Smoking habits in early pregnancy and attitudes towards smoking cessation among pregnant women and their partners.

One-hundred and eighty-seven general practitioners in western Norway recorded smoking habits among 2379 women, consulting for their first regular medical check-up in pregnancy. Forty-six per cent had been daily smokers the last 3 months before pregnancy. Thirty-nine per cent were still smoking at the time of their first check-up. Sixteen per cent of the daily smokers stopped smoking spontaneously during the first few weeks of pregnancy. Fifty-seven per cent of women younger than 20 and 28% of women 30 years and older, did smoke at the first check-up. Single women smoked more often than women living with a partner (58% versus 38%). Smoking habits were not associated with number of previous pregnancies. At the first check-up, 530 pregnant women, still smoking daily, 18-34 years of age, living with a partner, accepted to participate in a smoking intervention study. They filled in a questionnaire about their smoking habits, the smoking habits of their partners and their attitudes towards smoking cessation. Sixty-five per cent reported a reduction in their use of cigarettes after becoming pregnant. The mean reduction in the number of cigarettes smoked daily was 4.0 (31%). Most of the respondents expressed a strong motivation to quit or reduce their smoking habits during their pregnancy. Seventy-two per cent of the partners were daily smokers. Reduction in the consumption of cigarettes, negative attitudes towards smoking and determination to stop smoking was significantly higher among women who were encouraged by their partners to stop smoking and in those who perceived that their partners were willing to reduce their consumption.     

Changes in smoking and drinking behaviour before and during pregnancy in Italian mothers: implications for public health intervention. ICGDUP (Italian Collaborative Group on Drug Use in Pregnancy).

Cigarette and alcohol use before and during pregnancy were studied in 4966 Italian women who delivered single liveborn infants. Using a standardized questionnaire mothers were interviewed in the early postpartum period about pregnancy-related events. Data are part of the Drug Use in Pregnancy (DUP) Study, an international epidemiological co-operative survey conducted under the auspices of the World Health Organization, in 22 countries during 1989-1990. Italian pregnant smokers were women under 30 years of age with a middle-school education or less, and drinkers were 30 years of age and more with more than a middle-school education. When pregnancy was confirmed, most of them cut down smoking and drinking but more so for smoking than drinking: 12% stopped smoking and 6% stopped drinking. Less than 1% gave up both. The more the mother smoked during pregnancy the lower was the infant's birthweight and the association between reduced fetal growth and higher smoking level persisted after controlling for confounding variables. Only smoking habits were associated with delivery of small-for-gestational age babies. A large proportion of Italian women use alcohol and cigarettes before and during pregnancy. Smoking during pregnancy is an important preventable risk factor for the delivery of a small-for-gestational-age child. Thus it may be worth campaigning more vigorously to encourage women to give up smoking during pregnancy.     

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     

Alcohol use prior to pregnancy recognition.

BACKGROUND: Frequent alcohol use during the first 8 weeks of pregnancy can result in spontaneous abortion and dysmorphologic changes in the developing organ systems of the embryo, including the heart, kidneys, and brain. However, few population-based studies are available that describe the prevalence of frequent drinking (6 or more drinks per week) among women prior to and during early pregnancy (the periconceptional period), and the sociodemographic and behavioral factors that characterize these women. Such knowledge is fundamental to the design of targeted interventions for the prevention of fetal alcohol syndrome (FAS) and other prenatal alcohol-related disorders. METHODS: This cross-sectional study used survey data collected by the National Center for Health Statistics as part of the 1988 National Maternal and Infant Health Survey (NMIHS). Weighted prevalence estimates were calculated using SUDAAN, and multivariate analyses were used to determine risk factors for frequent drinking. RESULTS: Forty-five percent of all women surveyed reported consuming alcohol during the 3 months before finding out they were pregnant, and 5% reported consuming 6 or more drinks per week. Sixty percent of women who reported alcohol consumption also reported that they did not learn they were pregnant until after the fourth week of gestation. Risk factors for frequent drinking during the periconceptional period included 1 or more of the following: being unmarried, being a smoker, being white non-Hispanic, being 25 years of age or older, or being college educated. CONCLUSIONS: Half of all pregnant women in this study drank alcohol during the 3 months preceding pregnancy recognition, with 1 in 20 drinking at moderate to heavy levels. The majority did not know they were pregnant until after the fourth week of pregnancy, and many did not know until after the 6th week. Alcohol is a teratogen capable of producing a number of adverse reproductive and infant outcomes. Public health measures needed to reduce these potentially harmful exposures include alcohol assessment, education, and counseling for women of childbearing age, with referral sources for problem drinking, and family planning services for pregnancy postponement until problem drinking is resolved.     

DRINKING AND SMOKING PATTERNS AMONGST WOMEN ATTENDING AN ANTENATAL CLINIC-I. BEFORE PREGNANCY

This paper provides basic epidemiological data on smoking anddrinking patterns before pregnancy amongst 1117 pregnant womenattending a London antenatal clinic. Similar data are alreadyavailable from North America and surveys have been done in Scotlandbut there is a dearth of information from England and Wales. In the early stages of pregnancy, prior to recognition, heavyalcohol consumption (in excess of 56 units of alcohol per week)is associated with the Foetal Alcohol Syndrome. More moderatelevels of intake (as little as 10 units of alcohol per week)have been associated with Foetal Alcohol Effects such as growthretardation. In our sample 19% of the mothers were drinkingmore than 10 units of alcohol per week. Six per cent were consumingmore than the 14 units of alcohol currently recommended by threeof the medical Royal Colleges as ‘safe’ for non-pregnantwomen. Average weekly alcohol consumption was related to both the usualfrequency and amount drunk, but also to binge drinking, beveragechoice and combination, and reasons for drinking. In general,drinking was frequent and light. Those women who drank moreper week tended to drink more frequently than those in the lowerweekly consumption bands. Fourteen per cent of the sample admittedto binge drinking (more than 14 units of alcohol in a singlesitting). Wine was the most popular beverage type. The rangeof beverages consumed was wider in the higher alcohol consumptionbands. Those in the lower bands were more likely to drink onlyone beverage type. Social reasons for drinking were of far greaterimportance than reasons which emphasised the effects of drinking.However, heavy drinkers were unlikely to drink solely for socialreasons. Seventy-seven per cent of the mothers were non-smokers, butthe incidence of smoking increased in the higher alcohol consumptionbands. The demographic characteristics of the smokers were inmarked contrast to those of the heavier drinkers. Smokers tendedto be younger, of lower social status and multiparous, whereasthe heavier drinkers were more likely to be older, of highersocial status and primiparous. This finding is of fundamentalimportance to those interested in planning screening or interventionprogrammes.     

The association of alcohol consumption with outcome of pregnancy

Patterns of alcohol consumption were assessed in 12,440 pregnant women interviewed at the time of delivery. Only 92 women (0.7 per cent) reported drinking 14 or more drinks per week, with most consuming fewer than 21 drinks per week. In the crude data, alcohol intake of 14 or more drinks per week was associated with a variety of adverse pregnancy outcomes, including low birthweight, gestational age under 37 weeks, stillbirth, and placenta abruptio. After use of logistic regression to control for confounding by demographic characteristics, smoking, parity and obstetric history, only the association of placenta abruptio with alcohol consumption of 14 or more drinks per week remained statistically significant. With the exception of placenta abruptio, alcohol intake of fewer than 14 drinks per week was not associated with and increased risk of any adverse outcome. No association was seen with congenital malformations at any level of alcohol intake.     

ALCOHOL CONSUMPTION,CIGARETTE SMOKING AND FETAL OUTCOME IN VICTORIA, 1985

The aims of this study were to document the extent of cigarette smoking and alcohol consumption by Victorian women during pregnancy and relate the use of cigarettes and alcohol to various measures of pregnancy outcome. The study found that 24 per cent of women smoked during pregnancy and smoking was more common amongst younger women; 99.5 per cent of women drank, on average, less than two standard drinks per day and older women were more likely to be drinkers than younger women; 3.6 per cent of women reported at least one episode of binge drinking during pregnancy. There was an increasing trend in the proportion of low birthweight (>2500g) infants with increasing use of tobacco and a dose-dependent reduction in mean birthweight. Drinkers were less likely to have a pre-term or low birthweight infant than abstainers and babies born to drinkers had a higher mean birthweight than babies born to abstainers. The results of our study did not suggest that drinkers were at increased risk of delivering an infant with a congenital malformation, however heavy drinking was very uncommon in the studied population.     

Relationship between Eating Habits,Physical Activity and Tobacco and Alcohol Use in Pregnant Women: Sociodemographic Inequalities

Pregnant women must maintain or acquire healthy habits during pregnancy to protect both their own health and their child’s. Such habits include an adequate eating pattern along with good adherence to the intake of certain supplements, practice of moderate physical activity and avoiding the consumption of toxic products such as tobacco and alcohol. The objective of this study is to assess the interrelation between such habits and their association with sociodemographic variables. To such end, a cross-sectional study was conducted with a representative sample of pregnant women who attended the scheduled morphology echography consultation at the 20th gestational week in their reference public hospital in the city of Seville (Spain). Results: Younger pregnant women and with lower educational levels are the ones that present the worst eating habits and the highest smoking rate. Pregnant women with lower educational levels are the least active. Non-smoking pregnant women present better eating habits than those who smoke. Pregnant women with lower educational levels are those who accumulate more unhealthy habits during pregnancy. This should be taken into account when planning the health care provided to pregnant women and in public health intersectoral policies.     

Characteristics of women who binge drink before and after they become aware of their pregnancy

BACKGROUND: Consumption of high doses of alcohol on a single occasion (binge drinking) may harm the developing foetus and pregnant women are advised to avoid binge drinking while pregnant. We present characteristics of Danish women who binge drank in the pre-and post recognised part of their pregnancy. METHODS: During the years 1996-2002 approximately 100,000 pregnant women were enrolled into the Danish National Birth Cohort. Women with information on binge drinking, time of recognition of pregnancy, age, reproductive history, marital status, smoking, occupational status, pre-pregnancy BMI, alcohol consumption before pregnancy, and mental disorders (n = 85,334) were included in the analyses. RESULTS: Approximately one quarter of the women reported binge drinking at least once during pregnancy; most of these in the pre-recognised part of pregnancy. Weekly alcohol consumption before pregnancy, single status and smoking were predictors for binge drinking in both the unrecognised and recognised part of pregnancy. Moreover, binge drinking in the pre-recognised part of pregnancy was more common among women aged 25-29 years, who were nulliparous, well educated in good jobs or skilled workers. Binge drinking after recognition of pregnancy was more common among women who were unintended pregnant, multiparous unskilled workers, had been unemployed for more than one year, or had mental/neurotic disorder. CONCLUSIONS: In order to prevent binge drinking during pregnancy, health care providers should target their efforts towards pregnant women as well as pregnancy-planners. It is important to be aware that women who binge drink before versus after the pregnancy is recognised have different social characteristics.     

Alcohol consumption after the recognition of pregnancy and correlated factors among indigenous pregnant women in Taiwan

To examine the rates and factors associated with alcohol consumption after the recognition of pregnancy among indigenous pregnant women, as well as the rates and factors associated with continuing alcohol consumption after the recognition of pregnancy among indigenous pregnant women who drank alcohol before the recognition of pregnancy in 10 hospitals in southern and eastern Taiwan. A total of 806 indigenous women who had just given birth in 10 hospitals in southern and eastern Taiwan were recruited. They were interviewed to collect their substance use information, demographic characteristics, psychological health status, history of physical abuse, and pregnancy history. The rates of alcohol consumption after the recognition of pregnancy in all indigenous pregnant women and the rates of continuing alcohol consumption after the recognition of pregnancy among those who drank alcohol before the recognition of pregnancy were calculated. The factors relating to alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were examined using logistic regression analyses. The results of this study found that 26.6% of indigenous pregnant women drank alcohol at any stage after the recognition of pregnancy, and 52.5% of indigenous pregnant women who drank alcohol before the recognition of pregnancy persisted in drinking alcohol after the recognition of pregnancy. Multiple parities, smoking or chewing betel quid after the recognition of pregnancy, and a higher frequency of drinking alcohol before the recognition of pregnancy were significantly associated with alcohol consumption and continuing alcohol consumption after the recognition of pregnancy. Meanwhile, being single or divorced, and intimate partner violence after the recognition of pregnancy were significantly associated with alcohol consumption after the recognition of pregnancy. High prevalence rates of alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were found among indigenous pregnant women in Taiwan. Early detection of alcohol consumption and effective intervention for alcohol consumption during pregnancy are needed.     

Smoking cessation or reduction in women attempting to conceive after ectopic pregnancy

The relationship between smoking cessation or reduction and attempt to conceive was studied in 646 women treated for ectopic pregnancy (EP) (Auvergne register of EP, France). Women were prospectively followed. Tobacco consumption was recorded as the mean number of cigarettes smoked per day at the time of interview. Smoking reduction was defined as stopping smoking or decreasing tobacco consumption by at least 3 cigarettes per day. Statistical analysis was performed using conditional logistic regression. The results confirmed that women reduced tobacco consumption when they became pregnant. However, no association was found between smoking reduction and attempting to conceive again. These results suggest that both women and physicians need to be informed about the possible tobacco consumption effects of smoking on fertility.     

Prevalence of smoking and second-hand smoke exposure: differences between Spanish and immigrant pregnant women

Objectives

To identify differences in the prevalence of smoking and second-hand smoke exposure between Spanish and immigrant pregnant women, as well as the factors associated with continued smoking during pregnancy.

Methods

An epidemiologic cross-sectional study was carried out in women attended at delivery in Zaragoza (Spain). A smoking questionnaire was used to collect the following variables: the women's and partners’ sociodemographic factors and smoking behavior, second-hand smoke exposure and perception of the risks of this exposure.

Results

We included 2440 women (35% immigrants). A total of 31.1% smoked before becoming pregnant and 18.2% during pregnancy, with significant differences between Spanish and immigrant women (21.9% versus 8.7%; p < 0.001). Immigrant women lived with a greater number of smokers, smoked more inside the home, were exposed to second-hand smoke for a greater number of hours per day, avoided public places with second-hand smoke less, and more often worked in bars and restaurants. The following factors were associated with smoking during pregnancy: being Spanish, smoking a greater number of cigarettes before pregnancy, being exposed to second-hand smoke at home for a greater number of hours, having a low perception of risks and having a partner with lower educational attainment.

Conclusions

The prevalence of smoking is higher among Spanish pregnant women than immigrant women, although the immigrant population is more exposed to second-hand smoke at home and at work. There are socio-cultural differences that should be taken into account when carrying out interventions in women of reproductive age.     

Alcohol consumption among pregnant smokers: effects of a smoking cessation intervention program

This study describes patterns of alcohol consumption among pregnant women who participated in a randomized clinical trial of smoking cessation intervention. Data on alcohol habits were obtained prospectively prior to the 18th week of gestation and during the 8th month of pregnancy. Average alcohol intake for both groups was reduced primarily prior to registration for prenatal care. The smoking cessation intervention reduced smoking during pregnancy but had no effect on alcohol intake.     

Alcohol consumption and serum hormone levels during pregnancy.

Factors that change sex hormone levels during pregnancy may have long-term health consequences for the offspring, including changes in breast cancer risk. A cross-sectional analysis of alcohol consumption and hormone levels in 339 pregnant women sampled from the Child Health and Development Study cohort was undertaken. Alcohol intake was queried from 1959 to 1966, long before any hazards of drinking during pregnancy were publicized. Third trimester serum hormone levels including estradiol and testosterone were analyzed. Among 339 pregnant women, 196 reported some alcohol consumption during pregnancy. The drinkers were divided into three groups with intake levels of 0.2-0.5, 0.6-2.0, and 2.1-12.5 ounces of ethanol per week. The second group corresponds to a median intake of approximately 2 drinks per week, and the last group corresponds to a median intake of approximately 1 drink per day, which is considered "light" to "moderate" drinking. Maternal estradiol levels were not associated with alcohol intake during pregnancy. However, serum testosterone was significantly lower, by 12.2%, in the latter two groups of drinking pregnant women, [confidence interval (CI)=-3.0 to 25.2] and 25.6% (CI=9.2-39.5), respectively. The alcohol intakes reported are far below those shown to cause fetal alcohol syndrome, or any of the fetal alcohol effects so far studied. Light alcohol intake during pregnancy is associated with lower maternal testosterone. The health implications are uncertain, but may include an increased breast density in the daughters of drinking mothers.     

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.     

Weekday but not weekend alcohol consumption before pregnancy influences alcohol cessation during pregnancy

BACKGROUND: Cantabria has the highest prevalence of alcohol consumption among women in Spain. Patterns of alcohol consumption before pregnancy were assessed as a determinant of alcohol cessation in pregnant women in Cantabria. METHODS: Survey on a random sample of women delivering for the period 1998-2002 (n = 1510). Information was obtained from personal interview (data on alcohol consumption), clinical charts and prenatal care records. Relative risks (RR) and 95% confidence intervals (CI) were estimated. Multivariable analyses were carried out using logistic regression. RESULTS: Nearly half (49.5%) of the women drank regularly before pregnancy and 22.7% during pregnancy. Sociodemographic variables favouring alcohol cessation were: high education level and smoking cessation, whereas high social class, advanced maternal age and employment outside of home decreased the rate of alcohol cessation. Cessation decreased with the amount of alcohol consumed on weekdays (P < 0.001), but not with intake during weekends only. In women with alcohol use only during weekends, only the consumption of spirits increased the rate of alcohol cessation (adjusted RR = 1.40, 95% CI: 1.13-1.60). Pre-pregnancy binge drinking (> or =4 drinks on one occasion) decreased alcohol cessation in pregnancy (adjusted RR = 0.66, 95% CI: 0.40-0.97). CONCLUSIONS: Drinking patterns influenced the rate of alcohol cessation: the heavier the alcohol consumption on weekdays, the lower the rate of alcohol cessation.     

Alcohol use in pregnancy, craniofacial features, and fetal growth.

STUDY OBJECTIVE--The aim was to study the relationship between the level of alcohol consumption in pregnancy and craniofacial characteristics of the neonate. DESIGN--This was a prospective survey of a sample of pregnant women, stratified on prepregnancy level of alcohol consumption. SETTING--The study was carried out at the public antenatal clinic of Roubaix maternity hospital. PARTICIPANTS--During an eight month period, 684 women (89% of those eligible) were interviewed in a standardised way at their first antenatal clinic visit. Of these, all who were suspected of being alcoholic or heavy drinkers (at least 21 drinks per week) were selected for follow up, as was a subsample of light (0-6 drinks per week) and moderate (7-20 drinks per week) drinkers. Of 347 women selected in this way, 202 had their infants assessed by a standardised morphological examination. MEASUREMENTS AND AND MAIN RESULTS--Suggestive craniofacial characteristics of the infants, present either in isolation or in association with growth retardation ("fetal alcohol effects"), were compared in relation to maternal alcohol consumption (alcoholic 12%; heavy drinking 24%; moderate drinking 28%; light drinking 36%). No differences were found between light and moderate drinkers. Infants born to alcoholics had a greater number of craniofacial characteristics and the proportion with features compatible with fetal alcohol effects was higher. There was a similar trend for infants of heavy drinkers. Infants of heavy drinkers who had decreased their alcohol consumption during pregnancy had fewer craniofacial features. Infants of heavy smokers were also found to have increased numbers of craniofacial characteristics. CONCLUSIONS--Craniofacial morphology could be a sensitive indicator of alcohol exposure in utero. Altered morphology is usually considered specific for alcohol exposure, but the relation observed with smoking needs further exploration.     

General practitioners' promotion of healthy life styles: what patients think

Abstract: The study examined the prevalence of cigarette smoking, alcohol consumption, exercising to keep fit and dieting to lose weight among general practice patients, and patients' perceptions of the role of the general practitioner in advising about life style. A cross-sectional survey using a self-administered questionnaire was completed by 13 017 patients aged 18 to 70 years who were attending one of 119 general practitioners from 40 group practices in metropolitan Sydney over a six- to eight-week period. More women than men reported dieting to lose weight, just over half of the men and women were exercising regularly to keep fit, 35 per cent of men and 29 per cent of women reported smoking, and 12 per cent of men and 10 per cent of women were drinking alcohol at levels considered hazardous or harmful. More young people were smoking, drinking hazardously or harmfully, dieting to lose weight and exercising than the older age groups, and their smoking rates exceeded those of the general population. Most patients reported that general practitioners should be interested in their life-style behaviours, particularly smoking. Substantially fewer patients (particularly women who drank excessively) reported receiving advice about their habits. General practitioners were more likely to give advice when smoking and drinking levels were very high. There were discrepancies between patients' expectations of the doctor's role in promoting healthy life styles, and their likelihood of receiving advice. Doctors could reduce the diseases associated with unhealthy practices. Developments in medical training in the 1990s may extend the way they engage in advising on issues of life style.     

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.