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Connolly N, Kelly D, O'Donnell P, Hyde S. Effectiveness of smoking cessation interventions in pregnant women attending primary care: a scoping review. BJGP Open 2024:BJGPO.2023.0185. [PMID: 38490678 DOI: 10.3399/bjgpo.2023.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Smoking during pregnancy has many adverse effects for infant and mother. Despite this, many pregnant women continue smoking. Primary care is a suitable area to provide smoking cessation interventions. AIM To investigate available literature regarding effectiveness of smoking cessation interventions for pregnant women in primary care, the factors contributing to this effectiveness, and to provide suggestions for future research. DESIGN & SETTING Systematic scoping literature review. METHOD The methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Five electronic databases were searched. Inclusion criteria included original research studies and studies published in English. Data were extracted using a modified Joanna Briggs Institute (JBI) data-charting tool. RESULTS The initial search yielded 878 articles. Following article screening, 12 studies were included. Five studies found a statistically significant increase in smoking cessation rates or reduction in tobacco consumed in the intervention group. The remaining studies showed no significant difference between the groups. However, 10 studies showed the control group received usual antenatal care involving smoking cessation promotion. An increase in smoking cessation rates was seen in intervention and control groups, demonstrating the effectiveness of these interventions. Interventions included education, counselling, self-help, and financial incentives. They were delivered by GPs, midwives, counsellors, and pregnancy advisers. CONCLUSION Primary care is suitable to offer smoking cessation interventions to pregnant women, as it is often the first point of care and more easily accessible than secondary care. Future research is needed to determine the most effective types of interventions.
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Affiliation(s)
- Niamh Connolly
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Sarah Hyde
- School of Medicine, University of Limerick, Limerick, Ireland
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Ussher M, Fleming J, Brose L. Vaping during pregnancy: a systematic review of health outcomes. BMC Pregnancy Childbirth 2024; 24:435. [PMID: 38902658 PMCID: PMC11191278 DOI: 10.1186/s12884-024-06633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Smoking during pregnancy is harmful to maternal and child health. Vaping is used for smoking cessation but evidence on health effects during pregnancy is scarce. We conducted a systematic review of health outcomes of vaping during pregnancy. METHODS We searched six databases for maternal/fetal/infant outcomes and vaping, including quantitative, English language, human studies of vaping during pregnancy, to November 10th, 2023. We assessed study quality with the Mixed-Methods Appraisal Tool. We focused on comparisons of exclusive-vaping with non-use of nicotine and tobacco products and with smoking. Presentation is narrative as the studies were of insufficient quality to conduct meta-analysis. RESULTS We included 26 studies, with 765,527 women, with one randomised controlled trial (RCT) comparing vaping and nicotine replacement therapy for smoking cessation, 23 cohort studies and two case-control studies. While the RCT met 4/5 quality criteria, the quality of the cohort studies and case-control studies was poor; none adequately assessed exposure to smoking and vaping. For studies comparing exclusive-vaping with 'non-use', more reported no increased risk for vaping (three studies) than reported increased risk for maternal pregnancy/postpartum outcomes (one study) and for fetal and infant outcomes (20 studies no increased risk, four increased risk), except for birth-weight and neurological outcomes where two studies each observed increased and no increased risk. When the RCT compared non-users with those not smoking but vaping or using NRT, irrespective of randomisation, they reported no evidence of risk for vaping/NRT. For studies comparing exclusive-vaping and exclusive-smoking, most studies provided evidence for a comparable risk for different outcomes. One maternal biomarker study revealed a lower risk for vaping. For small-for-gestational-age/mean-birth-centile equal numbers of studies found lower risk for vaping than for smoking as found similar risk for the two groups (two each). CONCLUSIONS While more studies found no evidence of increased risk of exclusive-vaping compared with non-use and evidence of comparable risk for exclusive-vaping and exclusive-smoking, the quality of the evidence limits conclusions. Without adequate assessment of exposure to vaping and smoking, findings cannot be attributed to behaviour as many who vape will have smoked and many who vape may do so at low levels. STUDY REGISTRATION https://osf.io/rfx4q/ .
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Affiliation(s)
- Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK.
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK.
| | - Joy Fleming
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK
| | - Leonie Brose
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8BB, UK
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Pesola F, Smith KM, Phillips-Waller A, Przulj D, Griffiths C, Walton R, McRobbie H, Coleman T, Lewis S, Whitemore R, Clark M, Ussher M, Sinclair L, Seager E, Cooper S, Bauld L, Naughton F, Sasieni P, Manyonda I, Hajek P. Safety of e-cigarettes and nicotine patches as stop-smoking aids in pregnancy: Secondary analysis of the Pregnancy Trial of E-cigarettes and Patches (PREP) randomized controlled trial. Addiction 2024; 119:875-884. [PMID: 38229538 DOI: 10.1111/add.16422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/16/2023] [Indexed: 01/18/2024]
Abstract
AIMS The aim of this study was to examine the safety of e-cigarettes (EC) and nicotine patches (NRT) when used to help pregnant smokers quit. DESIGN A recent trial of EC versus NRT reported safety outcomes in the randomized arms. We conducted a further analysis based on product use. SETTING Twenty-three hospitals in England and a stop-smoking service in Scotland took part. PARTICIPANTS The participants comprised 1140 pregnant smokers. INTERVENTIONS We compared women using and not using EC and NRT regularly during pregnancy. MEASUREMENTS Measurements included nicotine intake compared with baseline, birth weight, other pregnancy outcomes, adverse events, maternal respiratory symptoms and relapse in early abstainers. FINDINGS Use of EC was more common than use of NRT (47.3% vs 21.6%, P < 0.001). Women who stopped smoking (abstainers) and used EC at the end-of-pregnancy (EOP) reduced their salivary cotinine by 45% [49.3 ng/ml, 95% confidence interval (CI) = -79.8 to -10]. Only one abstainer used NRT at EOP. In dual users, cotinine increased by 19% (24 ng/ml, 95% CI = 3.5-68). In women reporting a reduction of at least 50% in cigarette consumption, cotinine levels increased by 10% in those using nicotine products and by 9% in those who did not. Birth weights in dual users and exclusive smokers were the same (3.1 kg). Birth weight in abstainers using either nicotine product was higher than in smokers [3.3 kg, standard deviation (SD) = 0.7] versus 3.1 kg, SD = 0.6; difference = 0.15 kg, 95% CI = 0.05-0.25) and not different from abstainers not using nicotine products (3.1 kg, SD = 0.8). Abstainers and smokers using nicotine products had no worse pregnancy outcomes or more adverse events than abstainers and smokers not using them. EC users reported more improvements than non-users in cough [adjusted relative risk (aRR) = 0.59, 95% CI = 0.37-0.93] and phlegm (aRR = 0.53, 95% CI = 0.31-0.92), controlling for smoking status. EC or NRT use had no association with relapse. CONCLUSIONS Regular use of e-cigarettes or nicotine patches by pregnant smokers does not appear to be associated with any adverse outcomes.
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Affiliation(s)
- Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Katie Myers Smith
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Anna Phillips-Waller
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Dunja Przulj
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Robert Walton
- Blizard Institute, Queen Mary University of London, London, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Tim Coleman
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Rachel Whitemore
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Miranda Clark
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Division of Population Health Sciences and Education, St George's, University of London and Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Lesley Sinclair
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Emily Seager
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sue Cooper
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Peter Sasieni
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Isaac Manyonda
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Rábade-Castedo C, de Granda-Orive JI, Riesco-Miranda JA, De Higes-Martínez E, Ramos-Pinedo Á, Cabrera-César E, Signes-Costa Miñana J, García Rueda M, Pastor-Esplá E, Jiménez-Ruiz CA. Clinical Practice Guideline of Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on Pharmacological Treatment of Tobacco Dependence 2023. Arch Bronconeumol 2023; 59:651-661. [PMID: 37567792 DOI: 10.1016/j.arbres.2023.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION There are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction. MATERIAL AND METHODS 12 PICO questions are formulated from a GLOBAL PICO question: "Efficacy and safety of pharmacological treatment of tobacco dependence". A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations. RESULTS Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents. CONCLUSIONS The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence.
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Affiliation(s)
- Carlos Rábade-Castedo
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - José Ignacio de Granda-Orive
- Servicio de Neumología, Hospital Universitario 12 de octubre Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - Juan Antonio Riesco-Miranda
- Servicio de Neumología, Hospital Universitario de Cáceres, Cáceres, Spain; Centro de Investigación en Red de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain
| | - Eva De Higes-Martínez
- Unidad de Neumología, Hospital Universitario Fundación Alcorcón, Spain; Universidad Rey Juan Carlos, Madrid, Spain
| | - Ángela Ramos-Pinedo
- Unidad de Neumología, Hospital Universitario Fundación Alcorcón, Spain; Universidad Rey Juan Carlos, Madrid, Spain
| | - Eva Cabrera-César
- Servicio de Neumología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Jaime Signes-Costa Miñana
- Servicio de Neumología, Hospital Clínico Universitario de Valencia, Spain; Instituto de Investigación Sanitaria de Valencia (INCLIVA), Valencia, Spain
| | | | - Esther Pastor-Esplá
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Carlos A Jiménez-Ruiz
- Unidad Especializada en Tabaquismo de la Comunidad de Madrid, Hospital Clínico San Carlos, Madrid, Spain
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Shirwani A, Kuller JA, Dotters-Katz SK, Addae-Konadu K. Nicotine Use During Pregnancy: Cessation and Treatment Strategies. Obstet Gynecol Surv 2023; 78:589-597. [PMID: 37976314 DOI: 10.1097/ogx.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Abstract The use of tobacco and nicotine products during pregnancy is known to increase the risk of adverse effects on the fetus. Increased education and research have resulted in greater rates of smoking cessation during pregnancy, with a decline from 13.2% of pregnant individuals smoking in 2006 to 7.2% in 2016. However, smoking while pregnant still proves to be a prevalent issue that is associated with numerous adverse outcomes, including low birth weight, preterm birth, and developmental delays. Smoking cessation before or during pregnancy can help mitigate these effects, but the appropriate treatment can be challenging to ascertain. Accordingly, clinicians should look to provide individualized care composed of behavioral counseling in conjunction with pharmacotherapies when indicated, combined with ongoing support and education.
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Affiliation(s)
- Avan Shirwani
- Medical Student, Campbell University School of Osteopathic Medicine, Lillington, NC
| | - Jeffrey A Kuller
- Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Sarah K Dotters-Katz
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Kateena Addae-Konadu
- Private Practice, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Southeast Permanente Medical Group, Atlanta, GA
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Polak K, Haug NA, Dillon P, Svikis DS. Substance Use Disorders in Women. Psychiatr Clin North Am 2023; 46:487-503. [PMID: 37500246 DOI: 10.1016/j.psc.2023.04.006] [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] [Indexed: 07/29/2023]
Abstract
Substance use disorder (SUD) is among the leading causes of premature morbidity and mortality and imposes significant health, economic, and social burdens. Gender differences have been found in the development, course, and treatment of SUD, with women at increased risk for physiologic and psychosocial consequences compared with men. Reasons for these differences are multifold and include biological, genetic, environmental, and behavioral factors. This article discusses SUD among women, emphasizing clinical considerations for care. Specific topics include epidemiology, sex and gender differences, common comorbidities, screening, diagnosis, treatment, pregnancy, and sociocultural factors.
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Affiliation(s)
- Kathryn Polak
- Department of Psychiatry, Virginia Commonwealth University, 806 West Franklin Street, PO Box 842018, Richmond, VA 23284, USA.
| | - Nancy A Haug
- Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA
| | - Pamela Dillon
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, 1200 East Clay Street, Richmond, VA 23298, USA
| | - Dace S Svikis
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, 806 West Franklin Street, PO Box 842018, Richmond, VA 23284, USA
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Castro EM, Lotfipour S, Leslie FM. Nicotine on the developing brain. Pharmacol Res 2023; 190:106716. [PMID: 36868366 PMCID: PMC10392865 DOI: 10.1016/j.phrs.2023.106716] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
Developmental periods such as gestation and adolescence have enhanced plasticity leaving the brain vulnerable to harmful effects from nicotine use. Proper brain maturation and circuit organization is critical for normal physiological and behavioral outcomes. Although cigarette smoking has declined in popularity, noncombustible nicotine products are readily used. The misperceived safety of these alternatives lead to widespread use among vulnerable populations such as pregnant women and adolescents. Nicotine exposure during these sensitive developmental windows is detrimental to cardiorespiratory function, learning and memory, executive function, and reward related circuitry. In this review, we will discuss clinical and preclinical evidence of the adverse alterations in the brain and behavior following nicotine exposure. Time-dependent nicotine-induced changes in reward related brain regions and drug reward behaviors will be discussed and highlight unique sensitivities within a developmental period. We will also review long lasting effects of developmental exposure persisting into adulthood, along with permanent epigenetic changes in the genome which can be passed to future generations. Taken together, it is critical to evaluate the consequences of nicotine exposure during these vulnerable developmental windows due to its direct impact on cognition, potential trajectories for other substance use, and implicated mechanisms for the neurobiology of substance use disorders.
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Affiliation(s)
- Emily M Castro
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA, USA
| | - Shahrdad Lotfipour
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA, USA; Department of Emergency Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA; Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Frances M Leslie
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA, USA.
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Morales-Suárez-Varela M, Puig BM, Kaerlev L, Peraita-Costa I, Perales-Marín A. Safety of Nicotine Replacement Therapy during Pregnancy: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:250. [PMID: 36612572 PMCID: PMC9819948 DOI: 10.3390/ijerph20010250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Smoking during pregnancy is a public health problem worldwide and the leading preventable cause of fetal morbidity and mortality and obstetric disease. Although the risk of tobacco-related harm can be substantially reduced if mothers stop smoking in the first trimester, the proportion of women who do so remains modest; therefore, the treatment of smoking in pregnant women will be the first therapeutic measure that health professionals should adopt when providing care to pregnant women. The recommendation of nicotine replacement therapy during pregnancy remains controversial due to the potential effects on the health of the fetus. PURPOSE The aim of this review was to provide an overview of human studies about the use of nicotine replacement therapy during pregnancy, evaluating the efficacy and safety of the different formulations. METHODS The electronic databases PubMed and EMBASE were searched from May 2012 to May 2022. A total of 95 articles were identified through database searching using a combination of keywords. Out of 79 screened articles and after the removal of duplicates, 28 full-text articles were assessed for eligibility and 12 articles were finally included for review. RESULTS Although demonstrated to be effective in adult smokers, evidence in support of NRT in pregnant women is limited. The results of the apparent safety of the use of NRT during pregnancy contradict the FDA classification of the different NRT formulations. Faster-acting formulations seem to be the safest and even most beneficial forms for the offspring. CONCLUSIONS NRT is not completely harmless for the fetus or for the mother; however, if an adequate assessment of the risk-benefit binomial is made, its use during pregnancy to aid in quitting smoking does seem appropriate. It is necessary to establish individual recommendations on the formulation and dose to be used during pregnancy based on individual nicotinic needs.
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Affiliation(s)
- María Morales-Suárez-Varela
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, University of Valencia, Av. Vicente Andrés Estellés s/n, 46100 Burjassot, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3–5 Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Beatriz Marcos Puig
- Department of Obstetrics, La Fe University Hospital, Av. Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Linda Kaerlev
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark
- Research Unit of Clinical Epidemiology, Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216 Ground Floor East, 5000 Odense, Denmark
| | - Isabel Peraita-Costa
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, University of Valencia, Av. Vicente Andrés Estellés s/n, 46100 Burjassot, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3–5 Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Alfredo Perales-Marín
- Department of Obstetrics, La Fe University Hospital, Av. Fernando Abril Martorell 106, 46026 Valencia, Spain
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Ekblad MO, Blanc J, Berlin I. Special Issue on the Effects of Prenatal Smoking/Nicotine Exposure on the Child's Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5465. [PMID: 34065326 PMCID: PMC8161150 DOI: 10.3390/ijerph18105465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
Smoking increases the risk of negative pregnancy and perinatal outcomes and may have negative effects on a child's short and long-term health [...].
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Affiliation(s)
- Mikael O. Ekblad
- Department of General Practice, Institute of Medicine, Turku University and Turku University Hospital, 20014 Turku, Finland
| | - Julie Blanc
- Department of Obstetrics and Gynecology, North Hospital, APHM, Chemin des Bourrely, 13015 Marseille, France;
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, 13284 Marseille, France
| | - Ivan Berlin
- Department of Pharmacology, Assistance Publique-Hôpitaux de Paris, Sorbonne University, 75013 Paris, France;
- University Centre of General Medicine and Public Health, 1011 Lausanne, Switzerland
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