Exposure to Second-hand Smoke During Pregnancy and Preterm Delivery

Trends in under-five mortality rate in China, 1996-2020: a Joinpoint regression and correlation analysis

OBJECTIVES

To analyse annual trends of the under-five mortality rate (U5MR) and main cause-specific U5MR in China from 1996 to 2020 and to assess the potential correlation of the healthcare system and health expenditure with the U5MR in China.

DESIGN

A retrospective observational study using national data from 1996 to 2020. Joinpoint regression was employed to model U5MR trends and Pearson correlation analysis was conducted to examine the relationship between healthcare system factors, health expenditure and U5MR.

SETTING

Nationwide study covering both rural and urban populations across China over a 25-year period.

RESULTS

The U5MR in China experienced a three-stage decline from 1996 to 2020 with an average annual percentage rate change (AAPC) of -7.27 (p<0.001). The AAPC of the rural U5MR (-7.07, p<0.001) was higher than that in urban areas (-5.57, p<0.001). Among the five main causes, the decrease in pneumonia-caused U5MR was the fastest while the decreases in congenital heart disease and accidental asphyxia were relatively slow. The rates of hospital delivery (r=-0.981, p<0.001), neonatal visits (r=-0.848, p<0.001) and systematic health management (r=-0.893, p<0.001) correlated negatively with U5MR. The proportion of government health expenditure in the total health expenditure (THE) correlated negatively with the national U5MR (r=-0.892, p<0.001) while the proportion of out-of-pocket health expenditure in THE correlated positively (r=0.902, p<0.001).

CONCLUSION

China made significant advances in reducing U5MR from 1996 to 2020. The rural-urban gap in U5MR has narrowed, though rural areas remain a key concern. To further reduce U5MR, China should focus on rural areas, pay more attention to congenital heart disease and accidental asphyxia, further improve its health policies, and continue to increase the government health expenditure.

Barriers and Enablers to Implementing a Smoke-free Home and Car During Pregnancy: A Qualitative Study Among Expectant Israeli Fathers

INTRODUCTION

Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. This study aims to identify barriers and facilitators for implementing a smoke-free home and car among expectant Israeli fathers.

AIMS AND METHODS

Twenty-four qualitative semistructured telephone interviews were audio-recorded, transcribed, and analyzed according to a reflexive and collaborative thematic approach. Inclusion criteria were being male, Hebrew speaker, age ≥18 years, smoking at least one cigarette a day, and living with their nonsmoking pregnant spouse. The Capability, Opportunity and Motivation for Behavior (COM-B) model was used as a theoretical model for analysis.

RESULTS

Participants reported feeling a strong responsibility for their pregnant spouse's comfort and health, stating that they are doing the best they can to reduce their spouse's secondhand smoke exposure (Motivation). Participants had a low level of knowledge about specific secondhand smoke health consequences, effective strategies to reduce secondhand smoke exposure, with incorrect perceptions about what constitutes exposure (Capability). Couple relationships were not affected by the husband's smoking habits, and participants expressed mutual consideration and understanding (Opportunity). Participants also expressed positive attitudes regarding smoke-free home and car implementation but emphasized that any changes have to be their own decision (Motivation).

CONCLUSIONS

The present study identified principal Capability, Opportunity and Motivation barriers and facilitators that influence Israeli expectant fathers' decision to implement a smoke-free home and car. Those findings will inform the development of a digital behavioral intervention targeting expectant fathers to reduce prenatal secondhand smoke exposure.

IMPLICATIONS

Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. Interventions among expectant fathers that focus on creating a smoke-free home and car may be effective because pregnancy has been identified as a "window of opportunity" that generates a strong motivation and creates a sense of urgency to change smoking behavior, while being considered more achievable than smoking cessation. Interventions might be effective if they focus on strengthening the parental responsibility among expectant fathers and emphasize the benefits of a smoke-free home and car, while maintaining male autonomy and increasing skills to effectively implement a smoke-free home and car.

The Effect of Training Male Smokers About the Effects of Secondhand Smoke in Pregnant Wives on Their Self-Efficacy

Objective

Contact with second-hand cigarette smoke includes inhalation of cigarette smoke caused by the burning of the cigarette itself and inhalation of smoke exhaled by the smoker. Wife's pregnancy can be a motivating factor to change the behavior of men who smoke. Therefore, this study was conducted in order to determine the effect of training male smokers on the effects of secondhand smoke during pregnancy on their self-efficacy.

Materials and methods

The present study is an interventional type of pre-test and post-test. In this phase, random sampling was done from health centers in Isfahan, the participants were 140 smoking spouses of pregnant women, who referred to health centers to receive pregnancy care, and were divided into two intervention and control groups. The data collection tool was a researcher-made questionnaire on men's self-efficacy regarding second-hand cigarette smoke. The validity of the questionnaire was confirmed based on the opinion of the expert panel with content validity ratio (CVR)=0.87 and content validity index (CVI)=0.88, and its reliability was confirmed with Cronbach's alpha=0.97. All data were analyzed with SPSS18 software and Chi-score, Fisher, t-test.

Results

There was no significant difference between the comparison of demographic variables in the intervention and control groups (p>0.05). The results of the paired t-test to compare before and after the training showed that the average score of self-efficacy (p<0.001) in the intervention group had increased significantly after the training, and according to the independent t-test, the average score of self-efficacy After training, it was more in the intervention group than the control group (p<0.05).

Conclusion

Men's self-efficacy regarding second-hand smoke increased after training, so the current training package is effective in training and can be suggested for future studies.

The relationship between perceived stress and pregnancy distress with self-care of pregnant women: The mediating role of social support-A cross-sectional study

Background and Aims

Pregnancy is a stressful experience, which can affect different aspects of a woman's life. Yet, women with a supportive network of friends and family may experience lower stress and improved self-care behavior. The study aimed to investigate the relationship between perceived stress and pregnancy distress with the self-care of pregnant women, as well as the mediating role of social support.

Methods

This cross-sectional study was conducted from February to May 2022 in Babol, Iran. A total of 157 pregnant women participated in the study. The participants completed five questionnaires, including a demographic and obstetric questionnaire, a Self-care questionnaire, Perceived Social support (PSS), Perceived Stress Inventory (PSI), and Pregnancy Specific Distress. Structural equation modeling was used to test the hypothesis relationships among the variables.

Results

We found that Perceived stress (β = -0.221, p = 0.012β) and pregnancy distress (β = -0.203, p = 0.002β) had a negative and significant effect on the self-care of pregnant women. Also, perceived stress (β = -0.429, p < 0.001β) and pregnancy distress (β = -0.381, p < 0.001β) had a negative and significant effect on the social support of pregnant women. The results exhibited a significant specific indirect effect between pregnancy distress, perceived stress, and pregnancy self-care, with social support as the mediator: standardized indirect effect = -0.068, -0.076, respectively.

Conclusion

According to the findings, social support plays a direct and mediating role in improving self-care behaviors among pregnant women. Therefore, providing strategies and measures to improve perceived social support by maternal health professionals may be expected to reduce the impact of stress on pregnant women's self-care. The implementation of policies and social interventions to improve the social support of pregnant women can be one of the applications of the findings.

Designing, implementing and evaluating an educational program regarding the effects of second-hand smoke in pregnancy on the knowledge, attitude and performance of male smokers

INTRODUCTION

Contact with second-hand cigarette smoke includes inhalation of cigarette smoke caused by the burning of the cigarette itself and inhalation of smoke exhaled by the smoker. Wife's pregnancy can be a motivating factor to change the behavior of men who smoke. Therefore, this study was conducted with the aim of designing, implementing and evaluating an educational program regarding the effects of second-hand smoke in pregnancy on the knowledge, attitude and performance of male smokers.

METHODOLOGY

The present study is an interventional type of pre-test and post-test. In this phase, sampling from health centers in Isfahan was done randomly between March and July 2019, the participants were 140 smoking spouses of pregnant women, who visited health centers to receive pregnancy care, and were divided into two intervention groups and control were divided. The data collection tool was a researcher-made questionnaire on men's awareness, attitude and performance regarding second-hand smoke. All data were analyzed with SPSS18 software and Chi-score, Fisher, t-test.

RESULTS

The average age of the participants was 34 years. There was no significant difference between the comparison of demographic variables in the intervention and control groups (p > 0.05). The results of the paired t-test for comparing before and after the training showed that the average score of the emotional dimension of attitude in the two groups of intervention (p < 0.001) and control (p < 0.001), awareness (p < 0.001) and behavior (p < 0.001) was significantly increased in the intervention group after the training, and according to the independent t-test, the average score of the items mentioned after the training in the intervention group was higher than the control group (p < 0.05). Regarding perceived sensitivity (p = 0.066) and perceived severity (p = 0.065), no significant difference was observed.

CONCLUSION

The awareness, emotional aspect of men's attitude and behavior regarding secondhand smoke increased, but the perceived sensitivity and severity in this regard was not significant despite the increase, so the current training package is effective in training, but considering more training sessions It is necessary with more concrete training with model or training videos in order to improve the sensitivity and perceived intensity of men.

TRIAL REGISTRATION

Registration of this randomized control trial has been completed with the Iranian Registry of Clinical Trials, IRCT20180722040555N1.

Women's holistic self-care behaviors during pregnancy and associations with psychological well-being: implications for maternal care facilities

Background

Self-care behaviors during pregnancy significantly impacts mother and children's health. This study aimed to explore the self-care behaviors and the associations of these behaviors with the psychological well-being of women during pregnancy, as well as the mediating effects of different social support with these associations.

Methods

A cross-sectional data of 562 pregnant women at Hanoi Obstetrics & Gynecology Hospital and Ca Mau Obstetrics & Pediatrics in Vietnam were analyzed. Questions about self-care behaviors, pregnancy characteristics, social support, and psychological well-being were asked. Multivariate regression models were performed. Structural Equation Modeling (SEM) was employed to test the mediating effects of different social support with the association between self-care behaviors and psychological well-being.

Findings

Only 13% of pregnant women often or always did physical exercise at least three times a week, and 40% consumed enough fiber and five servings of vegetables a day. Only 78.7% always avoided alcohol drinking, and 53.9% of pregnant women avoided being exposed to second-hand smoking and 71,7% avoided using traditional medicine without physicians’ prescriptions. Around 66% of pregnant women always or often had prenatal care checkups as scheduled. Information sources, social support and childbirth expectation were major drivers for self-care practices. SEM model showed that social support mediated the relationship between maternal health behaviors and mental well-being.

Conclusion

This study highlighted the remarkable gaps in self-care practices among our pregnant women, which were significantly associated with their mental well-being. Social support-oriented consultancy and interventions should be warranted for improving behaviors and the mental well-being of pregnant women in Vietnam.

Vascular Endothelial Function Assessed by Flow-Mediated Vasodilatation in Young Adults Born Very Preterm or With Extremely Low Birthweight: A Regional Cohort Study

Background: Preterm birth and low birthweight have been associated with increased risk of cardiovascular disease in young adults. Endothelial dysfunction is established as an early marker for development of atherosclerotic cardiovascular disease. Previous studies of endothelial function in young adults born very preterm or with extremely low birthweight have, however, shown diverging results. Objective: We aimed to evaluate the risk of cardiovascular disease as measured by vascular endothelial function in young adults born very preterm (<29 weeks of gestation) or with extremely low birthweight (<1,000 g), compared with term-born controls. Methods: This study included 50 young adults born very preterm or with extremely low birthweight and 49 term-born controls born in Norway in the periods 1982-1985, 1991-1992, and 1999-2000 at mean age 28 (±6) years. The endothelial function was assessed by ultrasound measured flow-mediated dilatation (FMD) of the right brachial artery. The arterial diameter was measured at baseline, after release of 5 min of occlusion, and after sublingual administration of nitroglycerine. FMD was reported as absolute and percentage diameter change from baseline and relative to nitroglycerine-induced dilatation. Results: The participants were mainly normal weight non-smokers, without hypertension, diabetes, or established cardiovascular disease. The cases and controls had mean blood pressure 112/71 (SD 12/9) and 112/69 (SD 11/8) mmHg, body mass index 24.0 (SD 4.2) and 24.4 (SD 4.5) kg/m², and HbA1c 32.7 (SD 2.5) and 33.0 (SD 2.6) mmol/mol, respectively. For both groups, 4 (8%) were smokers. Mean FMD for the adults born very preterm or with extremely low birthweight was 0.17 mm (95% CI 0.14, 0.21) vs. 0.24 mm (95% CI 0.20, 0.28) for the controls (p = 0.01), corresponding to a percentage increase of 5.4% (95% CI 4.2, 6.6) and 7.6% (95% CI 6.2, 8.9), respectively (p = 0.02). The FMD relative to maximal nitroglycerine-induced dilatation was 20% and 31%, respectively (p = 0.001). Conclusions: Young adults born very preterm or with extremely low birthweight have significantly lower FMD compared with the term-born controls suggesting an increased risk of cardiovascular disease.

Subnational exposure to secondhand smoke in Iran from 1990 to 2013: a systematic review

Every year, almost eight million people die from tobacco-related diseases, among which around 1.2 million die from secondhand smoke (SHS) exposure. Generally, it is estimated that SHS constituents generated in the interval between puffs are approximately 3 times more toxic than those produced at the moment of puffing. There is no risk-free level of SHS exposure, and even brief exposure can be harmful to health. The aim of this study was to assess SHS exposure and its trend in the different provinces of Iran from 1990 to 2013. To collect available data on SHS exposure, a systematic review was performed. We searched international and national databases using a combination of Medical Subject Headings (MeSH) and relevant text words in the titles, abstracts, and/or keywords. Also, the data in national surveys were gathered. The frequency of exposure in different provinces as well as age, sex, and rural/urban areas were extracted. Afterwards, modeling was done to estimate SHS exposure from the smoking data. According to our findings, SHS exposure was more prevalent among young people. Moreover, this exposure was greater in rural areas as compared to urban areas. A national study on 13-15-year-old individuals showed the highest exposure occurred outdoors. In addition, a declining trend was observed on SHS exposure over time. It seems that attention to the importance of SHS exposure in researches in Iran dates back to 2001, and gradually, especially in recent years, further studies have been conducted on SHS exposure.

Preterm birth and secondhand smoking during pregnancy: A case-control study from Vietnam

Background

The relationship between women who are exposed to secondhand smoke and preterm birth is still controversial. The present study aimed to examine the association between maternal secondhand smoking (SHS) during pregnancy and preterm birth.

Methods

A 1:1 case-control study was conducted at delivery room of The Women’s and Children’s Hospital of An Giang, Vietnam. A total of 288 cases of preterm birth and 288 controls included in this study. A structured questionnaire in a face-to-face interview was used to assess SHS and potential confounders (maternal age, body mass index, occupation, education level, parity, antenatal care visits, history of preterm birth, prenatal bleeding and preeclampsia/eclampsia).

Results

SHS was reported more frequently by women who delivered preterm babies compared with women of term deliveries (67.4% vs. 51.0%; P <0.001). After controlling all potential confounders, multivariable logistic regression analysis showed a relationship between SHS during pregnancy and preterm delivery (adjusted Odds ratio: 1.92; 95% CI 1.31, 2.81)

Conclusions

Our findings suggest that exposure to household tobacco smoke during pregnancy is associated with preterm birth.

The effectiveness of family counselling on reducing exposure to secondhand smoke at home among pregnant women in Iran

INTRODUCTION

Pregnant women are often exposed to secondhand smoke that affects them and their child. Our aim was to determine the effectiveness of family counselling using the BASNEF model on reducing exposure to secondhand smoke at home among pregnant women.

METHODS

A quasi-experimental study was conducted on 103 pregnant women exposed to secondhand smoke. They were selected using a multi-stage cluster sampling method and allocated into intervention (50 people) and control (53 people) groups. Four family counseling sessions using the BASNEF model were held for the intervention group while the control group received routine care. The outcomes were measured before and at one month after the last session of counselling.

RESULTS

In the timeframe before the intervention, the number of days in which there was reported exposure to secondhand smoke was 5.08 ± 1.1 in the intervention group, significantly decreasing to 3.5 ± 1.6 after the intervention (p<0.001). No significant change was observed in the control group (p=0.1). Also, the mean scores of all constructs of the BASNEF model increased significantly after the intervention compared to those of the control group (p<0.05).

CONCLUSIONS

Family counseling had a positive effect on decreasing the exposure to secondhand smoke at home among a sample of pregnant women. The BASNEF model is useful for implementing educational care programs in these settings.

The association between secondhand smoke exposure and growth outcomes of children: A systematic literature review

INTRODUCTION

The strong relation between maternal smoking and maternal secondhand smoke (SHS) exposure and the growth of newborn infants has been proven. However, the effect of SHS on growth outcomes of older children is not well defined. Through a systematic literature review, we sought to determine whether a relationship exists between SHS exposure and growth outcomes of children up to 8 years of age.

METHODS

A systematic review was performed, including articles published between 2004–2019, related to SHS exposure (prenatal and postnatal) and children’s growth (weight, length/height, and head circumference). The relevant articles were identified from Science Direct, ProQuest, Sage Publication, Scopus, Wiley Online Library, CINAHL Plus with Full Text (via EBSCOhost) and Google search.

RESULTS

Seventeen articles were identified, of which three categories of growth measurements were extracted, comprising weight (weight, WAZ, WHZ, and BMI), height (height/length and HAZ) and head circumference. SHS exposure both pre or postnatally was inversely associated with weight (deficit in weight, risk of underweight, risk of wasting) and height (lower length and risk of stunting) and elevated BMI of children. Furthermore, prenatal SHS exposure was associated with a lower head circumference.

CONCLUSIONS

The current review identified that exposure to SHS may be associated with adverse growth outcomes in children. It is crucial that active smokers, specifically those who live with children or with a pregnant partner, are made aware of the potential effects of SHS exposure on non-smokers. Further assessment of the association between exposure to SHS and other growth outcomes in other age groups is needed.

Exposure to second-hand smoking as a predictor of fetal loss: Egypt Demographic and Health Survey 2014

BACKGROUND

Exposure to tobacco smoking during pregnancy has been shown to be associated with elevated risk of adverse pregnancy outcomes such as miscarriage and stillbirth. However, little is known regarding the association between passive smoking and birth outcomes. This study aims to measure the prevalence of passive smoking and assess its relationship with adverse birth outcomes.

METHODS

Self-reported birth outcomes (stillbirth/miscarriage/abortion) was the dependent variable that was regressed against self-reported exposure to household smoking along with various individual and community-level factors. We used propensity score matching to identify the sample and used regression analysis to quantify the association between passive smoking and birth outcomes. Sensitivity analysis was conducted to check for the robustness of the associations.

RESULTS

Of the 5540 women studied, about half (50.3%, 95% CI=49.3-51.3) reported being exposed to smoking by household members. The prevalence of stillbirth was 14.6% (95% CI=13.9-15.3). In the logistic regression analysis, the confounder-adjusted OR of stillbirth in relation to exposure to smoking was 1.321 (95% CI=1.150-1.517). In the subgroup analysis, we found that the association was significant among certain age groups only.

CONCLUSION

The findings of the present study imply a mildly positive association between the occurrence of stillbirth and exposure to smoking in the household.

Prevalence and Sources of Second-Hand Smoking Exposure among Non-Smoking Pregnant Women in an Urban Setting of Vietnam

Exposure to second-hand smoke (SHS) among non-smoking pregnant women can lead to adverse maternal and fetal outcomes. A cross-sectional study was performed from July to August 2016 among 432 pregnant women at Bach Mai Hospital, Hanoi, Vietnam, to assess the prevalence and sources of SHS exposure among non-smoking pregnant women. Socio-economic characteristics and information regarding SHS exposure of participants were collected. Multivariable logistic regression was employed to identify associated factors. Overall, 92.6% and 64.5% of pregnant women were exposed to SHS in their lifetime and in the last 30 days, respectively. Cafeterias and restaurants had the highest proportion of pregnant women exposed to SHS. Those who reported that “smoking is allowed at home” (OR = 3.18; 95%CI = 1.97–5.13); going to working place (OR = 1.86; 95%CI = 1.08–3.19), going to state authority offices (OR = 1.98; 95%CI = 1.15–3.41), and cafeterias (OR = 1.96; 95%CI = 1.22–3.16) had the highest risk of SHS exposure in the last 30 days. We have found a high proportion of SHS exposure among non-smoking pregnant women in Vietnam. This comes from a multitude of sources, including homes, workplaces, cafeterias, and restaurants. The data emphasises the need for further intervention to address this health issue.

Self-efficacy and perceived barriers of pregnant women regarding exposure to second-hand smoke at home

BACKGROUND AND AIM

The inability of women to demand from their husbands, for not smoking, has been reported as a factor in exposure to cigarette smoke. This study aimed to investigate the perceived barriers and self-efficacy of pregnant women regarding second-hand smoke (SHS) at home.

MATERIALS AND METHODS

This was a cross-sectional study, and the sample size was 255 pregnant women who visited the health-care centers in Isfahan, Iran, from July 2018 to September 2018, and were selected randomly and voluntarily. A questionnaire was designed to collect the data about the exposure to smoke, perceived barriers, and self-efficacy. The data were analyzed using descriptive statistics (mean score and standard deviation), inferential statistics (nonparametric Mann-Whitney and Kendall test), and Spearman's correlation and regression.

RESULTS

The mean score of self-efficacy in the exposure group was lower than that the other group (P = 0.000). The mean score of perceived barrier was not a significant difference (P = 0.449). Personal perceived barriers are the most important predictor of self-efficacy of pregnant women in exposure to SHS (95% confidence interval: 0.013-0.262) (P = 0.030). Kendall test comparing items within the group and Mann-Whitney test comparing the two groups showed that personal factors such as "Unaware of the dangers of SHS and protective measures" for notexposed women and environmental factor "the lack of ban smoking law at home" for exposed women are considered the most important barriers (P = 0.000). "Not being together a husband" (P = 0.293) and "going to another place when smoking a husband" (P = 0.000) are the highest self-efficacy items.

CONCLUSIONS

It is necessary to develop training programs to increase self-efficacy to avoid exposure to SHS and for both pregnant women and their husbands. It is also necessary to educate and inform about SHS and protective measures against it and to set up "smoking ban law" at home in our country to protect pregnant women.

Exposure to secondhand smoke in Iranian pregnant women at home and the related factors

INTRODUCTION

Fetus health is of high importance in pregnant women and exposure to secondhand smoke (SHS) endangers maternal and fetal health. Therefore, in this study we examined the prevalence of exposure to SHS in pregnant women at home and the related factors.

METHODS

This cross-sectional study was conducted with 255 pregnant women who were referred to the Isfahan health care center from July to September 2018. A questionnaire that was designed by the research team was applied to collect data about the participants' prevalence of exposure, attitude-emotional dimension, perceived susceptibility, perceived severity, and perceived barriers. The questionnaire used was self-administered. The validity and reliability of the questionnaire were confirmed by a panel of experts. Cronbach's alpha of attitude-emotional dimension, perceived susceptibility, perceived severity, and perceived barriers were also calculated as 0.81, 0.91, 0.92, and 0.89, respectively. Statistically significant differences were examined using chi-squared test and Mann-Whitney test.

RESULTS

We found that the prevalence of exposure to SHS in pregnant women was 23.1%. The age of the husband (p=0.041), education level of the smoking husband (p=0.005), the education level of the pregnant woman (p=0.002), employment status of husband (p=0.010), and whether the pregnancy was planned (p=0.010) had significant association with the participant prevalence of exposure to SHS. Thus, older age of husbands, lower education levels of husbands and wives, unwanted pregnancies, and unemployment of husbands resulted in higher exposure to SHS. The mean scores of knowledge and perceptions were lower in women exposed to smoke than in non-exposed women (p<0.05).

CONCLUSIONS

The rate of SHS exposure was high in pregnant women. The knowledge and perception scores of exposed women to SHS were lower than those of non-exposed women. Low levels of education of husbands and women, unemployment and higher age of husbands, and unwanted pregnancies were considered as health risk factors. Therefore, effective training programs should be designed to educate pregnant women and their husbands.

Designing an educational intervention on second-hand smoke in smoker men on the exposure of pregnant wives: a protocol for a randomized controlled trial

BACKGROUND

Complications of exposure to second-hand smoke (SHS) are known to affect the health of pregnant women; it requires designing an educational program to reduce the exposure of pregnant women to smoke. Therefore, the purpose of this study was to design an educational program to reduce the exposure of pregnant women with the second-hand smoke of their husband.

METHODS

This research-based program is designed in three phases, in the first phase of the study, the level of knowledge, attitude, and practice of men regarding SHS will be measured using a questionnaire. The questionnaire will be based on a literature review and experts opinions. In the next phase the educational program will be designed based on the results of the first phase of the study on the level of knowledge, attitude, self-efficacy, and practice of men, as well as a literature review and experts opinions, and the research team will finalize it according to priorities. To follow up the training will be sent reminders messages. Pregnant women will also be trained to protect themselves and support their husbands to quit smoking. The third phase includes the implementation of educational intervention with pretest-posttest with two intervention and control groups.

DISCUSSION

The present study provides strong information and data regarding the needs and strategies for reducing the exposure to second-hand smoke in pregnant women. Therefore, designing a program, and a review article and updated evidences can lead to avoid pregnant women the exposure to second hand smoke and reducing smoking in smoker husbands. It can also reduce their medical and treatment costs.

TRIAL REGISTRATION

Registration of this randomized control trial has been completed with the Iranian Registry of Clinical Trials, IRCT20180722040555N1 .

Socio-economic inequalities in secondhand smoke exposure at home in the context of mother-child pairs in Bangladesh

OBJECTIVES

This study aimed to examine socio-economic disparities in mother-child pairs' self-reported and cotinine-measured secondhand smoke (SHS) exposure at home.

STUDY DESIGN

This is a cross-sectional study.

METHODS

This study was conducted in the Rajshahi district of Bangladesh from May to July 2017. A total of 541 mother-child pairs were interviewed for self-reported measured SHS; cotinine-measured saliva test was performed on 263 mothers and 236 children. Mother-child pairs' SHS exposure at home was the outcome of interest.

RESULTS

Overall self-reported prevalence of SHS exposure at home was 49.0%. Self-reported SHS exposure among mothers (50.2%) and children (51.3%) were lower than the prevalence rate of cotinine-measured exposure for mothers (60.5%) and their children (58.9%). Maternal rich bands of wealth were found to be associated with lower likelihood of self-reported (adjusted odds ratio [AOR] = 0.59, 95% confidence interval [CI] = 0.35-0.99) and cotinine-measured SHS exposure among mothers (AOR = 0.17, 95% CI = 0.08-0.37). Maternal rich bands of wealth were also found to be associated with lower likelihood of cotinine-measured SHS exposure among children (AOR = 0.11, 95% CI = 0.07-0.26).

CONCLUSIONS

Socio-economic inequalities exist in exposure to SHS at home. Interventional approaches aimed at reducing SHS at home are urgently needed at public health and healthcare service level, with special focus given to the socioeconomically disadvantaged groups.

Tobacco use, exposure to second-hand smoke among pregnant women and their association with birth weight: A retrospective cohort study

Background:

There is paucity of studies on prevalence of SHS among pregnant women and its association with low birth weight (LBW).

Objectives:

The study was designed to determine the proportion of tobacco use, exposure to second hand smoke among pregnant women and their association with LBW.

Materials and Methods:

A Retrospective cohort study was conducted from March–June 2017 among 1043 pregnant women admitted for delivery in the Department of Obstetrics and Gynecology, JIPMER. Socio-demographic and obstetric characteristics, tobacco use and exposure to SHS during pregnancy were assessed by interviews. Birth weight of the baby was also extracted. Data was analysed using STATA v12. Univariate analysis was used to assess the association of socio-demographic, obstetric characteristics and exposure to SHS with LBW.

Results:

Out of 1043 pregnant women, the mean age was 25 (±3.9) years. More than half (57.4%) of women were primigravida. The proportion of women exposed to SHS during pregnancy was 69.9% (95% CI: 67.0-72.6) among which 24% of the women belonged to family, where family members were smokers. Only four had ever used tobacco in the past. However, none used any form of tobacco during pregnancy. LBW was present in 21.4% of the babies. There was no association between exposure to SHS and LBW [PR:0.98 (95% CI:0.71-1.35)].

Conclusion:

The study shows that there was no significant association between the SHS exposure of pregnant women and low birth weight.

Investigating the Prevalence of Preterm Birth in Iranian Population: A Systematic Review and Meta-Analysis

Introduction: Despite medical advances, preterm delivery remains a global problem in developed and developing countries. The present study was aimed at conducting a systematic review and meta-analysis of studies on the prevalence of preterm delivery in Iran.

Methods: This study was carried out on studies conducted in Iran by searching databases of SID, Magiran, Irandoc, MEDLIB, Iranmedex, PubMed, Web of science, Google Scholar and Scopus. The search was conducted using advanced search and keywords of preterm delivery and equivalents of it in Mesh and their Farsi’s Synonymous in all articles from 2000-2016.After extracting the data, the data were combined using a random model. Heterogeneity of the studies was assessed using Q test I2 index and the data were analyzed using STATA Ver.11 software.

Results: The total number of samples in this study was 41773. In 19 reviewed articles, the overall prevalence of preterm delivery, based on the random effects model, was estimated to be a total of 10% (95% CI, 9-12). The lowest prevalence of preterm labor was 5.4% in Bam and the highest prevalence was 19.85% in Tehran. There was no significant difference between the prevalence of preterm delivery compared to year of study and sample size.

Conclusion: This study reviewed the findings of previous studies and showed that preterm delivery is a relatively prevalent problem in Iran. Therefore, adopting appropriate interventions in many cases including life skills training, self-care and increasing pregnancy care to reduce these consequences and their following complications in high risk patients seem necessary.

Prenatal xenobiotic exposure and intrauterine hypothalamus-pituitary-adrenal axis programming alteration

The hypothalamic-pituitary-adrenal (HPA) axis is one of the most important neuroendocrine axes and plays an important role in stress defense responses before and after birth. Prenatal exposure to xenobiotics, including environmental toxins (such as smoke, sulfur dioxide and carbon monoxide), drugs (such as synthetic glucocorticoids), and foods and beverage categories (such as ethanol and caffeine), affects fetal development indirectly by changing the maternal status or damaging the placenta. Certain xenobiotics (such as caffeine, ethanol and dexamethasone) may also affect the fetus directly by crossing the placenta into the fetus due to their lipophilic properties and lower molecular weights. All of these factors probably result in intrauterine programming alteration of the HPA axis, which showed a low basal activity but hypersensitivity to chronic stress. These alterations will, therefore, increase the susceptibility to adult neuropsychiatric (such as depression and schizophrenia) and metabolic diseases (such as hypertension, diabetes and non-alcoholic fatty liver disease). The "over-exposure of fetuses to maternal glucocorticoids" may be the main initiation factor by which the fetal HPA axis programming is altered. Meantime, xenobiotics can directly induce abnormal epigenetic modifications and expression on the important fetal genes (such as hippocampal glucocorticoid receptor, adrenal steroidogenic acute regulatory protein, et al) or damage by in situ oxidative metabolism of fetal adrenals, which may also be contributed to the programming alteration of fetal HPA axis.