Costs of maternal conditions attributable to smoking during pregnancy

Context: Despite known adverse health effects, many women continue to smoke during pregnancy. Public attention has now focused on the economic as well as health effects of this behavior.Objective: To estimate health care costs associated with smoking-attributable cases of placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), pre-eclampsia, and spontaneous abortion.Design: Pooled odds ratios were used with data on total cases to estimate smoking-attributable cases. Estimated average costs for cases of ectopic pregnancy and spontaneous abortion were used to estimate smoking-attributable health care costs for these conditions. Incremental costs, or costs above those for a “normal” delivery, were used to estimate smoking-attributable costs of placenta previa, abruptio placenta, PPROM, and pre-eclampsia associated with delivery.Setting: National estimates for 1993.Participants: Data from the National Hospital Discharge Survey (NHDS) and claims data from a sample of large, self-insured employers across the country.Results: Smoking-attributable costs ranged from $1.3 million for PPROM to $86 million for ectopic pregnancy. Smoking during pregnancy apparently protects against pre-eclampsia and saves between $36 and $49 million, depending on smoking prevalence. Over all conditions smoking-attributable costs ranged from $135 to $167 million.Conclusions: Smoking during pregnancy is a preventable cause of higher health care costs for the conditions studied. While smoking during pregnancy was found to be protective against pre-eclampsia and, hence, saves costs, the net costs were still positive and significant. Effective smoking-cessation programs can reduce health care costs but clinicians will perhaps need to manage increased cases of pre-eclampsia in a cost-effective manner.     

Relationship of maternal smoking during pregnancy to placenta previa.

Although maternal smoking during pregnancy is reportedly associated with placenta previa, its etiology is unknown. We examined this association by using North Carolina vital records of 1988 and 1989. Among women who smoked 0, 1-9, 10-19, and > or = 20 cigarettes per day during pregnancy, the prevalence of placenta previa at delivery was 3.8, 5.7, 6.3, and 6.7 per 1,000 singleton live births, respectively, in the entire population. However, after the potential confounders (maternal age, race, gravidity, parity, previous pregnancy terminations, previous cesarean section, and gestational age) were controlled by individual matching, the adjusted overall odds ratio (OR) was 1.29 (95% confidence interval [CI] 1.05, 1.58) with slight dose-response gradients. Our study indicates that, although maternal smoking during pregnancy might affect placenta previa, the magnitude is substantially smaller than previously reported. This association may be attributable to other factors, such as detection bias.     

Sudden infant death syndrome and reported maternal smoking during pregnancy

We investigated the effect of maternal smoking during pregnancy on the relative risk of sudden infant death syndrome (SIDS) by linking data from Georgia birth and death certificates from 1997 to 2000. We estimated the effect of misclassifying smokers as non-smokers and the effect of being misclassified on SIDS rates, and we calculated the fraction of cases caused by exposure. Of all SIDS cases, 21% were attributable to maternal smoking; among smokers, 61% of SIDS cases were attributable to maternal smoking. Maternal smoking during pregnancy is associated with a significantly increased risk of SIDS.     

Social factors, psychopathology, and maternal smoking during pregnancy

We investigated the relative importance of sociodemographic factors and psychiatric disorders for smoking among 453 pregnant women in the National Epidemiological Survey on Alcohol and Related Conditions. Women with less than a high school education and those with current-year nicotine dependence had the highest risk of smoking (90.5%), compared with women with a college degree and without nicotine dependence (3.9%). More effective and accessible interventions for nicotine dependence among pregnant smokers are needed.     

The impact of maternal smoking during pregnancy on delivery outcome

BACKGROUND: Maternal smoking during pregnancy is associated with pre-term birth, intrauterine growth retardation, a small head circumference, a low Apgar score at 5 min and stillbirths and neonatal deaths. This study was undertaken in order to investigate the impact of maternal smoking during pregnancy when all these outcomes were considered. METHODS: With the use of the Swedish Medical Birth Registry, infants in any one of the above mentioned outcome groups were selected from 1,413,811 infants born between 1983 and 1996 with known smoking exposure in early pregnancy. Confounders such as year of birth, maternal age, parity and educational level were controlled for. The attributable risk of maternal smoking on the various negative delivery outcomes was obtained by application of the risk estimates to population counts. RESULTS: The present study confirmed the associations between maternal smoking and the miscellaneous outcomes mentioned above with high significance. The odds ratios (with 95% confidence intervals) for maternal smoking (< 10 cigarettes/day and > or = 10 cigarettes/day) for any one of the outcomes were 1.39 (1.37-1.41) and 1.65 (1.62-1.68) respectively (dose-response p < 0.001). The number of attributable cases caused by maternal smoking was estimated at 15,000, which represents 9% of all cases and 1% of all infants born in Sweden during the study period. CONCLUSION: Maternal smoking during pregnancy accounts for a substantial part of various negative delivery outcomes.     

Marital status disparities in maternal smoking during pregnancy, breastfeeding and maternal depression

One of the dramatic recent changes in family life in Western nations has been the rise in non-marital childbearing. Much of this increase is attributable to the growth in cohabitation. But in some countries, notably the UK (and the USA) this is much less the case with significant proportions of children being born to parents who are not living together. This study uses data from the Millennium Cohort Study, a British birth cohort established in 2001, to examine whether the closeness of the tie between parents, as assessed by their partnership status at birth, is related to smoking during pregnancy, breastfeeding and maternal depression. Four sets of parents are distinguished representing a hierarchy of bonding or connectedness: married and cohabiting parents, and two groups of solo mothers, those closely involved with the father at the time of the birth and those not in a relationship. Smoking in pregnancy, breastfeeding and maternal depression tests for trend, adjusted for socio-demographic factors, showed that there was a statistically increased risk of adverse health and health behaviours by degree of parental connectedness. There were also consistent and statistically significant differences between married and non-married mothers. Particularly noteworthy was the finding that cohabiting mothers have greater risk of adverse outcomes than married women. Among the non-married set, there were also differences in risk of adverse outcomes. For smoking in pregnancy, the key difference for continuing to smoke throughout the pregnancy lay between mothers involved with partners and those lacking an intimate relationship. For breastfeeding, stronger parental bonds were associated with initiation of breastfeeding, with a clear difference between cohabiting mothers compared to solo mothers. There was also an increased risk of maternal depression with looser parental bonding, and among non-married groups this increased risk was most noticeable among cohabiting mothers when compared with solo mothers.     

Protein malnutrition during pregnancy alters maternal behavior and anxiety-like behavior in offspring

Objective: The aim of this study was to evaluate the effects of protein malnutrition during pregnancy on maternal behavior, on the early behavior in pups by ultrasonic vocalizations (USVs) emission, and on the behavior of offspring in adulthood in an elevated T-maze.

Methods: Pregnant female rats were fed a normal protein-powdered diet (22% casein; control) or a low-protein (hypoproteic) diet (6% casein; protein restriction) during the first 2 weeks of pregnancy. On the fifth postpartum day (PND5), the number of USV was rated. On PND7, maternal behavior was assessed. Male offspring in adulthood were evaluated for behavioral performance in an elevated T-maze.

Results: Our results demonstrated that a hypoproteic diet during early pregnancy increased the maternal behavior, increased the number of USV by pups, and reduced the inhibitory avoidance responses in an elevated T-maze during adulthood. In addition, there was a reduction in weight gain of rats during pregnancy and of offspring during lactation.

Conclusion: In conclusion, the data found in our study suggest that the increase in USV emitted by pups due to hypoproteic diet during pregnancy accentuated maternal behavior. In addition, an increase in maternal care promoted the reduction in anxiety-like behavior in adult male offspring.     

Dose-response of birth weight to various measures of maternal smoking during pregnancy

Thus far little is known about the dose-response relationship between birth weight and the amount of maternal smoking during pregnancy. The purpose of this report is to describe the effects of smoking intensity, duration, and timing on birth weight with the use of three measures of exposure: self-reported daily consumption, self-reported cumulative consumption, and salivary thiocyanate. Data were obtained on 867 single live-born infants and their mothers who participated in a randomized anti-smoking intervention trial. Smoking was measured for the women at about 15 weeks gestation and again during the eighth month. Although all indicators of dose, as derived from early or late pregnancy smoking measures, were significantly associated with birth weight, whether or not the mother had quit smoking by the time of the 8th month follow-up was almost as predictive as any dose variable. For women who quit smoking before 30 weeks gestation, neither the duration nor the amount of smoking earlier in pregnancy was an important determinant of birth weight.     

Bias in maternal reports of smoking during pregnancy associated with fetal distress

BACKGROUND: Studies examining the adverse effects of smoking during pregnancy commonly use maternal reports. We hypothesized that if an adverse event occurred during pregnancy, women may underreport smoking. This study looked for bias in maternal report of smoking if fetal distress occurs. METHODS: Data were collected prospectively from patients attending The MotheRisk Program who smoked during pregnancy, and were categorized by delivery outcome, maternal and neonatal characteristics, and the raw number of cigarettes smoked per day during pregnancy reported at clinic and at follow-up. The difference between these two values was compared. RESULTS: 95 women had uneventful deliveries and 25 had fetal distress. Women who reported fetal distress decreased their report of smoking after delivery compared to their original report during pregnancy, whereas women with an uneventful labour did not (p = 0.04). CONCLUSIONS: Our results suggest that if an adverse pregnancy outcome occurs, mothers may tend to underreport their cigarette consumption.     

孕妇被动吸烟与胎儿出生体重关系的Meta分析

目的分析孕妇不同孕期的被动吸烟情况对新生儿出生体重的影响,以及探讨不同测量方式对被动吸烟效应的影响。方法对NCBI、OVID—MEDLINE、CNKI、VIP以及CBM数据库进行检索（截止日期为2008年4月）,通过Meta分析结果报告综合差值及95％CI。结果共获得38篇文献,其中19篇为前瞻性研究,19篇属回顾性研究。总合并效应值为-68．84g（95％CI：89．84～47．84）,调整合并效应值为-44．92g（95％CI：67．07～-22．77）;生物标志测量的合并效应值为-73．87g（95％CI：-113．41-～34．34）;问卷调查的合并效应值为62．93g（95％CI：-84．49～-41．37）;最低和最高水平暴露的合并效应值分别为44．61g（95％CI：78．36～-10．87）和116．37g（95％CI：-180．74～-52．01）;孕早期暴露的合并效应值为-2．70g（95％CI：-37．74～32．33）,但没有统计学意义。结论孕妇被动吸烟能降低新生儿出生体重,问卷凋查会低估真实暴露水平,孕中晚期可能是被动吸烟的效应期,被动吸烟引起低出生体重的阈值尚不明确。     

Influence of maternal cigarette smoking during pregnancy on neonatal serum folate levels

Purpose  

Folate is an essential micronutrient for fetal development because of its role in de novo synthesis of DNA. The aim of this study was to compare neonatal serum folate levels of babies born to smoking and non-smoking mothers.     

Maternal smoking during pregnancy and smoking by adolescent daughters.

OBJECTIVES. Since cigarette smoking in adolescence represents a crucial entry point in the progression to illicit drugs, risk factors for adolescent smoking have public health implications. The influence of mothers on children's smoking appears to be greater than that of fathers. To explain the selective influence of mothers, we examined the consequences of maternal smoking during pregnancy in two longitudinal samples. METHODS. Analyses were conducted on follow-up interview data from two dyadic samples of mothers and firstborn adolescents for whom data on maternal smoking during and after pregnancy were available (192 mother-child pairs originating from New York State and 797 dyads from a national sample). RESULTS. In both samples, maternal smoking during pregnancy, when postnatal smoking was controlled, selectively increased the probability that female children would smoke and would persist in smoking (adjusted odds ratios of about 4). CONCLUSIONS. The findings suggest that nicotine or other substances released by maternal smoking can affect the fetus, perhaps through the nicotinic input to the dopaminergic motivational system, so as to predispose the brain in a critical period of its development to the subsequent addictive influence of nicotine consumed more than a decade later in life.     

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     

Influence of maternal active and passive smoking during pregnancy on birthweight in newborns

Many studies have documented a strong association of active smoking during pregnancy with fetal growth retardation. Increasing interest has also been focused on whether there is an association between exposure of pregnant women to environmental tobacco smoke (ETS) and low birthweight of their babies. In the intervention controlled study "Healthy Pregnancy--Healthy Child", mothers after delivery were interviewed by medical students who collected data about their smoking and nutrition. Students were also trained to stimulate non-smoking behaviour and to explain the risks related to smoking and exposure to ETS. Data from 1147 mothers after delivery were collected but only single births were included in the analysis of birthweight. In our study, 63.4% women never smoked and 32.2% women reported they had stopped smoking either before pregnancy or during the first trimester. Only 4.4% of mothers (n = 50) smoked during the whole pregnancy. Women with the history of smoking were exposed to ETS more often than mothers who never smoked (51.6% vs 17.4%; p < 0.001). The number of heavily exposed both at home and workplaces was more than twice higher among former smokers compared with never smokers (22.4% versus 9.4%, p < 0.01). The average birthweight of babies born to women who had stopped smoking was higher than that born to never smokers. The average birthweight of babies born to women who smoked during pregnancy was lower by 119 g and 171 g than that of the babies born to never smokers and former smokers, respectively. When pre-term neonates were excluded, differences in birthweight between babies born to never smokers and either formerly smoking or still smoking mothers were slightly lower. The greatest effect of ETS exposure on birthweight was recorded in never smoking mothers; an average reduction in birthweight was 88 g. A strong dose-effect was observed; in mothers heavily exposed to ETS both at home and at work, the babies' birthweight was lower by 189 g in comparison with the group of non-exposed, never smoking mothers and even by 70 g compared with mothers smoking during pregnancy.     

The influence of active maternal smoking during pregnancy on birth weights in Cyprus

Cigarette smoking during pregnancy has been causally associated with an increased risk of both intrauterine growth retardation and preterm delivery but most strongly with low birth weight. No such study to date had ever dealt with the Cypriot population. In interviews with their gynaecologists 65,530 pregnant women were asked between January 1990 and August 1996 to answer two questions, whether they had been smoking before and whether they had been smoking during pregnancy. Data from 59,014 births were considered to have valid birth weight data for this investigation. In 81.2% of the cases the mother explicitly declared that she had neither smoked before or during pregnancy whereas in 1.4% of the cases the mother said that she had smoked both before and during pregnancy and in 1.4% of the cases the mother said that she had smoked before but not during pregnancy. Finally, in 15.3% of the cases no answer to smoking question was given, whereas in 0.7% of the cases the answer that was given was deemed as not clear. The average birth weight of babies born to women who had stopped smoking was insignificantly different than that of those born to never smokers. The average birth weight of babies born to women who smoked during pregnancy was lower compared to babies born to non smokers' babies by 92 grams, 66 grams, and 109 grams for all babies, singleton boys and singleton girls respectively. The greatest effect to their mean birth weights was observed in babies whose mothers did not answer the question on smoking. Their babies had birth weights lower than non smokers' babies by 203 grams, 197 grams, and 201 grams for all babies, singleton boys and singleton girls respectively.     

Sudden infant death syndrome, maternal smoking during pregnancy, and the cost-effectiveness of smoking cessation intervention

OBJECTIVES: This study analyzed the relationship between prenatal maternal smoking and sudden infant death syndrome (SIDS) and examined the cost-effectiveness of smoking cessation interventions. METHODS: All recorded US singleton SIDS deaths from the 1995 birth cohort with birthweight exceeding 500 g were investigated. Infants with available maternal smoking data were matched with controls who survived to 1 year. Conditional logistic regression was used to estimate SIDS risks and accompanying cost-effectiveness. RESULTS: A total of 23.6% of singleton SIDS deaths appear to be attributable to prenatal maternal smoking. Typical cessation services available to all pregnant smokers could avert 108 SIDS deaths annually, at an estimated cost of $210,500 per life saved. CONCLUSIONS: Typical prenatal smoking cessation programs are highly cost-effective but have limited impact on the population incidence of SIDS.     

孕妇孕期被动吸烟对母体血浆P-LAP、IL-6及IL-10的影响

目的 探讨孕期被动吸烟母体胎盘亮氨酸氨基肽酶(P-LAP)、白介素(IL-6)及IL-10在正常孕妇和早产孕妇血浆中的变化趋势,并分析其对早产的影响.方法 选取175例早产孕妇(28 ～ 36+6周)为研究组(早产组),根据有无被动吸烟分为早产被动吸烟组(n=96)和早产非被动吸烟组(n=79);同时选取177例足月孕妇为对照纽(足月组),同样根据妊娠期被动吸烟情况,分为足月被动吸烟组(n=78)和足月非被动吸烟组(n=99).采用酶联免疫吸附法,测定以上各组孕妇在相应孕周时的血浆P-LAP、IL-6和IL-10浓度.结果 早产被动吸烟组孕妇血浆P-LAP、IL-6和IL-10浓度与足月被动吸烟组比较差异有统计学意义(tP-LAP=3.678、tIL-6=3.865、tIL-10=2.114,均P＜0.05),早产被动吸烟组孕妇血浆P-LAP、IL-6及IL-10浓度与早产非被动吸烟组比较差异有统计学意义(tP-LAP=4.479、tIL-6=4.556、tIL-10=2.202,均P＜0.05);而足月被动吸烟组孕妇血浆P-LAP、IL-6及IL-10浓度与足月非被动吸烟组比较差异无统计学意义(tP-LAP=1.170、tIL-6=1.722、tIL-10=1.423,均P＞0.05).结论孕期被动吸烟可致孕妇P-LAP和IL-10水平降低,IL-6水平升高,引起早产分娩启动,可能是引起孕期被动吸烟孕妇早产发生的关键因素.     

Down's syndrome and maternal smoking in early pregnancy

Several previous studies have suggested that maternal smoking is associated with a decreased incidence of trisomy 21. By using the Swedish health registries, 1,321 infants with Down's syndrome (DS) were selected among 1,117,021 infants born in 1983–1993 with known smoking exposure in early pregnancy. No association between maternal smoking and all cases of DS was found [age-adjusted odds ratio (OR) for maternal smoking: 0.98; 95% confidence interval (CI): 0.86–1.11], but heterogeneity over strata existed. A slightly decreased OR (0.91; 95% CI: 0.72–1.15) for any maternal smoking was indicated among primiparas, but among multiparas, no effect of smoking on the incidence of DS could be detected (OR: 1.01; 95% CI: 0.87–1.17). The difference between the OR for smoking ≥10 cigarettes per day among primiparas (OR: 0.59; 95% CI: 0.38–0.90) and multiparas (OR: 1.06; 95% CI: 0.86–1.31) was statistically significant. If not due to statistical fluctuation, the findings indicate that no direct effect of smoking on DS risk exists but the association observed in primiparas is due to covarying factors. Genet. Epidemiol. 14:77–84,1997. © 1997 Wiley-Liss, Inc.     

2241例孕妇孕期被动吸烟情况调查及对妊娠结局的影响

目的 探讨孕妇孕期被动吸烟情况调查及对妊娠结局的影响。方法 选择2015年1月—2018年12月郑州人民医院的孕产妇2 241例为研究对象,采用自行设计的问卷获取孕妇的一般信息和被动吸烟情况,记录妊娠结局情况。结果 被动吸烟占比为33.96%。暴露组(被动吸烟)孕妇家庭月收入、孕次、流产史(率)、配偶吸烟史(率)均高于对照组(非暴露组),差异均有统计学意义(均P<0.05),暴露组孕妇配偶文化程度低于对照组(χ²=12.895,P<0.05)。暴露组(50.46%)不良妊娠结局发生率显著高于对照组(38.38%)(χ²=30.022,P<0.05)。暴露组流产、早产、出生缺陷、低出生体重儿、新生儿窒息、新生儿呼吸窘迫综合征发生率均显著高于对照组(均P<0.05),且对照组活产婴儿孕周、出生体重和Apgar评分均高于暴露组,差异有统计学意义(均P<0.05)。结论 2 241例孕妇中,被动吸烟率为33.96%,孕期被动吸烟导致孕妇流产、早产、胎儿畸形等不良妊娠结局发生率增加,应加强对高危人群健康教育,同时积极配合相关部门严格落实控烟规定,保障妊娠期妇女母婴健康。