Babies Whose Mothers Smoke Tobacco During Pregnancy Are More Likely to Have
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Smoking during pregnancy and harm reduction in nativity weight: a cantankerous-sectional study
BMC Pregnancy and Childbirth volume xviii, Article number:67 (2018) Cite this article
Abstract
Background
Different studies have shown the advantages of abstinence from cigarette smoking during pregnancy to promote full fetal evolution. Given that meaning women do not always abjure from smoking, this study aimed to analyze the effect of different intensities of smoking on birth weight of the newborn.
Methods
A cross-exclusive study was adopted to explore smoking in a population of meaning women from a medium-sized city in São Paulo state, Brazil, who gave birth betwixt Jan and June of 2012. Data were collected from maternal and pediatric medical files and, where data were absent-minded, they were nerveless by interview during hospitalization for delivery. For data analysis, the effect of potential misreckoning variables on newborn birth weight was estimated using a gamma response model. The result of the identified confounding variables was also estimated past means of a gamma response regression model.
Results
The prevalence of smoking during pregnancy was 13.four% in the study population. In full-term infants, birth weight decreased equally the category of cigarette number per 24-hour interval increased, with a significant weight reduction as of the category 6 to 10 cigarettes per day. Compared with infants built-in to not smoking mothers, hateful nativity weight was 320 g lower in infants whose mothers smoked 6 to x cigarettes per twenty-four hours and 435 g lower in infants whose mothers smoked 11 to 40 cigarettes per day during pregnancy.
Conclusions
Based on the study results and the principle of harm reduction, if a pregnant adult female is unable to quit smoking, she should be encouraged to reduce consumption to less than six cigarettes per mean solar day.
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Background
Since the adoption of the Framework Convention on Tobacco by member countries of the Globe Health Organization in 2003, there have been important global deportment to control smoking. Despite this, the smoking "epidemic" has grown in some countries because of the marketing ability of the tobacco manufacture, population growth in countries with extensive consumption, and the number of highly dependent people who are unable to quit smoking [1].
The Centers for Disease Command and Prevention has estimated that nineteen.0% of American adults smoked cigarettes in 2011 [2]. The Special Survey on Smoking, a supplement to the 2008 Brazilian National Household Sample Survey, reported a smoking prevalence rate of 17.2% for people anile 15 years or older [3]. In the developed population of 27 Brazilian cities, 14.viii% were smokers, and the frequency was greater for men (18.ane%) than for women (12.0%) [4].
It is known that smoking can cause lung and other cancers, eye disease, stroke and many other diseases [2]. When associated with pregnancy, tobacco consumption can have even more severe furnishings, potentially compromising not merely maternal health, only as well fetal health and viability [5]. In the U.s.a., about xx% of women are smokers at the beginning of pregnancy; withal, 30.two% to 61% surrender smoking in the prenatal period [half dozen]. Women who are able to quit tend to have been light smokers [7]. There are no national Brazilian data on the prevalence of smoking during pregnancy, nor are there estimates on smoking cessation during pregnancy; however, a population-based study carried out in Santa Maria, southern Brazil, reported that 23% of significant women were smokers [8].
Cigarettes are among the nigh frequently used drugs in pregnancy [9]. A Brazilian study identified greater gamble of smoking during pregnancy in women with a higher number of previous pregnancies and who did non undergo prenatal intendance [8].
Smoking in pregnancy is also associated with cerebral disabilities in the newborn, slower fetal growth, ballgame and premature nativity [8, 9].
The mechanisms through which smoking leads to negative furnishings during pregnancy have not been fully understood. Nicotine likely plays an important function. Nicotine causes reduction in uteroplacental circulation, leading to lower maternal weight gain and in turn, negative fetal outcomes, such equally pocket-size size for gestational age, low birth weight, short stature and compromised fetal neurological development. Additionally, cigarettes and their smoke contain more than 4000 potentially toxic substances, and the combination of these toxins in cigarette fume may be the main gene responsible for health damage [10].
Other important negative effects of smoking are seen in pregnancy and the postpartum menstruation. During pregnancy, smoking compromises local and systemic immune responses, which in turn may be associated with agin pregnancy outcomes [11]. Postpartum, cigarettes can crusade early cessation of breastfeeding and consequences for child health and evolution [12].
Although there are countless studies in the literature confirming the relationship between smoking and low nascence weight, they have not considered the dose–response effect of smoking on depression birth weight [five, viii, 13]. In view of the high prevalence of smoking during pregnancy in Brazil, the high likelihood of adverse perinatal consequences and the difficulty of quitting, this report aimed to analyze the effect of unlike intensities of smoking on nativity weight of the newborn.
Methods
This cross-sectional study evaluated smoking in significant women from xiii small towns belonging to the "Colegiado Pólo Cuesta", a health network in Botucatu, a medium-sized city (140,000 inhabitants) in southeastern São Paulo, Brazil.
In Botucatu, the Public Health Service operates 18 primary intendance units that provide basic health care and other health services. Childbirth intendance is provided by specialty obstetrics and neonatology services at a university referral hospital, which has 40 beds for pregnant/puerperal women, 24 beds for newborns, 30 beds in the Intensive Care Unit (ICU) for adults and xv beds for neonates.
In addition to public health services, private health insurance and services are also available in Botucatu. In that location is one private motherhood hospital with 16 beds for pregnant/puerperal women, six beds for newborns and an additional ten beds in the ICU for both adults and neonates.
Systematic sampling was used in this study: all meaning women admitted to give nascency at either of the 2 maternity hospitals during the study period from Jan i to June 30, 2012, were considered eligible for the study. Only women pregnant with a single fetus were included in the written report. A full of 1404 pregnant/puerperal women met those conditions. Seven women refused to participate and 84 were discharged before data drove was possible; thus, the final sample consisted of 1313 meaning/puerperal women, representing 93.five% of the eligible study population.
All subjects gave informed written consent prior to their participation in the study, in accordance with established principles of enquiry ethics. The written report was approved past the Research Ideals Committee of Botucatu Medical School (approval number 004/2013).
The variable under investigation was smoking during pregnancy (classified as: no; yes, from one to 5 cigarettes per mean solar day; aye, from 6 to x cigarettes per twenty-four hour period and aye, from 11 to 40 cigarettes per twenty-four hours. With this option, the report aimed to clarify the effect of dissimilar intensities of smoking on nativity weight of the newborn compared to the birth weight of newborns from nonsmoker pregnant women. Smoking during pregnancy information were obtained from medical records (56.three%) and when they were non recorded, they were obtained during interviews (43.seven%) with the puerperal women in the infirmary where the birth took identify. In the interviews, the question asked was: "Do/Did you lot fume during gestation period? If and then, how many cigarettes do/did y'all normally smoke per day". For both forms of data collection, women who reported having smoked just as they did not know they were pregnant or for a short menses of gestation (n = vi) were classified as non-smoking. Women classified as smokers during gestation were those who reported having maintained this habit throughout pregnancy.
Data were besides collected on potentially confounding sociodemographic, medical and behavioral variables. Sociodemographic variables included: historic period (classified every bit ≤xix years, 20–34 years, ≥ 35 years); education (≤ 8 years, 9–11 years, ≥ 12 years); paid employment (yes/no); and presence of a partner (yes/no). Medical variables included data on obstetrical history, namely: first pregnancy, aye/no; the interval between deliveries, just for multiparous women (≤ 2 years, 3–5 years, ≥ 6 years); and pregestational overweight or obesity (based on trunk mass index and classified according to the Constitute of Medicine) [14] (yep/no). The quality of prenatal care was too investigated using the variables: place of intendance (public service facility, private service facility); number of medical visits (observing that 7 visits are proposed as minimum by the Brazilian Ministry building of Health), (< 7 visits, vii–14 visits, ≥ 15 visits, subsequently classified into < 7 visits, ≥ 7 visits); participation in a prenatal educational group (yeah/no); previous advice regarding warning signs in pregnancy (yep/no); and use of both folic acid (every bit of the first prenatal visit) and fe sulfate (equally of the 20th week of gestation)(yeah/no). Finally, the presence of whatever issues during gestation (aye/no) was investigated, including emotional problems; alcoholic beverage consumption; use of illegal drugs; anemia; high blood pressure, pre-eclampsia, eclampsia, or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome; diabetes; hyperemesis; hemorrhage, bleeding, or threatened abortion; and infection, such as syphilis, urinary tract infection, toxoplasmosis, human being immunodeficiency virus (HIV), or hepatitis.
Infant data were besides collected to evaluate effects. The outcome variable was nascence weight (1000). Given the close relationship between birth weight and gestational historic period, the effects of smoking on term and premature newborns were studied separately [15, xvi]; therefore, data were as well nerveless on the birth condition (preterm, full-term) for stratification.
Simply equally for the information on smoking, all these other information were obtained from maternal or infant medical records (including prenatal care cards and records from the delivery room or the nursery) during hospital admission for delivery. Information that were not recorded were obtained by interview with the pregnant/puerperal women, also during hospital admission.
All data were collected past authorized health service professionals, under the supervision of a doctoral educatee in public health who was responsible for quality control. The data were input to a database and checked for consistency before statistical analysis.
The information analyses were performed in two phases. First, the issue of each possible confounding variable on newborn weight was estimated using a univariate gamma response model (crude assay); variables with p < 0.20 were chosen as potential confounders for inclusion in the following multivariate assay. In the 2nd stage, the smoking effect, corrected for the effect of the identified confounders, was estimated using a gamma response regression model (adjusted analysis). This model was selected for its ability to simultaneously estimate the main upshot and right for the effect of potential confounders (following the asymmetric probability distribution of the outcome). Relationships were considered significant if p < 0.05. All analyses were performed using the Statistical Bundle for the Social Sciences SPSS 5 20.0.
Results
Most study participants were anile 20–34 years and had 8 to 11 years of school omnipresence. Because premature and term newborns, almost mothers lived with a partner respectively), employed (49.7% and 56.five%, respectively), were multiparous (57.i% and 62.0%, respectively) and prenatal follow-up had been provided past public services (75.1% and 70.4%, respectively). Among the women who had preterm commitment (n = 189), 59.3% had attended ≤seven medical visits; among those who delivered at term (n = 1124), 73.2% had attended 8–14 prenatal visits.
The prevalence of smoking was 18.0% among mothers of premature infants and 12.6% amongst mothers of term infants. In both groups, the median of the number of cigarettes smoked per day ranged from i to xl cigarettes/twenty-four hours. The preterm birth rate was xiv.4%. Median birth weight was 2410 g and 3250 thousand for premature and full-term infants, respectively (Table 1).
The relationship between potential confounders and weight of premature infants is also shown in Tabular array 2. Attendance at ≥7 prenatal medical visits; participation in a prenatal educational group; presence of emotional issues; high blood pressure, pre-eclampsia, eclampsia or HELLP syndrome; hyperemesis; hemorrhage, bleeding or threatened abortion; and infection during pregnancy were all identified as possible confounders (p < 0.20).
The human relationship betwixt smoking during pregnancy and nativity weight of premature infants, adjusted for potential confounders (adjusted analysis), is shown in Tabular array 3. Again, no significant difference in nascency weight was found in relation to smoking.
In dissimilarity, in full-term infants the following potential confounding factors (p < 0.20) were identified: presence of a partner; first pregnancy; interval between deliveries; attendance at ≥vii prenatal visits; emotional problems during pregnancy; historic period at delivery; illegal drug use; anemia; loftier claret pressure, pre-eclampsia, eclampsia or HELLP syndrome; hyperemesis; and infection during pregnancy (Table four).
The contained effect of smoking intensity on nascency weight was estimated correcting for the potential confounding variables in the adjusted regression model (Table 5). Newborn weight decreased equally the category of number of cigarettes per twenty-four hour period increased, with a significant reduction at the 6 to 10 cigarettes: when mothers smoked 6 to 10 cigarettes per day, babe weight was 320.41 m (CI 95% = − 535.51 to − 105,32) lower than that of infants born to nonsmoker mothers; when mothers smoked 10 to forty cigarettes per twenty-four hours, infant weight was 435.01 one thousand (CI 95% = − 733.xvi to − 136,87) lower than that of infants born to nonsmoker mothers. When the mother smoked during pregnancy up to 5 cigarettes per day there was no outcome on birth weight (p = 0.715).
Discussion
This study evaluated the prevalence of smoking and the relationship between birth weight and smoking intensity in a population of women who gave birth in a medium-sized city in southeastern Brazil. The affect of tabagism was evaluated using a cathegorized blueprint instead of a continuous variable, because of the irregular distribution of the variable and high proportion of zeros (nonsmoker mothers). That procedure was performed so that a dilution of the smoking effect could be avoided (mean upshot), and the impact of unlike loads of maternal smoking could be detected: 1 to five cigarretes per day or light smokers, vi to 10 or medium smokers and xi to 40 or heavier smokers.
Analysis of the premature infant information showed no statistically significant differences between the birth weight of infants born to smoking and nonsmoking pregnant women. In contrast, the analysis of full-term infants revealed a negative, dose–response result of smoking on newborn weight. Compared with infants built-in to nonsmoking mothers, hateful birth weight was 320 g lower in newborns whose mothers smoked 6–x cigarettes per day and 435 one thousand lower in newborns whose mothers smoked 11–40 cigarettes per twenty-four hour period during pregnancy. This consequence was observed even after correction for identified potential confounders, such every bit maternal historic period, presence of a partner, parity, interval between deliveries, number of prenatal medical visits, emotional problems in pregnancy, illegal drug utilise, anemia, high blood pressure level, hyperemesis, gestational historic period and infection during pregnancy. Interestingly, no statistically pregnant differences were found in mean nativity weight when mothers smoked 1–five cigarettes per 24-hour interval.
An important consideration is that the accurateness of the data on smoking and the number of cigarettes smoked per twenty-four hour period during pregnancy may limit the validity of the study findings. It is known that the number of cigarettes smoked per day can vary throughout pregnancy [17], and this was not addressed in the cross-sectional design of the nowadays study, which relied on self-reporting at the time of delivery or medical records. Likewise, women who reported having quit the habit just at the starting time of gestation were considered every bit nonsmokers, and the passive exposure to tobacco smoke (non investigated) was not considered, which could upshot in some underestimation of the smoking effect on nascency weight. Still, an important negative upshot was observed.
The data are representative of a unmarried identify in the southeastern region of Brazil. The prevalence of smoking in the meaning women that was found in our study (overall prevalence of thirteen.four%) corroborates the importance of understanding its effects. The smoking prevalence among pregnant women in Botucatu was lower than that in non-pregnant developed women in São Paulo capital city (16.eight%) and college to the average value reported in other Brazilian capitals (12%), the only population information available for comparisons [4]. Furthermore, smoking furnishings are mainly a consequence of biological processes, and that fact also may support the generalization of our findings. Nevertheless, it is likely that in similar contexts and populations (middle-income countries with good availability of prenatal care), tobacco use during pregnancy will negatively affect term newborn weight to a similar extension as it did in the nowadays study.
About 40% of pregnant women are estimated to quit smoking spontaneously, primarily out of concerns for fetal health only too, out of business organization for their ain. Others may be encouraged to quit smoking, through concerted counseling about the risks of smoking to fetus and mother that begins at the initiation of prenatal care [18]. On the whole, meaning women are receptive to educational measures and health promotion [17] and are more likely to consider smoking abeyance in the context of the frequent contact with wellness professionals during prenatal care [ix]. Accordingly, the prenatal protocol of the Brazilian Health Ministry [16] instructs that smoking meaning women be identified in prenatal medical visits, advised to quit and offered support to attain this goal. As such, the findings of the report population are worrying. It is probable that non all pregnant women were accordingly counseled during their medical visits. The high prevalence of smoking in the written report population shows that actions to address prevention of tobacco use in full general and, peculiarly, during prenatal care, have been inadequate in the report region.
Despite the need for smoking abeyance, it may be more than challenging to attain it during pregnancy, particularly considering that a powerful psychoactive drug, nicotine, causes chemical addiction to smoking [19]. Nicotine replacement therapy has been constructive in helping the addicted population to quit smoking [twenty] and thus, reduces impairment from smoking; yet, its use during pregnancy is controversial [21]. Questions remain about long-term effects and the prophylactic of nicotine replacement therapy during pregnancy and the postpartum catamenia [thirteen, 21, 22].
From the perspective of applied advice for significant women unable to quit smoking, the study findings support the recommendation of less than half dozen cigarettes a twenty-four hour period to minimize the negative furnishings of smoking on newborn weight; however, this must be validated with further studies evaluating the effects of reduced tobacco use on birth weight and on other outcomes, such as prematurity, stillbirth and sudden baby expiry syndrome.
Conclusions
The study showed that smoking during pregnancy is associated with lower nascence weight in full-term infants. Smoking intensity is also of import. The study establish a dose–response that was pregnant as of the 6 to 10 cigarette-per-day category.
The high reported prevalence of smoking amid women during pregnancy shows that actions to promote and back up smoking cessation during pregnancy are definitely necessary in the report region. Smoke-free policies, both at a national level and globally, must remain strict, especially when related to recommendations of consummate smoking cessation during pregnancy. If, yet, the goal of total abstinence proves impossible, there is yet an opportunity to minimize the negative effects of smoking during pregnancy on birth weight by reducing as much equally possible the number of cigarettes smoked per day.
Abbreviations
- HELLP:
-
Hemolysis, elevated liver enzymes, low platelet count
- HIV:
-
Human immunodeficiency virus
- ICU:
-
Intensive Care Unit
- SPSS:
-
Statistical packet for the social sciences
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Acknowledgements
The authors gratefully admit the São Paulo Enquiry Foundation for funding this research.
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All authors have made substantial contributions to the report, and all endorsed the data and conclusions. MCK contributed to formulation and design of the study, data acquisition, and analysis and interpretation of data. APPC contributed to conception and pattern of the study, data acquisition, and analysis and interpretation of data; participated in writing the typhoon manuscript and revised information technology critically for of import intellectual content, and gave concluding approving of the version to be published. APF participated in writing the draft manuscript and revised information technology critically for important intellectual content, and gave final approval of the version to be published. MBM participated in writing the typhoon manuscript and revised it critically for important intellectual content, and gave final approving of the version to be published. MABLC participated in writing the draft manuscript and revised it critically for important intellectual content, and gave last approving of the version to exist published. CMGLP participated in writing the draft manuscript and revised it critically for of import intellectual content, and gave final approval of the version to exist published.
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Kataoka, M.C., Carvalheira, A.P.P., Ferrari, A.P. et al. Smoking during pregnancy and harm reduction in birth weight: a cross-sectional written report. BMC Pregnancy Childbirth eighteen, 67 (2018). https://doi.org/10.1186/s12884-018-1694-4
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DOI : https://doi.org/10.1186/s12884-018-1694-4
Keywords
- Pregnancy
- Smoking
- Tobacco utilise cessation
- Birth weight
Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1694-4
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