Comparison between data obtained through questionnaires and interviews: life-style habits of pregnant women

A random sample of pregnant women in the cities of Odense and Aalborg, Denmark, was taken as a part of a quasi-experimental study. The time period of the study was from October 1984 to March 1985. Out of 175 randomly selected pregnant women, 146 filled out the questionnaire in the 36th week of their pregnancy. The questionnaire was concerned with eating, smoking, and drinking habits before and during their pregnancy. These 146 pregnant women participated in an interview 3 weeks later where some of the same questions on the questionnaire were asked by the interviewer. In spite of the rather short interval between the two data collections, there were some differences in the answers given at the individual level. This is especially true for eating habits and estimated average drinking habits during pregnancy. No tendency was observed for a more frequent recalling of "less socially acceptable norms" in the questionnaire method of obtaining information. Lack of knowledge of the "true" classification is probably the main reason for the lack of stability in the answers given. This leads to some unavoidable misclassification in studies on self-reporting life style habits among pregnant women.     

Cigarette smoking in pregnancy and fetal growth. Does the type of tobacco play a role?

The effect of nicotine content of cigarettes on fetal growth was studied. From April 1985 to April 1987, 86% of all pregnant women in two well-defined geographical areas responded to a questionnaire on social conditions and lifestyle factors in pregnancy. After excluding multiple births and women who gave birth after elective caesarean section, 10,485 pregnant women were available for the study. Results showed that not only smoking, but also nicotine content in cigarettes was related to reduced fetal growth as measured by birthweight, birth length, and head circumference. The timing of smoking during pregnancy played a role. Smoking before pregnancy or smoking early in pregnancy was not related to fetal growth, nor were the partners' smoking habits. The study corroborates the hypothesis that smoking reduces fetal growth and points to nicotine as one of the potential causal factors.     

Selection bias in determining the age dependence of waiting time to pregnancy

Many studies have found decreased fecundability, that is, the ability to conceive in a menstrual cycle, with increasing female age. To evaluate the effect of maternal age on waiting time to pregnancy, the authors reviewed hospital charts of all pregnant women attending prophylactic antenatal care at Odense University Hospital, Denmark, during 1972-1987. Only the first pregnancy of each woman and only planned pregnancies were included (n = 14,754). The fecundability odds ratio (FR) was calculated as the odds of a conception in a menstrual cycle among the older women divided by the odds among women aged 15-24 years. The FR for women aged 25-29 years was 1.12 (95% confidence interval (CI): 1.04, 1.20), for women aged 30-34 years it was 1.15 (95% CI: 1.01, 1.30), and for women above 34 years the FR was 2.44 (95% CI: 1.84, 3.22) after adjustment for confounders. The increased fecundability with age is contrary to previous studies and may be explained by selection bias, as sterile women were not included. In addition, some very fertile young women who became pregnant by accident before efficient birth control methods were available and therefore were excluded from time to pregnancy studies may now use oral contraceptives until they plan a pregnancy later in life and are included.     

成都市某三甲医院孕妇孕期膳食习惯及行为调查

目的:调查成都市某三甲医院孕妇孕期膳食习惯及行为的变化情况。方法:以理性行为理论为基础,自行设计问卷对在成都市某三甲医院门诊就诊的600例孕妇进行调查。结果:孕妇普遍存在孕期膳食结构不合理,孕期营养知识缺乏的问题,不同年龄段孕前BMI之间差异有统计学意义(P=0.003);孕前、孕早期、孕中晚期在吸烟、喝酒、喝咖啡等方面差异具有统计学意义(P=0.000)。结论:孕妇孕期膳食行为及营养知识有待改善,应加强孕期膳食行为监督及营养知识健康教育指导。     

Coffee consumption, birthweight, and reproductive failures.

We studied the effect of coffee consumption on birthweight, preterm births, and congenital malformations. From April 1985 to April 1987, 11,858 pregnant women out of 13,815 in two Danish cities responded to a mailed questionnaire on eating and drinking habits during pregnancy. Data on pregnancy outcomes were recorded from medical files. Maternal coffee consumption of four cups a day or more was associated with a moderate decrease in birthweight, especially among smokers. The associations between coffee consumption and preterm births or congenital malformations were very weak.     

Socio-Economic Inequalities in Health, Habits and Self-Care During Pregnancy in Spain

Socioeconomic disadvantage can be harmful for mother’s health and can influence child’s health long term. The aim of this study is to analyse social inequalities between pregnant women from four INMA (INfancia y Medio Ambiente) cohorts. The analysis included 2,607 pregnant women recruited between 2004 and 2008 from four INMA cohorts. Data on maternal characteristics were collected through two questionnaires completed in the first and third trimester of pregnancy. The relationship between socioeconomic status (SES) and maternal health, dietary intake, lifestyle habits and self-care related variables was modelled using logistic regression analysis. 33.5 % of women had a university level of education and 47 % had high occupational class. Women with higher SES reported healthier habits, fewer complications during pregnancy, better weight gain control and attended more prenatal appointments than women with lower SES. The risk of sedentary behaviour and passive smoking was higher among women with a lower level of education (OR = 1.7, 95 % CI 1.3–2.2 and OR = 1.6, 95 % CI 1.2–2.3, respectively) and with less skilled occupations (OR = 1.7, 95 % CI 1.4–2.0 and OR = 1.2, 95 % CI 1.0–1.5, respectively). Although both SES indicators—occupation and education—act as social determinants of diet, occupation was a more powerful determinant than education. For other lifestyle and self-caring variables, education was a more powerful predictor than occupation. Social inequalities were observed in health, habits and self-care during pregnancy. Proper care during pregnancy requires the control of common clinical variables and the knowledge of socioeconomic conditions of the pregnant women.     

中山市孕产妇卫生服务利用公平性研究

目的:分析死亡孕产妇及普通孕产妇基本情况及卫生服务利用情况,了解中山市孕产妇卫生服务利用的公平性。方法:收集2002～2011年中山市死亡孕产妇病例与普通孕产妇资料。结果:流动人口孕产妇死亡率高于常住人口;死亡孕产妇中高龄、低文化程度、农民、计划外、孕次>3次以上孕产妇比例较普通孕产妇高;产前检查次数、初检孕周、分娩地点、死亡地点、死亡24 h内是否就医与孕产妇的文化程度、孕次、计划内外等有关。结论:要提高孕产妇卫生服务利用公平性,需积极推广国家基本公共卫生服务项目,加强健康教育,采取各种保障措施综合治理。     

Smoking before, during, and after pregnancy.

We report the first national data on smoking before, during, and after pregnancy. Estimates are based on the 1986 Linked Telephone Survey that reinterviewed 1,550 White women 20-44 years of age who were respondents to the 1985 National Health Interview Survey. An estimated 39 percent of White women who had smoked before pregnancy quit smoking while pregnant (27 percent when they found out they were pregnant and 12 percent later during pregnancy). Women with less than 12 years of education were five times as likely to smoke and one-fourth as likely to quit as those with 16 or more years of education. Women who smoked more than one pack of cigarettes per day before pregnancy were one-fifth as likely to quit as those smoking less. Of the women who quit, 70 percent resumed smoking within one year of delivery. Of those who relapsed, 67 percent resumed smoking within three months of delivery and 93 percent within six months. There is little evidence of educational differentials in relapse rates. The fact that relapse remains high suggests that while health of the fetus is a strong influence on women's smoking habits, women may be less aware of the effect of passive smoke on the infant.     

孕妇增补微量营养素状况及其与妊娠结局关联的队列研究

目的:了解安徽地区孕妇增补微量营养素的现况,探讨增补微量营养素与妊娠结局的关系。方法:以2008年10月～2010年10月在安徽省合肥、马鞍山、芜湖3个市的妇幼保健机构首次进行孕期保健体检的孕妇为对象,调查孕早期增补微量营养素的情况,通过孕妇保健手册了解妊娠结局情况。结果:至2011年5月分娩单胎活产儿的孕妇共10 269人。孕早期服用复合维生素、复合微量元素、钙剂、铁剂、叶酸坚持1个月以上的孕妇分别为660人(6.4%)、520人(5.1%)、384人(3.7%)、208人(2.0%)、5 358人(52.2%),孕前半年服用叶酸坚持1个月以上的孕妇2 021人(19.7%)。在控制母亲年龄、文化程度、家庭人均月收入、孕前BMI、自然流产史、人工流产史及胎儿性别后,孕早期持续服用复合微量元素(RR=0.25,95CI%=0.09～0.69)和叶酸(RR=0.72,95CI%=0.55～0.96)都会减少发生小于胎龄儿的风险。多元线性回归模型显示,控制母亲年龄、文化程度、家庭人均月收入、孕前BMI、自然流产史、人工流产及胎儿性别后,孕早期补充复合维生素、复合微量元素、叶酸均能增加胎儿出生体重,孕早期服用叶酸可增加胎儿出生胸围,差异具有统计学意义(P<0.05),而孕前半年增补叶酸与妊娠结局指标无显著关联(P>0.05)。结论:孕妇孕早期补充微量营养素可促进胎儿宫内生长,减少小于胎龄儿的发生。     

妊早期妇女血清叶酸水平与胎儿出生缺陷发病关系的队列研究

目的:探讨孕妇血清叶酸水平与胎儿出生缺陷发病的关系。方法:选择2007年4月～2010年4月在开封市妇产医院进行产检的、符合纳入标准的孕妇为调查对象,按其服用叶酸的情况分为A组(孕前、孕期从未口服叶酸)、B组(孕后口服叶酸)、C组(孕前、孕后均口服叶酸),比较三组血清叶酸水平;对其进行随访至胎儿出生6个月,调查出生结局,比较三组出生缺陷发生情况。结果:A组的血清叶酸平均水平明显低于B组和C组,C组的血清叶酸平均水平高于B组(P<0.05)。A组孕妇娩出出生缺陷胎儿发生率明显高于B组和C组(P<0.05)。与围孕期规律服用叶酸相比,不服用叶酸组娩出出生缺陷胎儿的相对危险度为3.48(2.02/0.58),其风险增加了2.48倍。结论:妊早期孕妇叶酸水平与出生缺陷有关系,围孕期服用叶酸增补剂可以降低出生缺陷的发生风险。     

Variability of self reported measures of alcohol consumption: implications for the association between drinking in pregnancy and birth weight.

STUDY OBJECTIVE--To describe the intra-subject variability of self reported maternal alcohol consumption using different ways of collecting information and to analyse the implications of this variability for research into the effect of low to moderate maternal alcohol consumption on birth weight. DESIGN--This was a longitudinal study. Self reported maternal alcohol consumption before, during, and after pregnancy was assessed on four occasions over two years. The data were collected by two self administered questionnaires and during two personal interviews (one by phone and another face to face). SETTINGS--The Obstetrics Department, Odense University Hospital, Odense, Fünen, Denmark. PARTICIPANTS--A total of 2880 pregnant women were recruited consecutively from the hospital catchment area. Altogether 328 pregnant women and their babies were selected. All women who reported an average alcohol consumption of five drinks or more per week were recruited to the study (164 women) and a 1:1 control group was selected from the remaining women based upon two matching criteria: expected date of delivery and the women's year of birth. Some 279 women (85%) completed the study. MEASUREMENTS AND MAIN RESULTS--Self reported alcohol consumption (number of drinks per week) and birth weight (g) were the main outcomes. Women's self reported alcohol consumption varied over time and according to the data collection method. When different methods of data collection were used to assess alcohol intake in similar periods of time, significant differences in reporting were found despite the relatively high correlations between the measurements. Although a consistent reduction in birth weight with increasing consumption of alcohol was found, there were differences in the shape and strength of this association when comparing the six available alcohol measurements. CONCLUSIONS--The type of questions used, the way the data were collected, the period of time referred to, and the time the questions were asked, should be taken into consideration when describing the drinking pattern of pregnant women. Furthermore, birth weight results from studies that have used different alcohol measures should be interpreted or compared with caution because of possible large differences resulting from the differing methods of assessing fetal exposure to alcohol.     

孕产妇艾滋病感染状况及母婴阻断的干预效果研究

目的为了解丽水市孕产妇HIV感染状况及母婴阻断的干预效果,指导艾滋病母婴阻断工作。方法对孕产妇进行HIV抗体检测,抗-HIV初筛阳性标本经艾滋病确认试验。结果 2006年10月1日—2010年9月30日4年间,孕产妇HIV感染率为2.29/万。孕期检出的HIV感染孕妇,更能配合母婴传播阻断措施的落实。目前存活的12名儿童有7名已满18个月,其中有6名抗-HIV抗体阴性,1名拒绝检测。结论丽水市孕产妇HIV感染处于较低水平。今后应加强艾滋病母婴阻断相关知识宣传,并将预防母婴传播服务与婚前、孕前、孕期保健有机结合,提高孕前和孕期HIV的检测率和HIV感染孕妇孕早期检出率。     

Dietary knowledge and practice in pregnant women

The objective of the study was to evaluate the level of knowledge about the influence of diet during pregnancy on the development and health of a child, among pregnant women in relation to their eating habits. The diet of a woman before and during pregnancy has immense influence on the course of pregnancy and health of a child--both after its delivery and in the future. Lack of dietary knowledge and the knowledge about consequences of malnutrition among future mothers may result in a lot of dietary indiscretion, which in turn can cause deficiency or excess of energy and particular nutrients, as well as abnormal course of pregnancy. Hence, for keeping a proper diet during pregnancy a woman must not only know the healthy eating guidelines, but also realise how a diet influences the course of pregnancy and child's health. The study was conducted with the use of 3 specially prepared questionnaires, among 77 women in the III trimester of pregnancy, participating in the Parturition School course. The first questionnaire referred to general data (age, education, antropometric data) and the way of supplementing diet with medicinal compounds supplying vitamins and minerals. The second questionnaire showed the dietary habits before pregnancy, while the third questioned the influence of diet on the course of pregnancy and health of the infant. In the second stage the eating habits of the subjects were studied also with the use of a 24-hour interview and an album of food products issued by the Institute of Food and Nutrition. Summing it up, the analysis of the results of the study showed that though pregnancy is a difficult period for a woman, it did not make the subjects pay particular attention to their diet. The study showed also that the majority of women does have knowledge on the influence of diet and the influence of her nourishment before pregnancy on the development of foetus, however, it hardly results in the change of their eating habits.     

Socioeconomic status and maternal cigarette smoking before, during and after a pregnancy

Abstract: Research suggests that cigarette use declines when women find out they are pregnant, increasing again after the birth. Pregnancy may provide many women with a substantial impetus to stopping smoking. Also, rates of smoking cessation and reduction may be class-related, with the highest socioeconomic-status groups manifesting higher rates of reduction. Using data from the Mater Hospital-University of Queensland Study of Pregnancy, we report family income related to rates of smoking before, during and after a pregnancy. Before becoming pregnant, 45.9 per cent of women in the sample were smokers. This declined to 34.7 per cent of women at their first clinic visit. Rates of heavy smoking (20 or more cigarettes per day) had returned to earlier levels by the six-month (after birth) follow-up. Women in the lowest family-income group had the highest rates of cigarette use before, during and after their pregnancy. Of the lowest family-income group, 8.4 per cent were heavy smokers before, during and after their pregnancy, compared with 2.8 per cent of women in the highest family-income group. Smoking cessation rates were highest in the highest family-income group (those who smoked least), but relapse rates after the birth were similar for all income groups. Arresting rates of smoking relapse by pregnant women should be seen as a major public health priority     

The study of risk habits in reproductive and perinatal epidemiologic research: the use of a donor inseminated population of women

In this study we assess whether a population of donor inseminated women (ADI) provides an efficient alternative to an open population of women of reproductive age to study the effects of risk habits (cigarette smoking and alcohol consumption) on reproductive and perinatal health. An ADI population can be prospectively monitored before and after pregnancy; women enter the programme because of their husband's infertility. In the pilot clinic every couple asking for first insemination was requested to fill in a self-administered questionnaire on risk habits and the use of medicine. Medical histories of both the man and woman were taken. In 1986 and 1987, 519 women entered the programme. The response rate was 95%. Distribution of the exposure variables of the women currently smoking (52%) and currently drinking (68%) compared well with a general population survey from the town of Rotterdam. With regard to their risk habits and reproductive health, the population of women married to totally infertile men seems representative of women of reproductive age from an open population.     

The impact of a minimal smoking cessation intervention for pregnant women and their partners on perinatal smoking behaviour in primary health care: A real-life controlled study

Background  

There is a demand for strategies to promote smoking cessation in high-risk populations like smoking pregnant women and their partners. The objectives of this study were to investigate parental smoking behaviour during pregnancy after introduction of a prenatal, structured, multi-disciplinary smoking cessation programme in primary care, and to compare smoking behaviour among pregnant women in the city of Trondheim with Bergen and Norway.     

2092例住院终止妊娠孕妇口腔保健意识及行为调查

目的:了解妊娠妇女口腔保健意识及行为,为完善门诊孕妇的口腔保健内容提供依据。方法:对2 092例妊娠妇女入院时进行问卷调查。结果:孕前半年内进行口腔检查保健的孕妇共452例,占21.6%,其中高学历、高收入人群明显高于低学历、低收入人群。1 554例孕妇孕期进行口腔健康状况检查,其中早孕孕妇占17.9%,中孕孕妇占53.7%,晚孕孕妇占28.4%,高学历、高收入孕妇早孕检查率明显高于其他组。孕期出现刷牙出血、对冷热不适、牙疼等孕妇有1 381例(66.0%),其中孕前半年进行口腔保健的孕妇发生率为22.8%(103/452),明显低于孕前半年未进行口腔保健的孕妇。1 677例孕妇孕期接受了口腔保健知识,其中58.2%(976/1 677)的知识主要来源于医务人员。结论:孕前半年及孕早期进行口腔健康保健意义更明显,高学历、高收入人群更注重孕期口腔健康。     

Non-occupational exposure to paint fumes during pregnancy and fetal growth in a general population

Occupational exposure to organic solvents during pregnancy has been associated with reduced fetal growth. Though organic solvents in the form of paint fumes are also found in the home environment, no studies have investigated the effect of such exposure in a general population. We studied associations between residential exposure to paint fumes during pregnancy and fetal growth within the Danish National Birth Cohort which consecutively recruited pregnant women from 1996 to 2002 from all over Denmark. Around the 30th pregnancy week, 19,000 mothers were interviewed about use of paint in their residence during pregnancy. The mothers were also asked about smoking habits and alcohol consumption during pregnancy, pre-pregnancy weight, height, parity and occupation. Information on birth weight and gestational age was obtained from national registers. We found that 45% of the mothers had been exposed to paint fumes in their residence during pregnancy. We found a statistically significant inverse relationship between exposure to paint fumes and the risk of being small for gestational age. There were no statistically significant associations between exposure to paint fumes and birth weight and risk of preterm birth after adjustment for potential confounders. Our results suggest that there are no causal relationship between non-occupational exposure to paint fumes in the residence during pregnancy and fetal growth.     

城市流动与户籍孕产妇产前保健利用状况比较分析

目的:了解流动孕产妇与户籍孕产妇产前保健服务的利用情况,发现两人群的差异,探讨影响因素并为制定干预措施提供依据。方法:采用对比研究,在广州、浙江、福建、北京对379名流动孕产妇和381名户籍孕产妇进行问卷调查,了解其社会人口学因素及产前保健利用情况,包括初检孕周、产检次数及早、中、晚孕期的产检项目等。结果:流动与户籍孕产妇孕早期初检率分别为40.5%和57.1%,产检5次及以上的比率分别为60.4%和80.6%;流动孕产妇孕早、中期各基本项目检查率低于户籍孕产妇,孕晚期差异不大。流动人口、文化程度低、经济收入低、未婚或离异、无保险、经产妇、计划外生育、怀孕后无人通知产检等会影响孕产妇的产检利用情况。结论:城市中流动孕产妇产前保健服务的利用情况与户籍孕产妇相比存在较大差异,孕产妇保健应注重提供普惠性的服务项目及加大服务宣教力度。     

Who continues to smoke while pregnant?

STUDY OBJECTIVE--The aim was to study changes in smoking habits during pregnancy and differences in characteristics between women who stop smoking and those who continue to smoke during pregnancy. DESIGN--The study was a population based prospective study. Self administered questionnaires were completed on three occasions. SETTING--The study area was Uppsala county, Sweden, in 1987. PARTICIPANTS--The participants were women registered with antenatal care clinics, which included all pregnant women in the county. Ninety six percent (n = 3678) of all pregnant women completed the first questionnaire. Thirty two percent of these were smokers at time of conception. MEASUREMENTS AND MAIN RESULTS--Twenty nine percent of the smokers stopped smoking at some stage of pregnancy, and the majority did so before having registered for antenatal care. Using logistic regression analysis it was found that high parity number, not living with infant's father, heavy smoking, and daily passive smoking at home were associated with significantly increased risk for continued smoking during pregnancy. High level of education and high age at onset of smoking decreased the risk. CONCLUSIONS--In order to reduce the smoking related risks for unsuccessful pregnancy outcome, general preventive efforts in society must be combined with the development of more specialised antenatal programmes designed with consideration of the characteristics and life situation of the pregnant smoker.