Olfactory and gustatory sensory changes to tobacco smoke in pregnant smokers

Models of smoking behavior change include addiction, social, and behavioral concepts. The purpose of this study was to explore the prevalence of two biologic factors, olfactory and gustatory responses to tobacco smoke, as potentially powerful contributors to smoking behavior change among pregnant women. Data were obtained from 209 pregnant smokers. The majority of women reported olfactory (62%) and gustatory (53%) aversions to tobacco. Aversions first appeared during the first trimester of pregnancy. Women who experienced olfactory aversions were more likely also to experience gustatory aversions. Olfactory aversions were associated with women smoking less. Aversions to tobacco smoke are common among pregnant smokers, are associated with women smoking less, and could help explain pregnant women's smoking patterns.     

Review of perinatal partner-focused smoking cessation interventions

One of the primary barriers to smoking cessation among pregnant women who smoke is having a partner who smokes. Prenatal tobacco exposure has been demonstrated to negatively affect infant health outcomes. Many smoking cessation interventions have been targeted at women who smoke in pregnancy, although research has indicated that one of the main barriers to cessation is lack of partner support. The family systems theory frames prenatal smoking cessation interventions in an inclusive manner for the woman and her partner. The aim of this article is to review smoking cessation intervention studies for partners of pregnant women. Efforts to promote smoking cessation among pregnant women should be inclusive of partners, recognizing that partners influence maternal prenatal health behaviors.     

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.     

Nicotine dependence and smoking topography among Black and White women

Nicotine dependence is a complex phenomenon involving behavioral, biological, and pharmacological components that influence smoking cessation rates. The purpose of this study was to characterize the multidimensional aspects of nicotine dependence and cigarette smoking topography behaviors among Black and White women smokers. Thirty-seven women participated in a 2-hr protocol in the General Clinical Research Center. Plasma cotinine to cigarette ratio was significantly associated with three topography variables: total puff duration, total cigarette time, and carbon monoxide (CO) boost. Black women scored higher on plasma cotinine levels, cotinine per cigarette ratio, and CO increase pre- to postcigarette than White women. Implications for clinical practice include assessing nicotine dependence beyond self-reported cigarettes per day to develop more appropriate smoking cessation interventions. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 505–514, 1997.     

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.     

Depression in pregnancy: drug safety and nursing management

Women who are already predisposed to depression are at increased risks during pregnancy because of endocrine changes; untreated depression in pregnant women might lead to adverse effects for both mothers and infants. This article examines outcomes associated with the use of antidepressants during pregnancy and identifies how nurses can help depressed pregnant women. It is recommended that pregnant women who have mild depression be treated with nonpharmacologic therapy, such as counseling, cognitive-behavioral therapy, or interpersonal psychotherapy. Current appropriate treatment for pregnant women with moderate and severe depression is antidepressant medication, although there is no consensus on the best antidepressants for use in pregnancy. Thus, the psychotropic drug must be chosen carefully to minimize negative effects on infants and mothers, for some studies have demonstrated deleterious effects on infants. Nurses in multiple settings who interact with pregnant women should be aware of the necessity of screening for depression. Nurses in antenatal care settings can refer appropriately screened women to mental health specialists; psychiatric nurse practitioners can identify suitable interventions based on potential risks and benefits to maternal and infant health.     

Short-term behavioral changes in pregnant women after a quit-smoking program via e-learning: A descriptive study from Japan

Approximately 20% of Japanese women in their reproductive years are smokers. Therefore, in the present study, we report the behavioral changes of woman who undertook a 3 month stop‐smoking program. Sixty‐six pregnant smokers in the first trimester of pregnancy participated in this study from two hospitals and an obstetric clinic in Japan. Our newly‐developed e‐learning program uses a cell phone Internet connection service to support pregnant women who want to quit smoking. Using this, service participants were given guidance concerning smoking, and were breath tested for their carbon monoxide levels every 4 weeks for 3 months. An e‐learning cessation smoking‐support program was maintained throughout the same period. Consequently, 52 of 66 pregnant smokers from three settings began the program, and 48 of 52 eventually completed it. The achievement rate of non‐smoking was 71.1% (37/48), and their carbon monoxide exhalation levels significantly decreased from 6.43 ± 4.5 ppm at the beginning to 0.7 ± 1.0 ppm in 1 month, to 0.29 ± 1.08 in 3 months (P < 0.001). These results suggest the effectiveness of our e‐leaning program. This paper reports the results of the study.     

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.     

Stages of change: surviving intimate partner violence during and after pregnancy

This article outlines clinical approaches to pregnant and recently delivered women who have experienced intimate partner violence. Several process theories are discussed, which help providers more deeply understand the meaning women attach to abuse and the complex nature of being both pregnant and abused. Distinctions are made between patient-centered and practitioner-centered approaches. The construct of stages of change is discussed as a basis for stage-based interventions designed to assist women at various points in their struggle to survive abuse.     

妊娠合并梅毒患者的多元化护理干预

目的探讨护理干预对妊娠合并梅毒患者的影响。方法对本院建档并确诊妊娠合并梅毒患者25例进行多元化护理干预。结果 25例患者阴道分娩15例,剖宫产10例,患者无严重母婴并发症,无1例新生儿死亡。结论妊娠合并梅毒患者是妊娠期常见严重的并发症之一,认真做好孕期梅毒筛查,早发现、早治疗,加强心理干预、健康干预、分娩干预、饮食干预、哺乳干预等多元化护理干预是防治母婴并发症,降低先天性梅毒儿发生率的关键。     

WIC providers' perspectives on offering smoking cessation interventions

PURPOSE: To examine the perspectives of WIC clinic providers on offering smoking cessation interventions for pregnant women. STUDY DESIGN AND METHODS: Four focus groups consisting of WIC nurses, dietitians, and social workers (N = 25) were conducted at WIC clinics in eastern Iowa. Researchers developed discussion guidelines to determine how WIC providers currently approached pregnant women who smoke cigarettes and what they considered barriers to providing effective smoking cessation interventions. Code mapping was used to analyze focus group discussions. RESULTS: Factors influencing the ability of WIC staff to provide a smoking cessation intervention for pregnant women included available time, clinic priorities, staff approaches to clients, and staff training. In addition, providers expressed concerns about educational materials for clients as well as additional client issues that prevented smoking cessation. The absence of mechanisms to track clinic outcomes related to smoking cessation was also noted. CLINICAL IMPLICATIONS: WIC providers have time limitations that may necessitate minimal or low-intensity interventions for smoking cessation, but did not know that such approaches are actually effective. WIC providers require more education about the entire issue of smoking cessation in order to become more proactive in their attempts to help pregnant women quit. Training that enhances self-efficacy and understanding of the impact of smoking on mothers, infants, and children should be initiated to motivate staff to intervene. Another strategy to motivate WIC staff in this regard could be tracking clinic outcomes in helping women to quit smoking or prevent relapse.     

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.     

Multicultural medication adherence: a comparative study

The purpose of this study was to evaluate the effect of several interventions on improving medication adherence among White, Black, and Hispanic older women. A total of 109 women older than age 65 who were participating in a clinical osteoporosis trial were recruited for this 12-month study examining medication adherence. After baseline medication adherence was assessed, participants underwent standardized teaching. Participants were contacted monthly by telephone and were seen in a clinic setting every 3 months. All participants used a pillbox for 6 months, and the minority women used an electronic monitoring bottle for 6 months. Adherence was highest in White women. Black women showed significant improvement in adherence at 9 and 12 months, and Hispanic women demonstrated a significant increase in adherence at 12 months. The use of electronic monitors had a positive effect on adherence for the minority women.     

A tailored video intervention to reduce smoking and environmental tobacco exposure during and after pregnancy: Rationale,design and methods of Baby's Breath

Low-cost interventions to decrease environmental tobacco smoke (ETS) exposure of pregnant women and their newborns are needed to lower health risks of exposed fetuses and infants. Baby's Breath is a tailored video intervention developed and tested in a randomized controlled trial. The study aimed to test the efficacy of tailored video versus usual care approaches to reduce the ETS exposure of fetuses of low-income women during and after pregnancy; and to assess this intervention separately among non-smoking and smoking women. Participating women, recruited early in pregnancy, who spoke English, were at least 18 years old, smoke exposed (current smokers, quit smoking on their own, or were exposed to smoke of others), pregnant with only one baby, and had access to a telephone and video player, were randomized to experimental or control conditions. Intervention participants received newsletters containing content aimed at smoking cessation and avoidance (5 during and 3 after pregnancy), in addition to videos (3 during and 2 after pregnancy) individually tailored on behavioral theory-based survey questions. Comparison participants received newsletters and videos on healthy pregnancy topics. Outcomes included salivary cotinine of both mother and baby (32 weeks gestation and 6 months postpartum) as well as self-reported ETS exposure and avoidance behaviors. This study may demonstrate the efficacy of a low-cost intervention to decrease ETS exposure, and will fill an important gap in describing the utility of this innovative intervention technology, as well as demonstration of potential benefits to this type of intervention.     

循征护理干预对妊娠糖尿病母婴结局的影响

目的研究护理干预对妊娠糖尿病(GDM)母婴结局的影响。方法以2008年1~12月在本院产检和分娩的确诊GDM但未进行护理干预的孕产妇50例为对照组,以2009年1~12月确诊GDM的孕妇50例为实验组进行护理干预,比较两组的的血脂代谢指标、孕产妇并发症及终止妊娠方式和新生儿发病率。结果实验组干预后血脂代谢值、妊高症、羊水过多、产后出血、酮症酸中毒、早产率明显低于对照组(P<0.05);胎膜早破、剖宫产两组间无显著差异;干预组新生儿发病率明显低于对照组。结论通过系统、科学、循序渐进的护理干预能明显改善GDM母婴结局。     

The effect of nonpharmacological interventions on the mental health of high-risk pregnant women: A systematic review

ObjectivesTo evaluate the effect of nonpharmacological interventions on the mental health of high-risk pregnant women.MethodsThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA) statement. The Cochrane Library, Embase, CINAHL, PubMed and Web of Science databases were systematically searched for randomized controlled trials and quasi-randomized controlled trials from inception to April 2021. The quality of the studies was assessed using the Cochrane Risk of Bias Tool 2.0. Data were independently extracted and narratively synthesized.ResultsFifteen studies involving 1723 pregnant women were selected. Nonpharmacological interventions included cognitive behavioral interventions, yoga, relaxation interventions, psychological and educational support interventions, and acupressure. Cognitive behavioral interventions and yoga for high-risk pregnant women had potential benefits on the symptoms of anxiety, stress and depression. There was insufficient evidence that relaxation interventions, psychological and educational support interventions and acupressure had positive effects on these women’s mental health.ConclusionsThis review showed that cognitive behavioral interventions and yoga during pregnancy may benefit women with high-risk pregnancies. However, due to methodological limitations of this review, further studies with robust methodological designs are needed to verify the efficacy.     

体外受精与胚胎移植孕妇的心理问题和护理干预效果的观察

目的探讨不孕症体外受精与胚胎移植（IVF—ET）治疗患者妊娠早期的心理和行为问题,并进行护理干预和对干预效果进行评定。方法对30例IVF—ET治疗患者妊娠早期的心理问题和行为变化进行调查,结合症状自评量表（SCL-90）问卷调查,对IVF—ET孕妇的心理和行为问题进行干预,对干预的效果在预产期前1周再进行评定,并与30例同期普通妊娠妇女进行对照。结果IVF-ET组孕妇在日常生活和行为方面与普通妊娠孕妇有显著差异,SCL-90评定发现,IVF-ET组孕妇的焦虑、躯体化、强迫、人际关系和偏执因子分均高于普通妊娠孕妇组。对这些孕妇进行干预后在预产期前1周再评定,SCL-90各因子分与普通孕妇已无明显差异。结论IVF—ET孕妇与普通妊娠妇女孕早期的心理和行为有明显差异,主要表现为过度的紧张、担忧、躯体化症状和人际关系敏感等。对IVF—ET早期妊娠妇女应采取及时有效的心理和行为干预,以解除她们不必要的担忧和焦虑,至预产期前1周IVF—ET孕妇的焦虑、躯体化、人际关系等各因子分已明显下降,与普通孕妇已无明显差异。     

Nursing intervention to enhance acceptance of pregnancy in first-time mothers: Focusing on the comfortable experiences of pregnant women

Aim:  The purpose of the present study was to describe effective nursing care through evaluation of a nursing intervention that enhanced acceptance of pregnancy and focused on a comfortable experience for pregnant women.
Methods:  Thirty-two subjects who were expected to have a normal pregnancy were assigned into either the intervention or the control group. The nursing intervention consisted of the use of a pregnancy diary and four interviews, two of which were held in the first trimester, one in the second and one in the third trimester. The nursing care given was recorded in tapes and field notes. The data were analyzed using a qualitative content analysis method.
Results:  As a result of analyzing the nursing care of 13 women pregnant for the first time who were provided with nursing intervention, the following seven categories of nursing care were extracted for the intervention: encouragement of women to record their experiences using a pregnancy diary; recognizing and acknowledging negative feelings; reducing the negative aspects of pregnancy and reframing; expression and reinforcement of positive feelings; clarification and reinforcement of positive meanings; awareness of own comfortable experiences; promotion of diverse comfortable aspects and continuation of comfortable experiences. The seven nursing care interventions were effective in increasing the comfortable experiences of pregnant women and enhancing a positive attitude towards pregnancy.
Conclusions:  Nursing intervention can aid in enhancing positivity and comfort in pregnant women. Furthermore, this nursing intervention can be applied to adolescents, socially disadvantaged pregnant women, and hospitalized women.     

A qualitative study of mild to moderate psychological distress during pregnancy

Background

Psychological distress is common in the antenatal period. In England, psychological distress is classified as mild, moderate or severe but only those who suffer severe psychological distress are referred to the specialist mental health services. Those who suffer mild to moderate psychological distress are managed by the primary care services. However, little is know about the psychosocial experiences of pregnant women who suffer from mild-moderate psychological distress.

Objective

This study explored the experiences of pregnant women who self-reported mild to moderate psychological distress during antenatal care.

Design

A qualitative study. Data were collected using digitally recorded, face-to-face, semi-structured interviews. Data were analysed using framework analysis.

Setting

A large teaching maternity hospital in North West England.

Participants

Twenty-four pregnant women who self-reported mild to moderate psychological distress to their midwife during routine antenatal care.

Results

Three main themes emerged: the causes of, impact of, and ways of controlling self-reported mild to moderate psychological distress. A range of experiences caused psychological distress including past life and childbearing experiences, and current pregnancy concerns. Mild to moderate psychological distress took over the lives of these pregnant women. The strategies used to control mild to moderate psychological distress included both positive and negative coping elements.

Conclusions

Psychological distress that is categorised as mild to moderate can be extremely debilitating for pregnant women. Identification of these women in clinical practice is crucial so that effective interventions can be targeted appropriately. Screening criteria that has the efficacy to identify depression and anxiety is needed. We recommend that a multidisciplinary approach to the management of care is developed to address the range of experiences that pregnant women who suffer mild to moderate prenatal psychological distress may have.