Focus group methodology was used to determine the barriers to smoking cessation for pregnant women prior to the commencement of a randomised controlled smoking cessation trial (RCT), using nicotine patches in the treatment arm. Attitudes to the use of nicotine patches and perceptions of care provider counselling were also explored. Women were identified by researcher interview in the antenatal clinics as current smokers or recent 'quitters' and recruited to one of three focus groups. A number of barriers to achieving smoking cessation were identified. Pregnancy-specific barriers included scepticism about smoking-related harms. Other barriers, such as addiction to nicotine and the smoking behaviour of others, particularly partners, are generic. The latter is magnified in pregnancy by the heightened complexities of familial relationships. Potential use of patches was acceptable to most women, although some high-risk patients expressed doubts about safety and believed continued smoking was preferable. Women recounted that care providers differed in approaches to smoking cessation. Reporting 'cutting down' generally avoided further inquiries about smoking. The knowledge gained of pregnant women's perspectives enhanced the researchers' understanding in these areas. These insights have been incorporated into staff training initiatives, have guided the planning of the RCT, and have continued to inform its conduct.
BACKGROUND Previous studies have suggested that maternal supplementation with n−3 long-chain polyunsaturated fatty acids may reduce the incidence of preterm delivery but may also prolong gestation beyond term; however, more data are needed regarding the role of n−3 long-chain polyunsaturated fatty acids in pregnancy. METHODS We performed a multicenter, double-blind, randomized trial in which women who were pregnant with single or multiple fetuses were assigned to receive either fish-oil capsules that contained 900 mg of n−3 long-chain polyunsaturated fatty acids (n−3 group) or vegetable-oil capsules that contained trace n−3 long-chain polyunsaturated fatty acids (control group) daily, beginning before 20 weeks of gestation and continuing to 34 weeks of gestation or delivery, whichever occurred first. The primary outcome was early preterm delivery, defined as delivery before 34 completed weeks of gestation. Other pregnancy and neonatal outcomes were also assessed. RESULTS A total of 5544 pregnancies in 5517 women were randomly assigned at six centers in Australia; 5486 pregnancies were included in the primary analysis. Early preterm delivery occurred in the case of 61 of 2734 pregnancies (2.2%) in the n−3 group and 55 of 2752 pregnancies (2.0%) in the control group; the between-group difference was not significant (adjusted relative risk, 1.13; 95% confidence interval [CI], 0.79 to 1.63; P = 0.50). There were no significant differences between the groups in the incidence of interventions in post-term (>41 weeks of gestation) deliveries, in adverse events, or in other pregnancy or neonatal outcomes, except that a higher percentage of infants born to women in the n−3 group than in the control group were very large for gestational age at birth (adjusted relative risk, 1.30; 95% CI, 1.02 to 1.65). Percentages of serious adverse events did not differ between the groups. Minor gastrointestinal disturbances were more commonly reported in the n−3 group than in the control group. CONCLUSIONS Supplementation with n−3 long-chain polyunsaturated fatty acids from early pregnancy (<20 weeks of gestation) until 34 weeks of gestation did not result in a lower incidence of early preterm delivery or a higher incidence of interventions in post-term deliveries than control.
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