Do pregnant women who report a reduction in cigarette consumption consume less tobacco?

Objective - To investigate the relationship between changes in self-reported cigarette consumption and changes in serum thiocyanate among pregnant and non-pregnant women who participated in a smoking cessation trial.

Design - Intervention study.

Setting - General practitioners in western Norway.

Subjects - 146 pregnant and 102 non-pregnant women who were daily smokers at inclusion. Self-reported cigarette consumption and serum thiocyanate were recorded at inclusion and after 12 months.

Results - Women who smoked in the first trimester of pregnancy reported 21% less cigarette consumption than non-pregnant women. This was in accordance with the serum thiocyanate values. Twelve months later the mean values of serum thiocyanate had increased irrespective of whether the postpartum women reported that they had reduced, increased, or not changed their cigarette consumption. However, among those who reported that they had stopped smoking, analyses of serum thiocyanate confirmed their statements, with very few exceptions. Among nonpregnant women, the serum thiocyanate changed in accordance with the reported changes in cigarette consumption in all groups.

Conclusion - Women smoking daily in the first trimester of pregnancy had a lower exposure to tobacco than daily smoking non-pregnant women. Twelve months later (six months after delivery) analyses of serum thiocyanate indicated that postpartum women underestimated their tobacco consumption.     

General Medicine; Breaking Down Frontiers

Lendahls L, Liljestrand J. Smoking during Pregnancy in Blekinge 1984–88. Scand J Prim Health Care 1989 7: 189–92

During the past 5-year period, midwives and doetors working in antenatal care in Blekinge county, Sweden, have increased their efforts to help pregnant smokers to stop or reduce smoking. To evaluate the effects of these efforts, all women giving birth during each September from 1984 to 1988 inclusive were asked to fill in an anonymous questionnaire on smoking habits before and during pregnancy.

The answering frequency was 81–86%. The frequency of never-smokers was constant at 44–49%, while the proportion of women who had stopped smoking before pregnancy increased significantly, from six to 31%. Six to 13% of the responders had stopped smoking during pregnancy, and the persistent smokers smoked significantly less at the end of the period. Thus, during the study there was a gradual reduction in the proportion of pregnant women who smoked, and the smokers smoked less.     

Angiogenic profile and smoking in the Finnish Genetics of Pre-Eclampsia Consortium (FINNPEC) cohort

Objectives: The biological mechanism by which smoking reduces the risk of pre-eclampsia (PE) is unresolved. We studied serum levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and their ratio, in addition to soluble endoglin (sEng) in early and late pregnancy to ascertain whether these factors are altered in women who smoke.

Subjects and methods: First trimester serum samples were available from 217 women who later developed PE and 238 women who did not develop PE. Second/third trimester serum samples were available from 174 PE and 54 non-PE women.

Results: PE women who smoked during pregnancy had elevated first trimester concentrations of serum PlGF [geometric mean (95% CI): 39.8 (32.6–48.5) pg/ml, p?=?.001] and reduced sEng concentration [5.0 (4.6–5.6) ng/ml, p?=?.047] compared to PE non-smokers [30.0 (28.1–32.1) pg/ml and 6.1 (5.9–6.4) ng/ml, respectively]. Non-smoking women in the PE group had the highest sFlt-1/PlGF ratio in early and late pregnancy.

Conclusions: The protective effect of smoking in reducing the risk of PE may be due to the early pregnancy change towards pro-angiogenic marker profile. Also, in late pregnancy, smoking exerted effect in sFlt-1/PlGF ratio in PE pregnancies, and may complicate its use as a prognostic and diagnostic marker.

• Key messages

• Smoking appears to have angiogenic effects in early pregnancy with reduced sEng concentrations and elevated PlGF concentrations in both normal and PE pregnancies.

• Throughout pregnancy, smoking exerted effect in PlGF concentration and sFlt-1/PlGF ratio in PE pregnancies, and thus may complicate its use as a prognostic and diagnostic marker.

     

Social attitudes towards smoking in pregnancy in East Surrey: A qualitative study of smokers,former smokers and non-smokers

A qualitative study was undertaken to explore social attitudes towards smoking by pregnant women, mothers of preschool children and their partners based in Merstham and Horley, East Surrey. All respondents felt that smoking in pregnancy was associated with considerable social stigma and negative social attitudes. Non-smokers were particularly negative in their views on smoking in pregnancy feeling that it was socially unacceptable. Women who smoked during pregnancy reported various negative social experiences such as receiving criticism from health professionals and community associates. They reported feeling under pressure to quit to achieve social acceptability as much as for health improvements. Some pregnant smokers denied smoking to health professionals, partners and colleagues and used private smoking places out of public view to reduce the chances of detection. Women who smoked or had a partner who smoked were more accepting of smoking in pregnancy than non-smokers and former smokers. Moreover, residents from the more socio-economically deprived area of Merstham were more tolerant of smoking in pregnancy and parenthood, compared to Horley-based respondents, regardless of their personal smoking status. They gave examples of local women they knew who had smoked in pregnancy without apparent complication. While all respondents were aware of health risks associated with smoking, smokers did not feel the risks were personally relevant to them and were exaggerated in an anti-smoking society. Health professionals need to be aware that pregnant women may not disclose smoking activity due to perceived social stigma and may require more intensive smoking cessation support services in socio-economically deprived areas.     

Smoking during pregnancy in Blekinge 1984-88

During the past 5-year period, midwives and doctors working in antenatal care in Blekinge county, Sweden, have increased their efforts to help pregnant smokers to stop or reduce smoking. To evaluate the effects of these efforts, all women giving birth during each September from 1984 to 1988 inclusive were asked to fill in an anonymous questionnaire on smoking habits before and during pregnancy. The answering frequency was 81-86%. The frequency of never-smokers was constant at 44-49%, while the proportion of women who had stopped smoking before pregnancy increased significantly, from six to 31%. Six to 13% of the responders had stopped smoking during pregnancy, and the persistent smokers smoked significantly less at the end of the period. Thus, during the study there was a gradual reduction in the proportion of pregnant women who smoked, and the smokers smoked less.     

Antenatal care in general practice, Trondheim, Norway

In this study from the city of Trondheim during 1979-81 nulliparae were found to be younger, higher educated, and more actively working outside the home than parous women. Most women were examined by their GP during the first trimester, and were seen about 10 times on average during the pregnancy. Women who smoked tended to consult later in pregnancy than the non-smokers. Drugs were prescribed for 33% of the women during their pregnancy, 10% during the first trimester. Medication was most frequently prescribed for genitourinary disorders. Sick leave was often the result of low-back-pain and lasted on average 5 weeks longer in parous women. Hospitalization was most often due to hypertension and threatened premature labour and lasted on average longer among nulliparae. Controlled trials are needed to evaluate future antenatal care provision in the light of pregnancy outcome.     

Smoking habits before, during and after pregnancy among Swedish women and their partners in suburban Stockholm.

Smoking habits of pregnant women and their partners at three health centres in Stockholm, Sweden, were monitored by a postal questionnaire. Of 582 women enlisted at the antenatal clinics, 433 (74%) were included. 253 (58%) women and 230 (53%) partners responded. 30% of the women were smokers at the start of pregnancy, compared with 27% of the men. During pregnancy 18% continued to smoke, and after the birth of the child 21% were smokers. The male partners stopped or decreased smoking less often. Fewer women aged 25 or more were smokers. The number of heavy smokers decreased considerably during and after pregnancy. The women were more prone to stop smoking if the partner was a non-smoker. 87% made some restriction in their smoking habits after the baby was born.     

Despite intention to breastfeed,smoking during pregnancy is associated with shorter breastfeeding duration

While maternal smoking is associated with lower breastfeeding rates, the intention to breastfeed is simultaneously related to higher breastfeeding success. This study aimed to i) analyse the association between maternal smoking and breastfeeding success in a cohort of women who intended to breastfeed and ii) characterise smokers according to a set of diverse variables in order to define efficient breastfeeding promotion interventions. This prospective observational study involved 401 pregnant women who intended to breastfeed. Breastfeeding success was evaluated in relation to maternal smoking status during pregnancy from birth to the first year, along with physiological and socio-cultural variables. Those who smoked during pregnancy had shorter breastfeeding durations when compared to non-smoking mothers. However, smoking cessation during breastfeeding was associated with longer breastfeeding duration. Mothers who smoked during pregnancy were significantly younger, had a lower level of education, gained more weight during pregnancy, used more oxytocin during labour, used a teat or pacifier more often and exclusively breastfed less during the first week. Knowledge of the characteristics of smoking mothers and their breastfeeding practices should help to improve the effectiveness of breastfeeding promotion strategies.     

Antenatal Care in General Practice. 1: A Questionnaire as a Clinical Tool for Collection of Information on Psychosocial Conditions

In pregnancy the woman's emotional sensitivity and also her receptiveness of emotional support increase. Antenatal care that is exclusively focused on somatic conditions may lead to ignorance of pregnant women's psychosocial problems, thus missing a chance of intervention. A psychosocial questionnaire, used as a clinical tool in history taking during the first two antenatal consultations, is described and evaluated. The purpose of the questionnaire was to elucidate the pregnant woman's psychosocial assets as well as problems. The information collected by means of this questionnaire is compared with the information on psychosocial conditions collected by means of the traditional antenatal care form.

Screening for psychosocial conditions in pregnant women may reveal information about important life aspects that are not detected in the antenatal care form.     

Smoking rates and smoking cessation among individuals with multiple sclerosis

Purpose. Adults with physical disabilities tend to smoke at higher rates than smokers in the general population. No study to date, however, has assessed smoking prevalence and cessation among individuals with multiple sclerosis (MS). Such information is critically needed because smoking is more deleterious for individuals with MS than for smokers without MS and increases MS risk.

Method. Questionnaires were sent to 700 National Multiple Sclerosis Society Rhode Island Chapter members.

Results. Based on a 50% response rate, results demonstrated a 15.2% current smoker prevalence rate, which is lower than USA and Rhode Island general adult population averages. Individuals who smoked, however, tended to be heavy smokers, consuming 20 – 30 cigarettes daily, and had been smoking 10 years or longer. Smokers varied in their interest in quitting but seemed confident in their ability to do so. Respondents reported that it was difficult to quit because smoking was pleasurable; smoking was helpful in coping with boredom and with having MS; withdrawal symptoms were unpleasant; and treatment for tobacco dependence was expensive.

Conclusions. Efficacious smoking cessation interventions for smokers with MS should be developed to address a critical health need for a population of highly nicotine-dependent smokers who face numerous obstacles to quitting.     

Does long-term smoking affect aortic stiffness more inwomen than in men?

Smoking is a well-known risk factor forcardiovascular disease, although understanding of the pathophysiological mechanism isincomplete. The effect of heavy smoking, for more than 20 years and of 20 cigarettes per day,on aortic stiffness was studied in women (n=23, age range 43–61years) and men (n=21, age range 43–61 years) who smoked but wereotherwise healthy and compared with a healthy reference population that did not smoke. Aorticstiffness (b) was calculated from the diameter and the pulsatile diameter change determinednon-invasively using an ultrasonic echo-tracking system and blood pressure obtained by theauscultatory method. The results showed that aortic diameter did not differ in smoking males (P=0·974) or in smoking females (P=0·361). Aortic stiffness was increased in the female (P=0·041) but not male smokers (P=0·222). Systolic,mean and diastolic blood pressure in the men and women who smoked did not differ fromthose in the healthy reference population. In conclusion, this investigation shows increasedaortic stiffness in female but not in male smokers. It indicates that the aorta of women might bemore vulnerable to smoking with regard to stiffening and degeneration than the aorta of men.     

Effect of smoking on pregnancy-associated plasma protein A, free β-human chorionic gonadotropin, and nuchal translucency in the first trimester of pregnancy

Data were collected from 1275 pregnant Turkish women screened prospectively for chromosomal anomalies to determine whether first-trimester levels of maternal serum pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG) and the thickness of nuchal translucency are affected by smoking and other covariables. Only normal singleton pregnancies were included. After weight correction, comparisons were made between smokers and nonsmokers. Mean values of PAPP-A and β-hCG were reduced in women who smoked 5 or more cigarettes a day compared with nonsmokers. The median β-hCG level decreased significantly as gravidity and parity increased; no effect was noted on PAPP-A. Median PAPP-A and β-hCG levels tended to increase, but not significantly in women who had had 2 or more miscarriages. Smoking alters maternal levels of serum analytes, with the magnitude of the impact related to the number of cigarettes smoked per day. This effect can be detected in the first trimester of pregnancy.     

If you are pregnant and smoke,admission to hospital may damage your baby's health

Summary

• ? It is recognized that smoking adversely affects the outcome of pregnancy. However, clinical experience suggested that women admitted to hospital during pregnancy smoked more than when they were at home.
• ? Forty-one women who were over 20 weeks pregnant, who smoked and had been in hospital for 2 days or more were interviewed using a structured schedule.
• ? The women had made a significant reduction in their cigarette consumption during pregnancy but on admission to hospital the number of cigarettes smoked had almost returned to the pre-pregnancy level. Boredom was seen as the main factor contributing to this increase.
• ? Strategies for reducing the effects of admission to hospital on smoking behaviour are suggested.

     

A couple-focused intervention to prevent postnatal smoking relapse: PRISM study design

BackgroundMaternal smoking is one of the most modifiable factors with clear adverse effects for the fetus and the entire family. Addressing the dearth of pregnancy smoking interventions with partner support, PRISM (Prevent Relapse In SMoking) is a partnership between a research institution and the two largest state-owned obstetrics and gynecology clinics in Cluj-Napoca, Romania. The study will assess the efficacy of a couple-focused telephone-counseling program to prevent smoking relapse among mothers who quit smoking closely before or during pregnancy.Methods/designThe intervention is a program for couples based on motivational interviewing delivered over the phone after birth. The study is an ongoing randomized controlled trial of 250 Romanian women recruited soon after childbirth, who quit smoking in the six months before pregnancy or no later than the end of the first pregnancy trimester and remained abstinent (which was biochemically verified) until delivery. Participants were randomized to: (1) a control arm (usual care); and (2) an intervention arm consisting of up to 4 postnatal counseling calls for mothers and their partners using motivational interviewing to encourage the woman to remain smoke-free and the partner to support her decision. The primary outcome is maternal smoking abstinence at 6 months postpartum (biochemically verified).DiscussionPRISM has the potential to identify strategies to reduce maternal postnatal relapse and increase partner quitting. If successful, the program may be an effective method to prevent and reduce smoking, which may lead to improved child, mother, and partner health both in the short and the long term.     

城镇中晚孕妇女产前抑郁危险因素的横断面研究

目的调查中国城镇中晚孕妇女产前抑郁的检出率,探索其发病的危险因素。方法收集2006年1月至2012年6月的临床样本共884例。采用症状自评量表(SCL-90)调查孕妇抑郁水平,采用基本信息问卷采集孕妇人口学信息(年龄、文化水平、家庭收入、怀孕次数),专家根据临床经验组织结构式访谈收集社会心理因素(意愿妊娠、性生活满意度、分娩恐惧、家庭支持、期待男孩、对婴儿的喜爱)。结果城镇妇女产前抑郁检出率为9.72%。Logistic回归分析揭示家庭支持的缺乏(OR=2.265;95%CI 1.36³.77)、高度期待男孩(OR=2.191;95%CI 1.143.77)、高度期待男孩(OR=2.191;95%CI 1.14⁴.20)、对分娩的恐惧(OR=1.757;95%CI 1.424.20)、对分娩的恐惧(OR=1.757;95%CI 1.42².17)以及较低的文化水平(OR=0.678;95%CI 0.52.17)以及较低的文化水平(OR=0.678;95%CI 0.5⁰.92)是产前抑郁的危险因素。结论产前抑郁在中国城镇妇女的检出率较高。家庭支持、婴儿期待、分娩恐惧以及文化水平是产前抑郁的危险因素。     

The effect of psychosocial risk factors on postpartum depression in antenatal period: A prospective study

PurposeThe aim of this study was to determine the psychosocial risk factors that may increase the risk of developing postpartum depression (PPD) symptoms in the antenatal period at postpartum 6–8 weeks.MethodsThis study was a prospective longitudinal design, in which women completed questionnaire measures both at the third trimester of pregnancy and 6–8 weeks after birth. The present study was conducted in the women's clinic of a Medical Faculty Hospital in the Central Anatolia region of Turkey between March 15 and August 15, 2019. A total of 245 pregnant women in the third trimester were included in the study. Data were collected using a sociodemographic and obstetric data collection form, Pregnancy Psychosocial Health Assessment Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, and Edinburgh Postnatal Depression Scale.ResultsForty-four (18%) of the 245 women had scores above the cut-off point (>13) in EPDS. Being subjected to violence from husband or another male member of the family during pregnancy, having problems in marriage, depression, anxiety, and high levels of perceived stress affect the risk of developing PPD by 55% (χ² = 101.034, P < 0.001). It was observed that those who scored low on the psychosocial health scale, those who experienced unplanned pregnancy, those with pregnancy that was not wanted by the husband, those who were emotionally abused, and those who experienced a sad event in their families were more sensitive to PPD symptoms.ConclusionsPsychosocial health, perceived stress, and psychosocial risk factors, such as depression and anxiety, during pregnancy are important determinants of postpartum depressive symptoms.     

The acute effects of smoking on the cyclic variations in blood echogenicity of carotid artery

The objective of this research is to study the cyclic variations in echogenicity (CVE) as an acute response to smoking. CVEs, caused by the aggregation of red blood cells (RBC) were measured from the cross-sectional images of the common carotid artery using coded harmonic imaging of a commercial ultrasound system. The amplitude of the CVE (A_cve) was analyzed among 28 smokers before and after smoking. A_cve was increased in 22 smokers and decreased in six smokers after 1-2 cigarettes were smoked. Heart rate (HR) was also estimated from the ultrasonic images before and after smoking. The smokers were optimally divided into two clusters with respect to the change in A_cve and the intrinsic characteristics of smokers (i.e., daily consumed cigarettes and smoking years) through a two-step cluster analysis (TSCA). The increase in A_cve after smoking was significantly higher in the heavy smoker cluster compared with the light smoker cluster. The results suggest that the acute changes in A_cve in response to smoking are different between heavy smokers and light smokers. This preliminary study demonstrates the potential application of coded harmonic ultrasound imaging to detect or characterize RBC aggregation. In addition, the results may be useful for understanding the acute physiologic changes caused by smoking. (E-mail: paeng@jejunu.ac.kr)     

First trimester serum levels of the soluble transcobalamin receptor,holo-transcobalamin,and total transcobalamin in relation to preeclampsia risk

Background: Human placenta expresses CD320, a receptor that ensures the uptake of holo-transcobalamin (holoTC). Soluble CD320 (sCD320) is present in the circulation and its concentration increases during pregnancy.

Aims: To investigate a possible association of sCD320, holoTC and total transcobalamin (TC) with the risk of subsequent preeclampsia using serum samples from asymptomatic first trimester pregnant women. Moreover, we aimed to establish reference intervals of the aforementioned biomarkers for first trimester pregnant women who remained healthy throughout pregnancy.

Study design: This study was a retrospective case-control study that we performed on biobank serum samples. Cases (n?=?50) and controls (n?=?198) (matched for gestational age and date of sample collection) were asymptomatic women in early pregnancy [median (range) gestational age?=?10 (8–12) weeks]. Cases developed preeclampsia while the controls remained normotensive throughout pregnancy. We measured the serum concentration of sCD320, holoTC, and total TC by using in-house ELISA methods.

Results: First trimester median concentrations of sCD320, holoTC and total TC were not significantly different between cases and controls. The odd ratio for developing preeclampsia based on exposure to low or high levels of sCD320, holoTC or total TC at first trimester was not significant. The reference intervals (2.5–97.5% percentiles (median)) derived from the controls were 50–170 (90) pmol\L for sCD320, 20–140 (70) pmol\L for holoTC and 560–1300 (810) pmol\L for total TC.

Conclusions: The risk of preeclampsia is not predicted by first trimester serum concentrations of sCD320, holoTC or total TC. The first trimester reference intervals for the three parameters is reported.     

Prevalence of tobacco smoking among urban population of Samara and causative factors

AIM: To examine prevalence and intensity of smoking among general population of Samara, physicians and students of Samara Medical University; to study dependence of this prevalence on different social factors. MATERIAL AND METHODS: A representative sample of adult population was selected by the lists of outpatients of Samara outpatient clinic. The study enrolled 2931 outpatients (1272 males, 1659 females aged 15 years and older)--3.95% of all Samara outpatients. The questionnaire survey covered 360 physicians aged 28-57 years (the response 96.5%), 652 senior medical students aged 21-24 years (the response 93.14%). The results were processed with the statistical computer program BIOSTAT. RESULTS: The percentage of smoking men among 15-19-year-olds was 42.94%, 20-29-year-olds--59.29% (p < 0.01), 30-39-year-olds--62.18%, 60-year-olds and older--35.64%. This proportion for smoking women was 15.04%, 27.11% (p < 0.01), 22.92%, 9.06% (p < 0.001), 5.04%, respectively. Among male physicians smokers were 47.37% (14.29% smoked less than 10 cigarettes, 50.79%--10-20 cigarettes, 34.92%--more than 20 cigarettes a day); 16.54% male physicians smoked earlier, 36.09% never smoked. Relevant percentage for female physicians was 25.99 (38.98, 47.46, 13.56, 13.66 and 60.35, respectively). Among male medical students smokers were 58.6% (29.2% less than 10 cigarettes a day, 55.8%--0-20, 14.9%--more than 20 cigarettes a day); 9.1% smoked earlier, 32.3% never smoked. Among female medical students smokers were 20.3% (70.9, 21.5, 7.6, 9.3 and 70.4%, respectively). CONCLUSION: Tobacco smoking depends on education and marital status. Both in men and women the least number of smokers are among persons with higher education and married ones.