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Association between early gestation passive smoke exposure and neonatal size among self-reported non-smoking women by race/ethnicity: A cohort study. PLoS One 2021; 16:e0256676. [PMID: 34793459 PMCID: PMC8601432 DOI: 10.1371/journal.pone.0256676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022] Open
Abstract
Understanding implications of passive smoke exposure during pregnancy is an important public health issue under the Developmental Origins of Health and Disease paradigm. In a prospective cohort of low-risk non-smoking pregnant women (NICHD Fetal Growth Studies—Singletons, 2009–2013, N = 2055), the association between first trimester passive smoke exposure and neonatal size was assessed by race/ethnicity. Plasma biomarker concentrations (cotinine, nicotine) assessed passive smoke exposure. Neonatal anthropometric measures included weight, 8 non-skeletal, and 2 skeletal measures. Linear regression evaluated associations between continuous biomarker concentrations and neonatal anthropometric measures by race/ethnicity. Cotinine concentrations were low and the percent above limit of quantification varied by maternal race/ethnicity (10% Whites; 14% Asians; 15% Hispanics; 49% Blacks). The association between cotinine concentration and infant weight differed by race/ethnicity (Pinteraction = 0.034); compared to women of the same race/ethnicity, per 1 log-unit increase in cotinine, weight increased 48g (95%CI -44, 139) in White and 51g (95%CI -81, 183) in Hispanic women, but decreased -90g (95%CI -490, 309) in Asian and -93g (95%CI -151, -35) in Black women. Consistent racial/ethnic differences and patterns were found for associations between biomarker concentrations and multiple non-skeletal measures for White and Black women (Pinteraction<0.1). Among Black women, an inverse association between cotinine concentration and head circumference was observed (−0.20g; 95%CI −0.38, −0.02). Associations between plasma cotinine concentration and neonatal size differed by maternal race/ethnicity, with increasing concentrations associated with decreasing infant size among Black women, who had the greatest biomarker concentrations. Public health campaigns should advocate for reducing pregnancy exposure, particularly for vulnerable populations.
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Amyx M, Zeitlin J, Hermann M, Castetbon K, Blondel B, Le Ray C. Maternal characteristics associated with gestational weight gain in France: a population-based, nationally representative study. BMJ Open 2021; 11:e049497. [PMID: 34215613 PMCID: PMC8256790 DOI: 10.1136/bmjopen-2021-049497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To provide nationally representative estimates of gestational weight gain (GWG) and identify maternal characteristics associated with inadequate GWG in France. DESIGN A population-based study using data from the French National Perinatal Survey: 2010 and 2016. SETTING All maternity units in metropolitan, mainland France (n=535 in 2010; n=493 in 2016). PARTICIPANTS Singleton live births with GWG data (N=24 850). PRIMARY OUTCOME MEASURES GWG was calculated as end of pregnancy minus pre-pregnancy weight (kg) and categorised as 'insufficient', 'adequate', or 'excessive' using 2009 Institute of Medicine thresholds. Classification accounted for pre-pregnancy body mass index (BMI) (kg/m2; underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), obese (≥30)) and gestational age at birth. We estimated average GWG and the percentage of women in each GWG category. Polytomous logistic regression identified characteristics associated with GWG adequacy. RESULTS Average GWG was 13.0 kg (SD 5.6), with 26.8% of women gaining insufficiently, 37.0% adequately and 36.1% excessively. Among other factors, insufficient GWG was associated with underweight (vs normal weight; adjusted OR (aOR) 1.4, 95% CI 1.2 to 1.5) and obese (aOR 1.5, 95% CI 1.4 to 1.7) BMI. Excessive GWG was associated with overweight (aOR 2.8, 95% CI 2.6 to 3.1) and obese BMI (aOR 3.3, 95% CI 2.9 to 3.6). Examining obesity classes separately, odds of insufficient GWG increased from obesity class I to III, while odds of excessive GWG decreased from obesity class I to III. Primiparity (insufficient: aOR 0.9, 95% CI 0.9 to 1.0; excessive: aOR 1.2, 95% CI 1.2 to 1.3), maternal characteristics indicative of lower socioeconomic status, and continuing or quitting smoking during pregnancy were also associated with inadequate GWG. CONCLUSIONS In France, insufficient and excessive GWG are common. For optimal outcomes, clinician education, with special attention to the needs of higher risk/vulnerable groups, is needed to ensure all women receive appropriate advice for recommended GWG.
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Affiliation(s)
- Melissa Amyx
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Monika Hermann
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Katia Castetbon
- Epidemiology, Biostatistics and Clinical Research Research Center, ULB School of Public Health, Brussels, Belgium
| | - Béatrice Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Camille Le Ray
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
- Cochin Hospital Port Royal, Port Royal Maternity, Department of Obstetrics, University of Paris, APHP, Paris, France
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The Effects of Different Smoking Patterns in Pregnancy on Perinatal Outcomes in the Southampton Women's Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217991. [PMID: 33143153 PMCID: PMC7663677 DOI: 10.3390/ijerph17217991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022]
Abstract
Maternal smoking during pregnancy has established associations with poor perinatal outcomes. Among continuing pregnant smokers, harm-reduction strategies have been suggested, including temporary cessation of smoking during pregnancy, also known as partial quitting. Support for this strategy, however, remains limited. Six hundred and ninety-seven women in the Southampton Women's Survey who smoked at their last menstrual period were categorised into sustained quitters, partial quitters (quit in either the first or third trimester but not both) or sustained smokers (continued to smoke throughout pregnancy). In regression models, compared with infants born to sustained smokers, infants born to sustained quitters and partial quitters were heavier at birth by β = 0.64 standard deviations (SD) (WHO z-score) (95% CI: 0.47-0.80) and 0.48 SD (WHO z-score) (95% CI: 0.24-0.72) respectively, adjusted for confounders, with similar patterns seen for other anthropometric measures (head circumference and crown-heel length). Sustained quitters had longer gestations by β = 3.5 days (95% CI: 1.8-5.2) compared with sustained smokers, but no difference was seen for partial quitters. While sustained quitting remains the most desired outcome for pregnant smokers, partial quitting should be explored as a strategy to reduce some of the harmful effects of smoking on offspring in those who cannot achieve sustained quitting.
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Polinski KJ, Wolfe R, Peterson A, Juhl A, Perraillon MC, Levinson AH, Crume TL. Impact of an incentive-based prenatal smoking cessation program for low-income women in Colorado. Public Health Nurs 2019; 37:39-49. [PMID: 31692104 DOI: 10.1111/phn.12682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/03/2019] [Accepted: 10/17/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess birth outcomes and cost-savings of an incentive-based prenatal smoking cessation program targeting low-income women in Colorado. DESIGN Prospective observational cohort with nonequivalent population control groups. SAMPLE Program participants (n = 2,231) linked to the birth certificate to ascertain birth outcomes compared to two reference populations from Pregnancy Risk Assessment Monitoring System (PRAMS) and Colorado live births based on the birth certificate. MEASUREMENTS Tobacco cessation metrics in the third trimester of pregnancy, neonatal low birth weight (<2,500 g), preterm birth (birth at <37 weeks gestation), neonatal intensive care unit (NICU) admission and maternal gestational hypertension. Cost-savings and return on investment (ROI) were projected using average Medicaid reimbursement. RESULTS Infants of mothers enrolled in the program had a lower risk of low birthweight (RR = 0.86; 95% CI = 0.75, 0.97), preterm birth (PTB) (RR = 0.76; 95% CI = 0.65, 0.88) and neonatal intensive care unit (NICU) admission (RR = 0.76; 95% CI = 0.66, 0.88) compared to the birth certificate population, corresponding to a ROI of $7.73 and an individual cost savings of $6,040. Compared to PRAMS, infants of enrolled mothers had a lower risk of PTB (RR = 0.72; 95% CI = 0.53, 0.99) and NICU admission (RR = 0.45; 95% CI = 0.32, 0.62), corresponding to an ROI of $2.79 and an individual cost savings of $2,182. CONCLUSIONS We found a reduction of adverse birth outcomes, and cost savings.
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Affiliation(s)
- Kristen J Polinski
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel Wolfe
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne Peterson
- Colorado Department of Public Health and Environment, Health Surveys and Evaluation Branch, Center for Health and Environmental Data, Denver, CO, USA
| | - Ashley Juhl
- Colorado Department of Public Health and Environment, Health Surveys and Evaluation Branch, Center for Health and Environmental Data, Denver, CO, USA
| | - Marcelo Coca Perraillon
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Arnold H Levinson
- Department of Community and Behavioral Health, Colorado School of Public Health and University of Colorado Cancer Center University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tessa L Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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di Giacomo E, Colmegna F, Pescatore F, Aspesi F, Fotiadou M, Clerici M. The burden of personality disorders on the DSM 5 addiction to tobacco during pregnancy. Compr Psychiatry 2018; 84:101-105. [PMID: 29729554 DOI: 10.1016/j.comppsych.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Tobacco smoking is a major health concern. Many women smoke during their reproductive years, some of them during their pregnancy. Adverse outcomes for the newborns physical health are well recognized, while the influence on their mental health is still under investigation. We aim at demonstrating the contribution of maternal personality disorders in maintaining addiction to tobacco during pregnancy, to underline their role and the need of their detection as a preventive effort. METHOD 150 women, consecutively admitted to the Perinatal Psychiatric Outpatient Department were tested with the SCID II, CTQ, WHOQOL-BREF, EPDS, BDI and BAI. Tobacco use disorder was attested with the fulfillment of DSM 5 criteria. RESULTS 46% (n = 69) of the sample was affected by at least one personality disorder ("PD+"). "PD+" showed a significant higher rate of pregnant women addicted to tobacco (p = 0.021). The average number of cigarettes per day was notably distinct, since patients affected by "NPD" smokes twice the amount compared to "PD-" and "other PDs", while those affected by Borderline PD has a halfway consumption (7.20 ± 5.54 vs 3.37 ± 4.62 vs 3 ± 3.39 vs 5.50 ± 4.10). ANOVA and POST HOC showed a significance between "NPD" and "other PDs" (p = 0.035), and "other PDs" has significantly the highest rate of active smokers. CONCLUSION Personality disorders demonstrate to be a clear contributor in supporting addiction to tobacco during pregnancy. Short and long term health and mental consequences attested in the newborn, encourage awareness in detecting tobacco dependency during this sensitive period. The inclusion of personality evaluation and management in tobacco dependency treatment programs is strictly encouraged to boost their efficiency and increase tobacco abstinence.
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Affiliation(s)
- Ester di Giacomo
- PhD program in Neuroscience, Doctorate School of the University of Milano-Bicocca, Italy; School of Medicine and Surgery-University of Milano Bicocca, Italy; Psychiatric Department-ASST Monza, Italy.
| | | | | | | | - Maria Fotiadou
- Female Medium Secure Forensic Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Massimo Clerici
- School of Medicine and Surgery-University of Milano Bicocca, Italy; Psychiatric Department-ASST Monza, Italy
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Westergaard N, Gehring U, Slama R, Pedersen M. Ambient air pollution and low birth weight - are some women more vulnerable than others? ENVIRONMENT INTERNATIONAL 2017; 104:146-154. [PMID: 28390661 DOI: 10.1016/j.envint.2017.03.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/21/2017] [Accepted: 03/31/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Ambient air pollution is controllable, and it is one of the greatest environmental threats to human health. Studies conducted worldwide have provided evidence that maternal exposure to ambient air pollution during pregnancy enhances the risk of low birth weight at term (TLBW, <2500g among infants born ≥37 completed weeks of gestation), a maker of intrauterine growth restriction (IUGR), and suggest that some subgroups of pregnant women who are smoking, of low or high body-mass index (BMI), low socioeconomic status (SES) or asthma are more vulnerable towards the effect of ambient air pollution. The aim of this commentary is to review the published literature on the association between ambient air pollution and TLBW regarding increased vulnerability for the above-mentioned subgroups. RESULTS Although more than fifty epidemiological studies have examined the associations between ambient air pollution and TLBW to date, we only identified six studies that examined the potential effect modification of the association between ambient air pollution and TLBW by the above listed maternal risk factors. Two studies assessed effect modification caused by smoking on the association between ambient air pollution and TLBW. The adjusted odds ratio (OR) for TLBW associated with exposure to ambient air pollution were in one study higher among women who smoked during pregnancy, as compared to the OR of non-smoking women, while in the other study the association was in the opposite direction. The association of ambient air pollution and TLBW were higher among women characterized by extreme BMI (two studies) and low SES compared to non-obese women or women of higher SES (four studies), respectively. Only one study reported the estimated effects among asthmatic and non-asthmatic women and no statistically significant effect modification was evident for the risk of TLBW associated with ambient air pollution. CONCLUSION AND RECOMMENDATIONS The current epidemiologic evidence is scarce, but suggests that pregnant women who are smoking, being underweight, overweight/obese or having lower SES are a vulnerable subpopulation when exposed to ambient air pollution, with and increased risk of having a child with TLBW. The limited evidence precludes for definitive conclusions and further studies are recommended.
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Affiliation(s)
- Nadja Westergaard
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ulrike Gehring
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Rémy Slama
- INSERM/Centre National de la Recherche Scientifique (CNRS), Université Grenoble Alpes Joint Research Center, Grenoble, France
| | - Marie Pedersen
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Danish Cancer Society Research Center, Copenhagen, Denmark.
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