Smoking during pregnancy: Missouri longitudinal study

Maternal smoking during pregnancy has been shown to be associated with reduced birthweight and increased fetal and infant mortality. This paper examines these patterns in first and second maternally-linked singleton pregnancies from 1978 to 1990 among 176 843 Missouri resident women with known smoking status in both pregnancies. Generally women were more likely to smoke in their second pregnancies (27.4%), than in their first (25.8%). This pattern was strongest among those whose first pregnancies occurred as teenagers, and for black women. The relationships of smoking during the first and second preg-nancies to outcomes in the second pregnancies were examined primarily through multivariate logistic regression. The adjusted relative risk (RR) of low birthweight (<2500 g) in the second pregnancy to not smoking in either pregnancy was 1.82 for those who smoked during the second pregnancy only, and 1.87 for those who smoked in both pregnancies. For those who smoked in the first pregnancy only, the RR was 0.97, not significantly different from 1. Adjusted smoking RRs for small-for-gestational age were larger, while adjusted RRs for fetal and neonatal mortality were smaller than the smoking RRs for low birthweight.     

Smoking during pregnancy: Missouri longitudinal study

Maternal smoking during pregnancy has been shown to be associated with reduced birthweight and increased fetal and infant mortality. This paper examines these patterns in first and second maternally-linked singleton pregnancies from 1978 to 1990 among 176 843 Missouri resident women with known smoking status in both pregnancies. Generally women were more likely to smoke in their second pregnancies (27.4%), than in their first (25.8%). This pattern was strongest among those whose first pregnancies occurred as teenagers, and for black women. The relationships of smoking during the first and second preg-nancies to outcomes in the second pregnancies were examined primarily through multivariate logistic regression. The adjusted relative risk (RR) of low birthweight (<2500 g) in the second pregnancy to not smoking in either pregnancy was 1.82 for those who smoked during the second pregnancy only, and 1.87 for those who smoked in both pregnancies. For those who smoked in the first pregnancy only, the RR was 0.97, not significantly different from 1. Adjusted smoking RRs for small-for-gestational age were larger, while adjusted RRs for fetal and neonatal mortality were smaller than the smoking RRs for low birthweight.     

Changes in characteristics of women who smoke during pregnancy: Missouri, 1978-88

The Missouri birth certificate has had a question, "cigarettes smoked per day?" since 1978; the current data base contains more than 800,000 records. A comparison of the Missouri data for married mothers with the National Natality Survey (NNS) data shows mainly consistent findings between the two data sets. The Missouri data, however, also provided information on the smoking status during pregnancy of unmarried women that is not available from the NNS. The Missouri data show a substantial difference in the smoking rates of married (23.2 percent) and unmarried (40.9 percent) women. The highest smoking rates during pregnancy are found among unmarried women, ages 20-24, with less than a high-school education, and those with a fourth or higher order child. There has been a relatively small overall drop in the smoking rate from 1978-80 to 1986-88 (31.1 percent versus 27.5 percent). However, blacks and teenagers have had very substantial drops in smoking rates. There has been only a slight decrease for other high-risk groups such as white unmarried women, women with less than a high-school education, and those having a fourth or higher order birth. Missouri started using the new national standard birth certificate in 1989 with a differently worded smoking question. The percentage of women smoking and those smoking less than one pack per day in 1989 went down more than would be expected from the trend data. It appears that the new birth certificate question will provide a lower estimate of the percentage of mothers who smoke cigarettes than was acquired from the previous version on the Missouri certificate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Adolescent age at first pregnancy and subsequent obesity

Adolescent pregnancy has been associated with subsequent obesity. This paper examines the patterns of obesity for second and third pregnancies among women who had their first singleton pregnancy as teenagers. We used maternally-linked data from 1978 to 1990 among 43 160 Missouri resident women. Age, parity, interpregnancy interval and prior body mass index were significantly associated with subsequent obesity among adolescents. Race, marital status and smoking had significant interactions with age. Among older women, being African–American and never having married was associated with an increased probability of obesity, and smoking had a greater effect on obesity at higher maternal age. Race and marital status did not have significant effects on obesity among younger women. The most important predictor of obesity was prior body mass index. Body mass index before the first pregnancy had a greater effect on subsequent obesity if the intervening interpregnancy weight gains were large. Excessive weight gain during pregnancy presents the health care provider with a dilemma. An increase in birthweight associated with high prenatal weight gains may diminish the risk of infant mortality and morbidity in an index pregnancy, but subsequent obesity may increase perinatal mortality rates, the rates of obstetric problems and neural tube defects.     

Black teenage pregnancy: An obstetrician's viewpoint

The Black pregnant teen is a microcosm of the impact of society on the most vulnerable. Who is the pregnant adolescent? What racial and ethnic connotations are implied? What is the quality of her progeny? What health risks and mortality attend Black pregnant adolescents? What measures are indicated to address teen pregnancy? Health providers must more intensively address the essentials of the socio-medical phenomenon of Black teenage pregnancy. The United States leads other developed countries of the world by substantial margins in births to teenagers, ranging from 3/1,000 in Japan to 52/1,000 in the United States. In 1983 in New York City, 40,000 teenagers became pregnant resulting in 14,000 births, 20,000 abortions, and 6,000 miscarriages. Sixty-six percent of the births occurred in areas with large concentrations of residents of lower socioeconomic status. Special attention, then, needs to be focused on both pregnancy prevention and early prenatal care in these high risk areas. Most teenagers do not intend to become pregnant. There are suggested racial differences regarding both the intention of becoming pregnant and teen births. Twenty percent of pregnant teenagers conceive during the first sexual expsoure and fifty percent become pregnant within the first six months. The younger the age at initiation of intercourse, the greater the likelihood of pregnancy. The desire to terminate a teen pregnancy is more closely associated with socio-economic status than ethnicity. The course of pregnancy in teenagers is more likely to be complicated by a variety of clinical problems than in adults. Further, the maternal mortality rate in pregnant black teenagers is significantly higher than in white teenagers. The younger the pregnant teenager is, irrespective of ethnicity, the higher the maternal mortality and morbidity rates. Future directions which are indicated vary. Further, it will take concerted effort by all segments of society to eliminate unplanned pregnancies, which continue to prove devastatingly costly.     

Racial/ethnic differences in smoking, other risk factors, and low birth weight among low-income pregnant women, 1978-1988

Because of the adverse effects of low birth weight (LBW) on infant morbidity and mortality, one of the 1990 health objectives for the nation has been to reduce the incidence of LBW to 5% among all live births in the United States. Public health surveillance of cigarette smoking during pregnancy has demonstrated an association between smoking and an increased risk of LBW, defined as birth weight of less than 2,500 g. For the period 1978-1988, information on nearly 248,000 women from CDC's Pregnancy Nutrition Surveillance System showed an LBW rate of 6.9%, a high prevalence of smoking during pregnancy (29.7%); and a strong association between smoking during pregnancy and the likelihood of delivering an LBW infant in all age, racial/ethnic, and prepregnancy weight groups. The risk of LBW was greater for smokers than for nonsmokers (9.9% versus 5.7%), creating an excess LBW risk of 4.2% associated with smoking. Overall, the average birth-weight deficit related to smoking was 178 g. Among both smokers and nonsmokers, black women had a higher percentage of LBW infants than did white women, and the risk of LBW related to smoking was greater among black women. That risk tended to increase with age, especially among women with low pregravid weight. Major reductions in LBW might be achieved if smoking were eliminated among pregnant women.     

Smoking rates among pregnant women in Tennessee, 1990-2001

BACKGROUND: Pregnant smokers represent a major public health challenge. The objective of this study was to determine trends in smoking during pregnancy in Tennessee, a state with one of the highest smoking burdens in the nation, and to confirm characteristics of high-risk groups to target for smoking prevention. METHODS: Population-based cohort study of pregnant women in Tennessee who delivered live births from 1990-2001. Trends in smoking were determined by maternal age, race and insurance status using vital records and Medicaid data. Characteristics of women who smoked during pregnancy were described for 2001. RESULTS: Among 900,986 pregnant women in the cohort, there were statewide decreases in smoking rates during pregnancy; however, smoking among pregnant women younger than 25 years in Medicaid increased from 1996 to 2001: among whites from 31% to 34%, and among blacks from 6% to 9% (P values for trend shifts <0.0001). Characteristics of pregnant women who smoked during pregnancy included white race, Medicaid enrollment, nonurban residence, and less than a high school education. CONCLUSIONS: Smoking rates increased significantly among pregnant women <25 years enrolled in Medicaid between 1996 and 2001. Tennessee needs smoking cessation and prevention efforts that target young, low-income women with less than a high school education.     

The dissemination of smoking cessation methods for pregnant women: achieving the year 2000 objectives.

The smoking prevalence rate among adult women and pregnant women has decreased only 0.3 to 0.5% per year since 1969. Without a nationwide dissemination of efficacious smoking cessation methods based on these trends, by the year 2000 the smoking prevalence among pregnant women will be approximately 18%. This estimate is well above the US Department of Health and Human Services Year 2000 Objective of 10%. The US dissemination of tested smoking cessation methods could help an additional 12,900 to 155,000 pregnant smokers annually and 600,000 to 1,481,000 cumulatively to quit smoking during the 1990s. Dissemination could help achieve 31 to 78% of the Year 2000 Objectives for pregnancy smoking prevalence. (With dissemination, at best a 15% smoking prevalence during pregnancy, rather than the 10% objective, is likely to be observed.) Our results confirm a well-documented need for a national campaign to disseminate smoking cessation methods.     

Prenatal smoking cessation among Black and White women in Eastern North Carolina

PURPOSE: Limited information is available about Black:White disparities in prenatal smoking cessation, and the results of prior research are inconsistent. We analyzed smoking cessation and factors associated with cessation (attitudes, environment, and nicotine addiction) in a sample of pregnant Black and White women. METHODS: Women were interviewed at the first prenatal visit at two hospital-based clinics. RESULTS: Among former and current smokers, there were no significant differences in the percentage of former smokers between Black (46.8%) and White (43.3%) pregnant women, or in the percentage of "spontaneous quitters" (i.e., those who quit after learning that they were pregnant) for Blacks (36%) and Whites (28%). Both Black and White spontaneous quitters had evidence of occasional relapses to smoking. For Black and White women, smoking more than a pack a day prior to pregnancy was associated with smoking during pregnancy. DISCUSSION: Among current and former smokers, spontaneous cessation was about the same for Black and White women, and about two thirds of women who were smokers when they learned of the pregnancy continued to smoke during pregnancy. Nicotine addiction contributed to continued smoking.     

Decreasing smoking prevalence during pregnancy in Sweden: the effect on small-for-gestational-age births.

OBJECTIVES: This study examined whether recent changes in smoking prevalence among pregnant women have affected risks of small-for-gestational-age births. METHODS: With data for all live single births in Sweden from 1983 through 1992 (n = 1048139), odds ratios [ORs] and attributable risks of small-for-gestational-age births were calculated for 1983 through 1985, 1986 through 1989, and 1990 through 1992. RESULTS: Daily smoking decreased from 29.4% in 1983 to 21.8% in 1992. For the three time periods, the odds ratios of small-for-gestational-age births by maternal smoking were almost identical: 1-9 cigarettes/day OR = 2.1 or 2.2; for > or = 10 cigarettes/day, OR = 2.8. The attributable risk of smoking for small-for-gestational-age births declined from 26.2% in 1983 through 1985 to 20.9% in 1990 through 1992. CONCLUSIONS: The findings point to a true decrease in tobacco exposure during pregnancy and a reduction in the attributable risk for small-for-gestational-age births.     

Race-specific patterns of abortion use by American teenagers.

Between 1972 and 1978, as legal abortion became more widely available nationally, abortion rates (abortions per 1,000 women) and ratios (abortions per 1,000 live births) increased for all American teenagers; from 1972 to 1975, the rates and ratios for teenagers for Black and other races increased faster than those for White teenagers. For all seven years, abortion rates were higher for teenagers of Black and other races than for white teenagers. This reflected both higher proportions of sexually active teenagers of Black and other races and a greater risk of pregnancy in these teenagers compared with White teenagers. Race-specific differences in legal abortion ratios narrowed during the seven-year interval, as did differences in alternative outcomes of teenage premarital pregnancies (term births, illegal abortions).     

Factors Associated With Quitting Smoking During Pregnancy Among Women Veterans

IntroductionLittle is known about the rates of smoking among pregnant veterans. Our objective was to examine rates of smoking during pregnancy and factors associated with quitting smoking during pregnancy.MethodsWe used data from a cohort study of pregnant veterans from 15 Veterans Health Administration facilities nationwide. Veterans who reported smoking during pregnancy were included in this analysis. Poisson regression models were used to estimate the relative risk (RR) of quitting smoking during pregnancy.ResultsOverall, 133 veterans reported smoking during pregnancy. Among this group of women who smoked, the average age was 31.6 years, 20% were Black, and 14% were Hispanic/Latino. More than one-half of women (65%) who reported smoking at the start of pregnancy quit smoking during pregnancy. Multivariable models, adjusted for history of deployment and age, indicated that prenatal care initiation at 12 or fewer weeks compared with more than 13 weeks (relative risk [RR], 2.06; 95% confidence interval [CI], 1.18–3.58), living without household smokers compared with any household smokers (RR, 1.58; 95% CI, 1.14–2.17), and first pregnancy (RR, 1.51; 95% CI, 1.17–1.95) were significant predictors of quitting versus persistent smoking during pregnancy.ConclusionsWomen veterans who quit smoking may be different than those who continue to smoke during pregnancy. Establishing prenatal care early in pregnancy, which likely includes counseling about smoking cessation, seems to be an important factor in quitting. Those for whom it is not a first pregnancy and who live with other smokers may especially benefit from such counseling.     

Violence, pregnancy and birth outcome in Appalachia

Summary. Few studies have followed pregnant women prospectively to examine the impact of violence on birth outcome. We included such an assessment in a prospective study of pregnancy among low-income women. Nurses and social workers interviewed pregnant women (n = 364) and asked if they had been the object of violence since they became pregnant. These prenatal interviews were linked with information from perinatal records and with birth and death information. In total, 15.9% of women in the study indicated they had been abused since they became pregnant. Abused women were more likely to be teenagers and to have partners who were teenagers. Abused women were more likely to be primiparous, to smoke during pregnancy and to have physical problems related to stress. Women battered during pregnancy were more likely to suffer fetal distress or fetal death [Odds Ratio (OR) 3.68; 95% Confidence Interval (CI) 1.36,9.94], even after adjusting for maternal age and smoking status. Finally the infants of abused women were more likely to remain in hospital after their mother's discharge (OR: 3.75; 95% CI: 1.38, 10.23). Our findings suggest that fetuses may be compromised in utero , as shown by higher rates of fetal distress and fetal death found among women physically abused during pregnancy.     

Smoking during pregnancy--United States, 1990-2002

Cigarette smoking during pregnancy adversely affects the health of both mother and child. The risk for adverse maternal conditions (e.g., premature rupture of membranes, abruptio placentae, and placenta previa) and poor pregnancy outcomes (e.g., neonatal mortality and stillbirth, preterm delivery, and sudden infant death syndrome) is increased by maternal smoking. Infants born to mothers who smoke weigh less than other infants, and low birthweight (<2,500 grams) is a key predictor for infant mortality. Infertility and conception delay also might be elevated by smoking. National health objectives for 2010 target an increase in cessation to 30% among pregnant smokers during the first trimester and abstinence from cigarettes by 99% of women giving birth. To assess progress toward these goals, CDC analyzed state-specific trends in maternal smoking during 1990-2002 by using data collected on birth certificates. This report summarizes the results of those analyses, which indicated that whereas participating areas observed a significant decline in maternal smoking during the surveillance period, 10 states reported recent increases in smoking by pregnant teens. Although the widespread public health message to abstain from smoking during pregnancy has helped decrease maternal smoking, to reduce prevalence further, implementation of additional interventions are required.     

孕妇被动吸烟状况分析

目的:了解孕妇被动吸烟状况及相关影响因素。方法:选取河南省妇幼保健院、开封市妇幼保健院、开封市妇产医院、开封县妇幼保健院、杞县妇幼保健院及杞县阳固乡卫生院6家医疗保健机构作为研究现场。抽取在研究现场进行产前检查的孕妇共1660人进行调查研究。结果:被调查对象中有82.4%的孕妇在孕前接触过"二手烟",68.3%的孕妇在孕期接触过"二手烟",孕期被动吸烟率为26.6%。孕周13周、年龄20岁、居住于城镇、孕妇文化程度为小学及以下、孕妇职业为农民、丈夫文化程度为小学、丈夫职业为农民、家庭月收入500～999元、孕期家庭结构为独居、孕妇孕前吸烟、孕前丈夫吸烟以及丈夫吸烟时间10年的孕妇,孕期被动吸烟率较高。孕妇居住地、孕妇孕前吸烟状况及孕前丈夫吸烟时间与孕妇被动吸烟状况有关联。结论:孕妇被动吸烟状况不容忽视,建立无烟家庭势在必行。     

300名孕妇被动吸烟状况与健康教育干预策略的探讨

１９９６年５月，在北京市海淀区妇产医院，以个人访谈方法，对３００名来院门诊作产前检查的孕妇进行吸烟与被动吸烟的现状及影响因素调查，并组织两个专题小组收集信息。结果显示：孕妇孕前吸烟率为３３％；孕后为０％；３００名丈夫在妻子孕前吸烟率为６２３％，孕后为５９０％；孕妇被动吸烟率为４６３％，其中来自丈夫吸烟引起的为２４３％，较孕前的５２０％有较大幅度的下降；影响孕妇被动吸烟率的因素可能有孕期、孕妇文化程度、孕妇户口所在地、丈夫文化程度、丈夫户口所在地等。     

Smoking and drinking habits before and during pregnancy in Spanish women.

STUDY OBJECTIVE--To investigate possible changes in smoking and drinking habits during pregnancy and to elucidate the sociodemographic factors associated with these changes in Spanish women. DESIGN--A cross-sectional survey. PARTICIPANTS AND SETTING--A total of 1004 pregnant women of between 12 and 18 weeks of gestation who were attending the antenatal clinic of the main regional hospital of Valencia (Spain) during 1989 were studied. All participants completed the study and only one eligible woman refused to participate when approached. MEASUREMENTS AND MAIN RESULTS--Information was obtained by structured questionnaire (Euromac questionnaire), which included items on age, educational level, marital status, occupation, parity, previous and present smoking habits, and previous and present alcohol consumption. Women were asked about the consumption of cigarettes and alcohol for a typical week before they knew they were pregnant, and details of current consumption were obtained for the week before the interview. The number of drinks taken per week was later converted to the amount of absolute alcohol (in g). Sixty per cent of the women smoked and 72% drank alcohol before pregnancy. Forty eight per cent of smokers stopped smoking and 37% of drinkers stopped drinking alcohol during pregnancy. No sociodemographic factor showed an independent association with either smoking or drinking cessation. Only the number of cigarettes and the amount of alcohol consumed before pregnancy were identified as significant independent predictors for stopping. CONCLUSIONS--Pregnant Spanish women seemed to stop smoking at about three times the rate found in Spanish women in the reproductive years. The sociodemographic variables usually associated with stopping smoking could not account for the high rate of quitting in these Spanish women, a rate higher than that in women from other developed countries. The high prevalence of smoking before pregnancy might explain not only the high rate of stopping smoking but also the absence of a well defined profile of "quitters". In our study, high levels of alcohol consumption were limited to a small group of pregnant women, and preventive efforts should be focused on this group.     

Leptin and maternal growth during adolescent pregnancy

BACKGROUND: Maternal growth on the basis of knee height occurs in nearly 50% of pregnant teenagers and is associated with greater gestational weight gain and accrual of subcutaneous fat in the mother but lower fetal growth compared with nongrowing teenagers and mature pregnant women. OBJECTIVE: The objective of this study was to determine whether leptin is a biomarker for continued maternal growth. DESIGN: Leptin concentrations were measured in 162 growing and nongrowing teenage gravidas (aged 5-fold, fetal growth restriction increased >6-fold, and infant birth weight decreased by approximately 200 g. Gravidas who developed pregnancy-induced hypertension showed a different pattern-higher leptin concentrations at entry and week 28, no difference in the leptin surge, and no postpartum difference in leptin concentration. CONCLUSION: A leptin surge by week 28 appears to mark reduced mobilization of maternal fat stores that is associated with maternal growth on the basis of knee height during adolescent pregnancy.     

The working-class context of pregnancy smoking

The risk of smoking during pregnancy in the US is strongly associated with women's individual socioeconomic status (SES) but little is known about the influence of local area context. The aim of this study was to examine whether local-area characteristics increase the risk of smoking during pregnancy above and beyond individual SES. In a hospital-based cohort of 878 pregnant women in California, who delivered between 1980 and 1990, we compared risk of smoking during pregnancy based on individual and local-area factors. Adjusting for individual SES, neighborhood social class was related to smoking in early pregnancy. Living in a predominantly working-class area significantly increased the risk of pregnancy smoking for both working-class and non-working-class women. However, local-area economic and demographic indicators were not related to smoking early in pregnancy. Individual and family characteristics alone may be insufficient to explain smoking during pregnancy; the social class context of the places in which pregnant women live may also influence this behavior.