Maternal and Child Health Library

MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National Sudden and Unexpected Infant/Child and Pregnancy Loss Resource Center. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

September 26, 2008

1.ARTICLE ASSESSES SMOKING PATTERNS AND USE OF CESSATION INTERVENTIONS DURING PREGNANCY

"If women enter prenatal care while smoking, there is an opportunity for clinicians to assess smoking status, counsel them to quit smoking, and provide referrals for cessation services," state the authors of an article published in the October 2008 issue of the American Journal of Preventive Medicine. Maternal smoking has been causally associated with fetal growth restriction, premature rupture of the membranes, placenta previa, placental abruption, preterm delivery, and low birthweight. In addition, in utero exposure to cigarette smoke can have long-term negative effects on the growth, development, and behaviors of offspring. Further, women who quit smoking during pregnancy have better health outcomes than those who continue to smoke. However, more than 10% of women who delivered a live infant in 2004 reported smoking during pregnancy -- far above the Healthy People goal of 1%. This study analyzed population-based surveillance data to describe women's smoking patterns and the use of cessation services during pregnancy. Smoking status during pregnancy as well as before and after entry into prenatal care was examined. Health professional assistance, the use of interventions, and barriers to quitting were also described.

Data were analyzed from 4,473 women who responded to a questionnaire from the New Jersey PRAMS (Pregnancy Risk Assessment and Monitoring System) during 2004-2005. PRAMS, a population-based survey of women whose pregnancies resulted in a live birth, is conducted in partnership with the Centers for Disease Control and Prevention and the New Jersey Department of Health and Senior Services. New Jersey was selected because it is the only PRAMS state that includes detailed supplemental questions on patterns of smoking and the use of cessation services.

The authors found that

• Among New Jersey women who delivered a live infant, an estimated 16.2% smoked in the 3 months before pregnancy, and 7.3% smoked during the last 3 months of pregnancy. Of the 16.2% who smoked before pregnancy, half (49.8%) quit before entering prenatal care, and 5.2% quit afterwards.
• Of women who smoked before pregnancy, 92.7% reported that they were asked by their prenatal care health professionals about their smoking status. Of women who were smoking when they entered prenatal care, 56.7% reported that a health professional spent time discussing how to quit, and 31.1% reported that a health professional set a specific date to quit.
• Among women who smoked during the last 3 months of pregnancy, 52.4% tried to quit or cut back on their own, 10.2% tried to quit or cut back but did not report using a cessation method, 25.9% did not try to quit or cut back, and 11.5% used a cessation method when trying to quit or cut back.
• The most frequent barriers to quitting were cravings for a cigarette, loss of a way to handle stress, and having other people around who smoke.
  

The authors conclude that "increasing the knowledge, promotion, and referral of effective smoking-cessation interventions is necessary to reduce the harmful impact of smoking on the health of women and their newborns."

Tong V, Englad LJ, Dietz PM, et al. 2008. Smoking patterns and use of cessation interventions during pregnancy. American Journal of Preventive Medicine 35(4):327-333. Abstract available at http://www.ajpm-online.net/article/S0749-3797(08)00602-8/abstract.

Readers: More information is available from the following MCH Library resources:

- Smoking During Pregnancy: Bibliography at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_smokingpreg.html&-MaxRecords=all&-DoScript=auto_search_smokingpreg&-search

- Smoking/Tobacco Use Prevention: Bibliography at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_smokingprev.html&-MaxRecords=all&-DoScript=auto_search_smokingprev&-search

• For white women, the mean MSA rate of VPT birth was 12.3 per 1,000 (SD=2.7); for black women, the mean rate was 34.8 per 1,000 (SD=6.9); and for Hispanic women, the mean MSA rate was 15.7 per 1,000 (SD=4.0).
• Black women consistently had two to three times the city-to-city variation for any given analysis, compared with white women and Hispanic women.
• The overall pattern of black-white racial disparity in mean rates, as well as in increased variance, persisted in subsequent analyses.

• The SIDS incidence rate decreased significantly from 1.38 per 1,000 births in 1989 to 0.31 per 1,000 births in 2004.
• Of the 77% decrease in the SIDS incidence rate, 37% of the decrease occurred in 1989 to 1994, before the national Back to Sleep campaign, and 40% occurred in 1995 to 2001, after the campaign’s launch. In 2002-2004, no further decrease in the SIDS incidence rate was noted.
• The proportion of infant deaths from SIDS had decreased from 16% in the beginning of the study period to 6% in 2004. The proportion of infant deaths from SIDS remained constant in 2002 to 2004, at 6%.
• The decrease in incidence rates was highest among the Asian and Pacific Islander group (83%), followed by the Hispanic group (77%) and the white group. (71%). The decrease was lowest for the black group (67%).
• In 2002 to 2004, the peak age at death had increased to age 3 months (4th month of life), compared with age 2 months in 1989 to 1994.
• The high (winter) to low (summer) season incidence ratio decreased significantly from 2.13 in 1989 to 1994 to 1.69 in 1995 to 2001, and it decreased further to 1.34 in 2002 to 2004.
• The weekday-to-weekend difference increased from 7% higher on weekdays in 1989 to 1994 to 28% higher on weekdays in 2002 to 2004.

• A 1% decrease in monthly employed persons precedes by 1 month a 1.11-fold increase in the odds of reporting a prone infant sleep position.
• Unlike findings in black women, findings in white women indicated no association between employment changes and infant sleep position.