term folate storage. Participants were early to mid-trimester pregnant women who received antenatal care between 2011 and 2015 at the Genesis Clinic of Tampa (Florida). A total of 496 women were enrolled in the study. Associations between smoking status/maternal salivary cotinine concentrations, sociodemographic factors, and folate concentrations were investigated using Tobit regression analyses.

RESULTS

The mean folate level of the participants was 718.3 ± 183.2 ng/mL, and only 2 (0.4%) participants were deficient in folate. We observed no significant difference in folate levels by smoking status. In contrast, salivary cotinine levels were significantly associated with decreased RBC folate concentrations (β -11.43, standard error 5.45, P = 0.032). Prepregnancy maternal body mass index, gestational age, stress, and depression also were associated with folate levels.

CONCLUSIONS

Low RBC folate is associated with perinatal factors, including high maternal cotinine levels, body mass index, stress, and depression. The effect of low folate levels among smokers cannot be overemphasized, considering that tobacco products not only reduce folate levels but also decrease the bioutilization of folate.

Associations of smoking behavior with lifestyle and mental health among Japanese dental students

BACKGROUND

Smoking is a major risk factor for cancer and cardiovascular disease. However, mental stress leads to smoking in dental students. We believe that dentists, as health professionals, should set an example for the public. Therefore, this study determined the prevalence of and factors associated with regular smoking among Japanese dental students. We also surveyed their attitudes regarding smoking cessation and how to counsel smokers about quitting.

METHODS

We collected demographic and behavioral data from 453 students at Kyushu Dental University, and evaluated their mental health with the 12-item General Health Questionnaire (GHQ 12). We also asked them nine questions related to their intentions to counsel smokers about quitting. A multivariate binary logistic regression analysis was used to identify factors associated with smoking.

RESULTS

Fifty-two (11.5%) of the dental students smoked. Univariate analyses indicated that male gender, higher academic year, greater number of times eating out per day, alcohol consumption, prevalence of skipping breakfast, poor health, and poor sleep habits were significantly associated with regular smoking. Regular smokers were less likely to have GHQ 12 scores ≥4. On multivariate analysis, male gender (OR = 5.449, 95% CI = 1.851-16.040), sixth year students (OR = 21.971, 95% CI = 1.686-286.290), eating out two or more times a day (OR = 2.492, 95% CI = 1.165-5.331), drinking alcohol three or more times per week (OR = 9.484, 95% CI = 3.335-26.970), and GHQ 12 score ≥ 4 (OR = 0.339, 95% CI = 0.136-0.845) were significantly associated with regular smoking. Overall, 50.1% of the non-smokers and 71.2% of the regular smokers responded that patients' chances of quitting smoking are not increased when a dentist advises them to quit.

CONCLUSIONS

Regular smoking was strongly associated with male gender, higher academic year, alcohol consumption, and higher frequency of eating out per day. Mental health status among regular smokers was better than that among non-current smokers. Furthermore, we found that more than half of dental students have inadequate attitudes to advise their patients to quit smoking. It is necessary to develop educational programs regarding smoking for dental students.

Does Maternal Exposure to Secondhand Tobacco Smoke During Pregnancy Increase the Risk for Preterm or Small-for-Gestational Age Birth?

Introduction While associations between active smoking and various adverse birth outcomes (ABOs) have been reported in the literature, less is known about the impact of secondhand smoke (SHS) on many pregnancy outcomes. Methods We examined the relationship between maternal exposure to SHS during pregnancy and preterm (< 37 weeks gestation) and small-for-gestational age (SGA; assessed using sex-, race/ethnic-, and parity-specific growth curves) singleton births using non-smoking controls from the National Birth Defects Prevention Study (1997-2011). Multivariable logistic regression models for household, workplace/school, and combined SHS exposure-controlled for maternal education, race/ethnicity, pre-pregnancy body mass index, and high blood pressure-were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Interaction was assessed for maternal folic acid supplementation, alcohol use, age at delivery, and infant sex. Results Infants of 8855 mothers were examined in the preterm birth analysis with 666 (7.5%) categorized as preterm, 574 moderately preterm (32-36 weeks), and 92 very preterm (< 32 weeks). For the SGA analysis, infants of 8684 mothers were examined with 670 (7.7%) categorized as SGA. The aORs for mothers reporting both household and workplace/school SHS were elevated for preterm (aOR 1.99; 95% CI 1.13-3.50) and moderately preterm birth (32-36 weeks) (aOR 2.17; 95% CI 1.22-3.88). No results for the SGA analysis achieved significance, nor was evidence of interaction evident. Conclusion The findings suggest an association between SHS from multiple exposure sources and preterm birth, but no evidence for association with SGA births. Continued study of SHS and ABOs is needed to best inform public health prevention programs.

Public health benefits from pictorial health warnings on US cigarette packs: a SimSmoke simulation

INTRODUCTION

While many countries have adopted prominent pictorial warning labels (PWLs) for cigarette packs, the USA still requires only small, text-only labels located on one side of the cigarette pack that have little effect on smoking-related outcomes. Tobacco industry litigation blocked implementation of a 2011 Food and Drug Administration's (FDA) rule requiring large PWLs. To inform FDA action on PWLs, this study provides research-based estimates of their public health impacts.

METHODS

Literature was reviewed to identify the impact of cigarette PWLs on smoking prevalence, cessation and initiation. Based on this analysis, the SimSmoke model was used to estimate the effect of requiring PWLs in the USA on smoking prevalence and, using standard attribution methods, on smoking-attributable deaths (SADs) and key maternal and child health outcomes.

RESULTS

Available research consistently shows a direct association between PWLs and increased cessation and reduced smoking initiation and prevalence. The SimSmoke model projects that PWLs would reduce smoking prevalence by 5% (2.5%-9%) relative to the status quo over the short term and by 10% (4%-19%) over the long term. Over the next 50 years, PWLs are projected to avert 652 800 (327 000-1 190 500) SADs, 46 600 (17 500-92 300) low-birth-weight cases, 73 600 (27 800-145 100) preterm births and 1000 (400-2000) cases of sudden infant death syndrome.

CONCLUSIONS

Requiring PWLs on all US cigarette packs would be appropriate for the protection of the public health, because it would substantially reduce smoking prevalence and thereby reduce SADs and the morbidity and medical costs associated with adverse smoking-attributable birth outcomes.

Low-level maternal exposure to nicotine associates with significant metabolic perturbations in second-trimester amniotic fluid

Decades of public health research have documented that smoking in pregnancy poses significant health risks to both mother and child. More recent studies have shown that even passive maternal exposure to secondhand smoke associates with negative birth outcomes. However, the mechanisms linking exposure to outcomes have remained obscure. As a first step toward defining the metabolic consequence of low-level nicotine exposure on fetal development, we conducted an untargeted metabolomic analysis of 81 paired samples of maternal serum and amniotic fluid collected from karyotypically normal pregnancies in the second trimester. By comparing the m/z and retention times of our mass spectral features with confirmed standards, we identified cotinine, a nicotine derivative, and used the calculated cotinine concentrations to classify our maternal serum samples into exposure groups using previously defined cut-offs. We found that cotinine levels consistent with low-level maternal exposure to nicotine associated with distinct metabolic perturbations, particularly in amniotic fluid. In fact, the metabolic effects in amniotic fluid of ostensibly low-level exposed mothers showed greater overlap with perturbations previously observed in the sera of adult smokers than did the perturbations observed in the corresponding maternal sera. Dysregulated fetal pathways included aspartate and asparagine metabolism, pyrimidine metabolism, and metabolism of other amino acids. We also observed a strong negative association between level of maternal serum cotinine and acetylated polyamines in the amniotic fluid. Combined, these results confirm that low-level maternal nicotine exposure, indicated by a maternal serum cotinine level of 2-10ng/mL, is associated with striking metabolic consequences in the fetal compartment, and that the affected pathways overlap those perturbed in the sera of adult smokers.

Postnatal Cardiovascular Consequences in the Offspring of Pregnant Rats Exposed to Smoking and Smoking Cessation Pharmacotherapies

Approximately 20% of pregnant women smoke despite intentions to quit. Smoking cessation drugs, such as nicotine replacement therapy (NRT) and bupropion, are recommended treatments. Adverse cardiovascular outcomes in offspring have raised concerns about NRT's safety during pregnancy. However, the effect of bupropion is unknown. Using a rat model, we determined whether NRT and bupropion interventions during pregnancy are safer than continued smoking on offspring's cardiovascular function. Male offspring of controls and dams exposed to cigarette smoke (1.6 packs/day, inhalation), nicotine (2 mg/kg/d subcutaneously), and bupropion (13 mg/kg twice daily orally) were assessed for fetoplacental weight, cardiac function, blood pressure, and vascular reactivity. Fetoplacental weights were decreased and spontaneous beating and intracellular calcium in neonatal cardiomyocytes were increased in smoking, nicotine, and bupropion offspring; however, these effects were more accentuated in smoking followed by nicotine and bupropion offspring. Increased heart rate and decreased cardiac output, stroke volume, and left ventricular percent posterior wall thickening were observed in smoking, nicotine, and bupropion offspring. The left ventricular mass was reduced in smoking and nicotine but not in bupropion offspring. Blood pressure was higher with decreased endothelium-dependent relaxation and exaggerated vascular contraction to angiotensin II in smoking and nicotine offspring, with more pronounced dysfunctions in smoking than nicotine offspring. Maternal bupropion did not impact offspring's blood pressure, endothelium-dependent relaxation, and vascular contraction. In conclusion, maternal nicotine intervention adversely affects offspring's cardiovascular outcomes, albeit less severely than continued smoking. However, bupropion causes cardiac derangement in offspring but does not adversely affect blood pressure and vascular function.

Smoking Trajectories during the Perinatal Period and Their Risk Factors: The Nationally Representative French ELFE (Etude Longitudinale Française Depuis l’Enfance) Birth Cohort Study

BACKGROUND

In France, rates of perinatal smoking are among the highest worldwide; however, perinatal smoking trajectories and associated factors have still not been adequately researched.

METHODS

Among women participating in the French nationally representative etude longitudinale française depuis l'enfance birth cohort (n = 15,540), perinatal smoking trajectories were estimated using group-based modelling. Associated characteristics were studied using multinomial logistic regression.

RESULTS

Four trajectories were identified: non-smokers (59%), quitters (20%), persistent moderate (12%) and persistent heavy (9%) smokers. Older age, being native French, low socioeconomic position, persistent psychological difficulties and alcohol use in pregnancy, lack of social support, partner's smoking, mistimed pregnancy, and child formula feeding at birth were associated with persistent heavy smoking. Most of these factors were also associated, but to a lesser extent, with persistent moderate smoking, except for age and migrant status, which had opposite effects. Women who successfully lost weight prior to pregnancy had higher levels of quitting smoking.

CONCLUSION

Women's long-term smoking trajectories vary in terms of initial tobacco consumption level but also in relation to socio-demographic, psychological, behavioral and partner characteristics. Health professionals in contact with pregnant smokers should address perceived risks and benefits of smoking, including partner's smoking and weight-gain concerns.

Associations between maternal periconceptional exposure to secondhand tobacco smoke and major birth defects

BACKGROUND

While associations between secondhand smoke and a few birth defects (namely, oral clefts and neural tube defects) have been noted in the scientific literature, to our knowledge, there is no single or comprehensive source of population-based information on its associations with a range of birth defects among nonsmoking mothers.

OBJECTIVE

We utilized data from the National Birth Defects Prevention Study, a large population-based multisite case-control study, to examine associations between maternal reports of periconceptional exposure to secondhand smoke in the household or workplace/school and major birth defects.

STUDY DESIGN

The multisite National Birth Defects Prevention Study is the largest case-control study of birth defects to date in the United States. We selected cases from birth defect groups having >100 total cases, as well as all nonmalformed controls (10,200), from delivery years 1997 through 2009; 44 birth defects were examined. After excluding cases and controls from multiple births and whose mothers reported active smoking or pregestational diabetes, we analyzed data on periconceptional secondhand smoke exposure-encompassing the period 1 month prior to conception through the first trimester. For the birth defect craniosynostosis, we additionally examined the effect of exposure in the second and third trimesters as well due to the potential sensitivity to teratogens for this defect throughout pregnancy. Covariates included in all final models of birth defects with ≥5 exposed mothers were study site, previous live births, time between estimated date of delivery and interview date, maternal age at estimated date of delivery, race/ethnicity, education, body mass index, nativity, household income divided by number of people supported by this income, periconceptional alcohol consumption, and folic acid supplementation. For each birth defect examined, we used logistic regression analyses to estimate both crude and adjusted odds ratios and 95% confidence intervals for both isolated and total case groups for various sources of exposure (household only; workplace/school only; household and workplace/school; household or workplace/school).

RESULTS

The prevalence of secondhand smoke exposure only across all sources ranged from 12.9-27.8% for cases and 14.5-15.8% for controls. The adjusted odds ratios for any vs no secondhand smoke exposure in the household or workplace/school and isolated birth defects were significantly elevated for neural tube defects (anencephaly: adjusted odds ratio, 1.66; 95% confidence interval, 1.22-2.25; and spina bifida: adjusted odds ratio, 1.49; 95% confidence interval, 1.20-1.86); orofacial clefts (cleft lip without cleft palate: adjusted odds ratio, 1.41; 95% confidence interval, 1.10-1.81; cleft lip with or without cleft palate: adjusted odds ratio, 1.24; 95% confidence interval, 1.05-1.46; cleft palate alone: adjusted odds ratio, 1.31; 95% confidence interval, 1.06-1.63); bilateral renal agenesis (adjusted odds ratio, 1.99; 95% confidence interval, 1.05-3.75); amniotic band syndrome-limb body wall complex (adjusted odds ratio, 1.66; 95% confidence interval, 1.10-2.51); and atrial septal defects, secundum (adjusted odds ratio, 1.37; 95% confidence interval, 1.09-1.72). There were no significant inverse associations observed.

CONCLUSION

Additional studies replicating the findings are needed to better understand the moderate positive associations observed between periconceptional secondhand smoke and several birth defects in this analysis. Increased odds ratios resulting from chance (eg, multiple comparisons) or recall bias cannot be ruled out.

Smoking during pregnancy: A population-based study

AIMS

Tobacco is a major cause of disease and mortality in modern times. The risk of smoking in pregnancy is a serious threat to the development and future health of an unborn child. The aim of this study was to explore the epidemiological factors associated with smoking during pregnancy in a primary healthcare setting.

METHODS

All 856 maternity records at the Glaesibaer Health Care Centre in Reykjavik during 2006-2013 were reviewed and information on smoking habits investigated.

RESULTS

The records showed that in 108 (12.2%) pregnancies, women smoked at first visit and 63 stopped smoking in early pregnancy, leaving 45 (5.3%) mothers smoking throughout the whole gestational period. The mean age of the smoking women was 27.8 years and for the non-smokers 29.7 years. Low social status (odds ratio (OR) = 2.66; 95% confidence interval (CI): 1.19-5.96), previous mental health diagnosis (OR = 2.7; 95% CI: 1.3-5.6), and unstable relationship with a partner (OR = 3.78; 95% CI: 2.1-7.0) were associated with smoking. Smoking fewer cigarettes was associated with a 0.04-unit lower risk of smoking during pregnancy (OR = 0.04: 95% CI: 0.02-0.08).

CONCLUSIONS

Our results indicated that the women who smoked during pregnancy were often heavy smokers and living without a partner. They were younger, had worse mental health, and a lower social status than those pregnant women who did not smoke. Bearing in mind the consequence of smoking in pregnancy, this subgroup should get increased assistance to quit smoking before and during early pregnancy, as well as appropriate medical and social support.

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.

Understanding Inequalities of Maternal Smoking--Bridging the Gap with Adapted Intervention Strategies

Women who are generally part of socially disadvantaged and economically marginalized groups are especially susceptible to smoking during pregnancy but smoking rates are underreported in both research and interventions. While there is evidence to support the short-term efficacy of nicotine replacement therapy (NRT) use in pregnancy, long-term abstinence rates are modest. Current health strategies and interventions designed to diminish smoking in pregnancy have adopted a simplified approach to maternal smoking-one that suggests that they have a similar degree of choice to non-pregnant smokers regarding the avoidance of risk factors, and overlooks individual predictors of non-adherence. As a result, interventions have been ineffective among this high-risk group. For this reason, this paper addresses the multiple and interacting determinants that must be considered when developing and implementing effective strategies that lead to successful smoking cessation: socioeconomic status (SES), nicotine dependence, social support, culture, mental health, and health services. Based on our review of the literature, we conclude that tailoring cessation programs for pregnant smokers may ultimately optimize NRT efficacy and reduce the prevalence of maternal smoking.

Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use

OBJECTIVES

Previous estimates of smoking-attributable adverse outcomes, such as preterm births (PTBs), low birth weight (LBW) and Sudden Infant Death Syndrome (SIDs) generally do not address disparities by maternal age, racial/ethnic group or socioeconomic status (SES). This study develops estimates of smoking-attributable PTB, LBW and SIDS for the US by age, SES and racial/ethnic groupings.

METHODS

Data on the number of births and the prevalence of PTB, LBW and SIDS were used to develop the number of outcomes by age, race/ethnicity, and SES. The prevalence of prenatal smoking by age, race/ethnic and education and the relative risk of outcomes for smokers were used to calculate smoking-attributable fractions of outcomes.

RESULTS

Prenatal smoking among ages 15-24 is above 12 %, with 20-24 year olds representing at least 35 % of PTB, LBW SIDS cases. Women with a high school education or less represented more than 50 % of PTB and LBW births, and 44 % of SIDS cases. While non-Hispanic Whites had the majority of smoking-attributable outcomes, non-Hispanic Blacks represented a disproportionately high percentage of PTBs (18 %), LBW births (22 %), and SIDS cases (13 %).

CONCLUSIONS

Reducing prenatal smoking has the potential to reduce adverse birth outcomes and costs with long-term implications, especially among the young, non-Hispanic Blacks and those of lower SES. Stricter tobacco control policies, especially higher cigarette taxes, higher minimum purchase ages for tobacco and improved cessation interventions can help reduce disparities and the cost to insurers, especially public costs through Medicaid.

Estimating the Potential Impact of Tobacco Control Policies on Adverse Maternal and Child Health Outcomes in the United States Using the SimSmoke Tobacco Control Policy Simulation Model

INTRODUCTION

Numerous studies document the causal relationship between prenatal smoking and adverse maternal and child health (MCH) outcomes. Studies also reveal the impact that tobacco control policies have on prenatal smoking. The purpose of this study is to estimate the effect of tobacco control policies on prenatal smoking prevalence and adverse MCH outcomes.

METHODS

The US SimSmoke simulation model was extended to consider adverse MCH outcomes. The model estimates prenatal smoking prevalence and, applying standard attribution methods, uses estimates of MCH prevalence and relative smoking risks to estimate smoking-attributable MCH outcomes over time. The model then estimates the effect of tobacco control policies on adverse birth outcomes averted.

RESULTS

Different tobacco control policies have varying impacts on the number of smoking-attributable adverse MCH birth outcomes. Higher cigarette taxes and comprehensive marketing bans individually have the biggest impact with a 5% to 10% reduction across all outcomes for the period from 2015 to 2065. The policies with the lowest impact (2%-3% decrease) during this period are cessation treatment, health warnings, and complete smoke-free laws. Combinations of all policies with each tax level lead to 23% to 28% decreases across all outcomes.

CONCLUSIONS

Our findings demonstrate the substantial impact of strong tobacco control policies for preventing adverse MCH outcomes, including long-term health implications for children exposed to low birth weight and preterm birth. These benefits are often overlooked in discussions of tobacco control.

Knowledge and attitudes of adults towards smoking in pregnancy: results from the HealthStyles© 2008 survey

Smoking during pregnancy is causally associated with many adverse health outcomes. Quitting smoking, even late in pregnancy, improves some outcomes. Among adults in general and reproductive-aged women, we sought to understand knowledge and attitudes towards prenatal smoking and its effects on pregnancy outcomes. Using data from the 2008 HealthStyles© survey, we assessed knowledge and attitudes about prenatal smoking and smoking cessation. We classified respondents as having high knowledge if they gave ≥ 5 correct responses to six knowledge questions regarding the health effects of prenatal smoking. We calculated frequencies of correct responses to assess knowledge about prenatal smoking and estimated relative risk to examine knowledge by demographic and lifestyle factors. Only 15 % of all respondents and 23 % of reproductive-aged women had high knowledge of the adverse effects of prenatal smoking on pregnancy outcomes. Preterm birth and low birth weight were most often recognized as adverse outcomes associated with prenatal smoking. Nearly 70 % of reproductive-aged women smokers reported they would quit smoking if they became pregnant without any specific reasons from their doctor. Few respondents recognized the benefits of quitting smoking after the first trimester of pregnancy. Our results suggest that many women lack knowledge regarding the increased risks for adverse outcomes associated with prenatal smoking. Healthcare providers should follow the recommendations provided by the American Congress of Obstetricians and Gynecologists, which include educating women about the health risks of prenatal smoking and the benefits of quitting. Healthcare providers should emphasize quitting smoking even after the first trimester of pregnancy.

Inequities in workplace secondhand smoke exposure among nonsmoking women of reproductive age

OBJECTIVES

We characterized workplace secondhand smoke exposure among nonsmoking women of reproductive age as a proxy for workplace secondhand smoke exposure during pregnancy.

METHODS

We included nonsmoking women aged 18 to 44 years employed during the past 12 months who participated in the 2010 National Health Interview Survey. We estimated the prevalence of workplace secondhand smoke exposure and its associations with sociodemographic and workplace characteristics.

RESULTS

Nine percent of women reported workplace secondhand smoke exposure. Prevalence decreased with increasing age, education, and earnings. Workplace secondhand smoke exposure was associated with chemical exposure (prevalence odds ratio [POR] = 3.3; 95% confidence interval [CI] = 2.3, 4.7); being threatened, bullied, or harassed (POR = 3.2; 95% CI = 2.1, 5.1); vapors, gas, dust, or fume exposure (POR = 3.1; 95% CI = 2.3, 4.4); and worrying about unemployment (POR = 3.0; 95% CI = 1.8, 5.2), among other things.

CONCLUSIONS

Comprehensive smoke-free laws covering all workers could eliminate inequities in workplace secondhand smoke exposure, including during pregnancy.

Public Health Effects of Restricting Retail Tobacco Product Displays and Ads

OBJECTIVES

To estimate the public health impact from restricting US retail point-of-sale (POS) tobacco product displays and advertising.

METHODS

Based on existing research, this paper estimates the effects on initiation and cessation rates from restricting POS tobacco product displays and ads in the US and uses the SimSmoke simulation model to project related smoking declines and health benefits.

RESULTS

New comprehensive POS restrictions are projected to reduce smoking prevalence by approximately 16% [range=3%-31%] relative to the status quo by 2065, preventing about 630,000 smoking-attributable deaths [range=108,000-1,225,000], 215,000 low birth weight births [range=33,000-421,000], 140,000 preterm births [range=22,000-271,000], and 1900 infant deaths from SIDSs [range=300-3800].

CONCLUSIONS

Federal, state, or local action to restrict POS tobacco product displays and ads would contribute to a substantial reduction in smoking-attributed death and disease.

In utero exposure to cigarette smoking, environmental tobacco smoke and reproductive hormones in US girls approaching puberty

BACKGROUND/AIMS

Evidence is unclear whether prenatal smoking affects age at menarche and pubertal development, and its impact upon hormones has not been well studied. We aim to identify potential pathways through which prenatal smoking and environmental tobacco smoke (ETS) affect reproductive hormones in girls approaching puberty.

METHODS

We examined the association between prenatal smoking, current ETS and luteinizing hormone (LH) and inhibin B (InB) in 6- to 11-year-old girls in the 3rd National Health and Nutrition Examination Survey, 1988-1994. Parents/guardians completed interviewer-assisted questionnaires on health and demographics at the time of physical examination. Residual blood samples were analyzed for reproductive hormones in 2008.

RESULTS

Of 660 girls, 19 and 39% were exposed to prenatal smoke and current ETS, respectively. Accounting for multiple pathways in structural equation models, prenatally exposed girls had significantly lower LH (β = -0.205 log-mIU/ml, p < 0.0001) and InB (β = -0.162, log-pg/ml, p < 0.0001). Prenatal smoking also influenced LH positively and InB negatively indirectly through BMI-for-age. ETS was positively associated with LH, but not with InB.

CONCLUSION

Exposure to maternal smoking may disrupt reproductive development manifesting in altered hormone levels near puberty.

Serum cotinine and whole blood folate concentrations in pregnancy

PURPOSE

Prenatal tobacco smoke exposure may be associated with low maternal folate levels that increase the risk of adverse infant and child health outcomes by reducing folate availability during fetal development.

METHODS

Using data from the Health Outcomes and Measures of the Environment Study, we examined the relationship between secondhand or active tobacco smoke exposure and whole blood folate concentrations in pregnant women from Cincinnati, Ohio (n = 362) at approximately 16-week gestation. We used multivariable linear regression to examine the association between continuous or categorical serum cotinine levels and whole blood folate levels, adjusting for sociodemographic, dietary, and perinatal variables.

RESULTS

After adjustment for potential confounders, an interquartile range increases in serum cotinine concentration (0.012-0.224 ng/mL) was suggestively associated with decreased whole blood folate levels (β, -23 nmol/L; 95% confidence interval (CI), -49, 3; P value = .08). Compared with unexposed women, reductions in mean whole blood folate were observed among active smokers (β, -94, 95% CI, 195, 6 nmol/L; P value = .40); smaller reductions were observed among women with secondhand exposure (β, 26; CI, 84, 32 nmol/L; P value = .07).

CONCLUSIONS

Consistent with prior studies, active smoking was associated with reduced whole blood folate levels among these pregnant women. Secondhand tobacco smoke exposures were associated with small and imprecise reductions in whole blood folate levels.

Smoking during pregnancy: childbirth and health study in primary care in Iceland

OBJECTIVE

To study the prevalence and possible predictors for smoking during pregnancy in Iceland.

DESIGN

A cross-sectional study.

SETTING

Twenty-six primary health care centres in Iceland 2009-2010. SUBJECTS. Women attending antenatal care in the 11th-16th week of pregnancy were invited to participate by convenient consecutive manner, stratified according to residency. A total of 1111 women provided data in this first phase of the cohort study.

MAIN OUTCOME MEASURES

Smoking habits before and during early pregnancy were assessed with a postal questionnaire, which also included questions about socio-demographic background, physical and emotional well-being, and use of medications.

RESULTS

The prevalence of smoking prior to pregnancy was 20% (223/1111). During early pregnancy, it was 5% (53/1111). In comparison with women who stopped smoking during early pregnancy, those who continued to smoke had on average a significantly lower level of education, had smoked more cigarettes per day before pregnancy, and were more likely to use nicotine replacement therapy in addition to smoking during pregnancy. A higher number of cigarettes consumed per day before pregnancy and a lower level of education were the strongest predictors for continued smoking during pregnancy.

CONCLUSION

The majority of Icelandic women who smoke stop when they become pregnant, and the prevalence of smoking during pregnancy in Iceland is still about 5%. Our results indicate stronger nicotine dependence in women who do not stop smoking during pregnancy. Awareness of this can help general practitioners (GPs) and others providing antenatal care to approach these women with more insight and empathy, which might theoretically help them to quit.

The effects of smoking on steroid metabolism and fetal programming

Tobacco addiction is a serious psychosocial and health problem. A pregnant woman who smokes not only influences the maternal organism, but also passes health risks on to the unborn child. A fetus exposed to maternal smoking is not only directly influenced, but is also endangered by a wide range of diseases up to his or her adult years. The components of tobacco smoke play a significant role in the development of a number of diseases for a large proportion of the smoking population, as well as among those pregnant. This article summarizes findings regarding the impacts on the production of steroid hormones - first describing the smoking-related changes in steroidogenesis in women, and then focusing on the influence of maternal smoking on the fetus's developing steroidogenesis. We assume that if during prenatal development the fetus has already been exposed to the effect of endocrine disruptors at the time fetal steroidogenesis begins fetal programming, this exposure can have serious pathophysiological effects both in the pregnancy as well as later in life. An example of such effects might be a delay in the creation of kidney adrenal androgens, which could also be evident on the level of steroid neuroactive metabolites that may influence the individual's psychological state and lead to later addictions.

A pilot study testing SMS text delivered scheduled gradual reduction to pregnant smokers

INTRODUCTION

Smoking during pregnancy causes multiple perinatal complications; yet, the smoking rate among pregnant women has remained relatively stagnant. Most interventions to help pregnant smokers quit or reduce their smoking are not easily disseminable. Innovative and disseminable interventions are needed.

METHODS

We recruited 31 pregnant smokers in their second trimester from prenatal clinics. We assessed feasibility, acceptability, and preliminary efficacy of an SMS text-based intervention in a 2-arm design. We compared SMS-delivered support messages to an intervention that provided support messages plus a scheduled gradual reduction (SGR) to help women reduce their smoking more than 3 weeks. We sent women in the SGR arm "alert texts" at times to instruct them to smoke. We asked women not to smoke unless they received an alert text.

RESULTS

Most women (86%) reported reading most or all of the texts. Women in both arms rated the program as helpful (M = 6, SD = 1 vs. M = 5, SD = 2, SGR vs. support only, respectively). Women in the SGR arm had a higher rate of biochemically validated 7-day point prevalence at the end of pregnancy 13.4% versus 7.5%. Of those still smoking, women reduced their smoking substantially with more reduction in the SGR arm (SGR arm: M = 16, SD = 11 vs. support messages only: M = 12, SD = 7).

CONCLUSIONS

We developed an easily disseminable intervention that could possibly promote cessation and reduction among pregnant women with SMS texting ability. Women in this pilot were enthusiastic about the program, particularly those in the SGR arm. This program needs further examination.

Postnatal metabolic and reproductive consequences of fetal and neonatal exposure to the smoking cessation drug bupropion

INTRODUCTION

In all, 10% to 20% of all pregnant women smoke despite intentions to quit. Smoking cessation drugs such as nicotine replacement therapy (NRT) and bupropion are recommended for pregnant women. Our observation that developmental exposure to nicotine adversely affects metabolic and reproductive outcomes in rats has raised concerns about NRT's safety during pregnancy. Conversely, the effect of bupropion has not been reported.

OBJECTIVE

The goal of this study was to examine the effect of fetal and neonatal exposure to bupropion on postnatal metabolic and reproductive outcomes.

METHODS

Dams (N = 5/group) were exposed to saline or bupropion (5 or 10 mg/kg per d) for 2 weeks prior to mating until weaning. We assessed weight, adiposity, and glucose homeostasis in all offspring until 26 weeks of age. Onset of puberty, fertility, and pregnancy outcomes in the female offspring were also assessed.

RESULTS

Fetal and neonatal exposure to bupropion did not cause metabolic derangement in the offspring despite a significant decrease in birth weight in the offspring of dams treated with 10/mg/kg per d bupropion (5.9 ± 0.2 g vs control 6.7 ± 0.2 g; P = .02). Moreover, with the exception of accelerated pubertal onset in F1 and F2 offspring, bupropion administration to pregnant dams had no impact on fertility or pregnancy outcomes for either the dam or the female offspring.

CONCLUSION

Fetal and neonatal exposure to the smoking cessation drug bupropion, unlike NRT, does not appear to adversely affect metabolic outcomes or the fertility of the female offspring. However, bupropion does appear to alter pubertal onset through an as yet unknown mechanism.

[Perinatality in the context of addictions]

We must remove bad representations the medical team has upon the pregnant drug users and the same way in reverse. Opiate substitution treatment (OST) improves prenatal prognosis for both mother and child. There is no need to change OST for a stabilized woman discovering pregnancy. Nevertheless, buprenorphine appears to be first-range medication. OST posology is the most important for prenatal prognosis. Practician must never hesitate to adapt it whether increasing or fractionate it. Neonatal abstinence syndrome (NAS) is not linked with OST's posology. OST is not contra-indicated for breast-feeding. Breast-feeding should be encouraged. It does not treat or cure NAS but allows a skin-to-skin contact that could lessens an occurring withdrawal.

Prenatal secondhand smoke exposure and infant birth weight in China

Epidemiologic evidence provides some support for a causal association between maternal secondhand smoke (SHS) exposure during pregnancy and reduction in infant birth weight. The purpose of this cross-sectional study is to examine the magnitude of this association in China, where both prevalence and dose of SHS exposure are thought to be higher than in U.S. populations. Women who gave birth in Beijing and Changchun September 2000–November 2001 were interviewed to quantify self-reported prenatal SHS exposure. Their medical records were reviewed for data on pregnancy complications and birth outcomes. Non-smoking women who delivered term babies (≥37 weeks gestation) were included in the study (N = 2,770). Nearly a quarter of the women (24%) reported daily SHS exposure, 47% reported no prenatal exposure, and 75% denied any SHS exposure from the husband smoking at home. Overall, no deficit in mean birth weight was observed with exposure from all sources of SHS combined (+11 grams, 95% CI: +2, +21). Infants had higher mean birth weights among the exposed than the unexposed for all measures of SHS exposure. Future studies on SHS exposure and infant birth weight in China should emphasize more objective measures of exposure to quantify and account for any exposure misclassification.

Micronuclei levels in mothers and their newborns from regions with different types of air pollution

The aim of this study was to analyze genetic damage in human lymphocytes measured using automated image analysis of micronuclei (MN) in a group of 178 mothers and their newborns from two locations in the Czech Republic. The concentrations of benzo[a]pyrene (B[a]P), particulate matter of aerodynamic diameter <2.5 μm (PM2.5) and benzene were measured by stationary monitoring in the winter season of 2008/2009 in the capital city of Prague and in Ceske Budejovice, a regional city in a rural area. The 3-month mean concentration of B[a]P before delivery was lower in Prague in comparison with Ceske Budejovice: 1.9 ± 0.5ng/m³ vs. 3.2 ± 0.2ng/m³ (p<0.001). The opposite trend was found for PM2.5 and benzene: 27.0 ± 2.5μg/m³ and 2.5 ± 0.5μg/m³ vs. 24.5 ± 0.7μg/m³ and 2.1 ± 0.8μg/m³ (p<0.001) for Prague vs. Ceske Budejovice, respectively. The average age of the mothers was 31 years (range, 18-49 years). The frequencies of MN per 1000 binucleated cells were 8.35 ± 3.06 vs. 6.47 ± 2.35 (p<0.001) for mothers from Prague and Ceske Budejovice, respectively, and 2.17 ± 1.32 vs. 3.82 ± 2.43 (p<0.001) for newborns from Prague and Ceske Budejovice, respectively. Other factors, including vitamin intake, exposure to tobacco smoke, body mass index (BMI) before pregnancy, the education level of the mothers and the impact of the mothers' and fathers' ages were analyzed in our study. The results suggest that the different sensitivity of the study groups to various mixtures of carcinogenic pollutants could be affected by significant differences in lifestyle factors. Possible higher genetic damage was analyzed in newborns of smoking mothers, and the birth weight of this group was 7.4% lower (p<0.05) in comparison with the newborns of nonsmoking mothers. No impact of the age of the mothers or fathers on MN frequency in the newborns was observed.