Characteristics of women who continue smoking during pregnancy: a cross-sectional study of pregnant women and new mothers in 15 European countries

Abstract

BackgroundSome women continue smoking during pregnancy despite the extensive information available on the dangers smoking poses to their fetus. This study aimed to examine the prevalence and determinants of smoking before and during pregnancy and the extent of smoking during pregnancy from a European perspective in relation to maternal sociodemographic characteristics, health literacy, morbidity, and pregnancy-related factors.MethodsThis multinational, web-based study evaluated pregnant women and new mothers in 15 European countries recruited from October 2011 to February 2012. Data were collected via an anonymous online questionnaire.ResultsOf 8344 women included, 2944 (35.3%) reported smoking before pregnancy, and 771 (26.2%) continued smoking during pregnancy, 88 (11.4%) of whom smoked more than 10 cigarettes per day. There was a wide variation among the 15 European countries in smoking rates before and during pregnancy, ranging from 25.0% (Sweden) to 50.0% (Croatia) before and 4.2% (Iceland) to 18.9% (Croatia) during pregnancy. Women who lived in Eastern Europe, without a spouse/partner, with a low education level and unplanned pregnancy, who did not take folic acid, and consumed alcohol during pregnancy were the most likely to smoke before pregnancy. Women who lived in Eastern or Western Europe, without a spouse/partner, with a low education level and health literacy, being a housewife, having previous children and unplanned pregnancy, and who did not take folic acid were the most likely to continue smoking during pregnancy. Women who smoked more than 10 cigarettes per day during pregnancy were the most likely to be living in Eastern Europe and to have a low education level.ConclusionWomen with fewer resources living in Western or Eastern Europe are more likely not only to smoke before pregnancy but also to continue smoking during pregnancy. These high-risk women are characterized as living alone, having high school or less as highest education level, having low health literacy, being a housewife, having previous children, having unplanned pregnancy, and no use of folic acid. Our findings indicated that focus on smoking cessation is important in antenatal care in Europe as many women smoke before pregnancy, and still continue to do so in pregnancy.

Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy – A Review

“…Nicotine consumption was often also associated with concurrent consumption of alcohol and illegal drugs, either prior to or during pregnancy [51,58,62,65]. Pregnant women who smoked were also more likely to have an unplanned pregnancy [51,62,67] and these women also attended routine antenatal medical checkups less often or only in the advanced stage of pregnancy compared to non-smokers [32,35,61]. Multipara were found to be a group at particular risk of continuing to smoke during pregnancy compared to women who were pregnant with their first child or women who had previously given birth to only one child [32, 35, 56-57, 65, 67].…”

“…Baskin et al [38] interpreted the correlations between poor quality nutrition and mental health problems analogously to nicotine and alcohol consumption as constituting a type of coping mechanism; on the other hand the authors speculated that limited drive and low motivation to pay attention to oneʼs own diet over the course of the entire pregnancy could play an important role. Important health-related factors and behaviors which are associated with malnutrition include reduced physical activity [77], being overweight or obese pre-pregnancy [81,84,85] and the continued consumption of nicotine or alcohol during pregnancy [51,67,77,79,81,86,87]. Pregnant smokers, for example, were more likely to live on a diet of fatty foods (e.g.…”

“…Pregnant smokers, for example, were more likely to live on a diet of fatty foods (e.g. junk food, chips) [81,87] compared to pregnant non-smokers and also were much less likely to take folic acid supplements [51,67,79,86]. A diet lacking in micronutrients was more common among women who had already given birth to several children [78,79,82,86], while indications of an unhealthy and unbalanced diet were reported for both nullipara and multipara [77,81,84,87].…”

Instrumentos de avaliação do letramento em saúde: revisão de literatura

“…Concerning design, the majority of the studies was observational and cross-sectional (n= 22; 81.5%) (11,12,(14)(15)(16)(17)(18)(20)(21)(22)(24)(25)(26)(27)(28)(29)(30)(31)(32)(35)(36)(37) , and some received additional specifications: 3 were pilot studies (11.1%) (20,24,25) , 4 were multi-center studies (14.8%) (11,16,17,30) , and 5 focused on validation of assessment instruments (18.5%) (22,26,31,32,37) . Randomized clinical trials -studies that present higher levels of scientific evidence -totaled only 4 occurrences (14.8%) (19,23,33,34) , and 2 of them were multi-center studies (7.4%) (33,34) .…”

“…Five of these articles used the full version (18.6%) (11,25,(32)(33)(34) , 1 of them used the short version (3.7%) (12) , and 1 used the reviewed version (3.7%) (30) . Of these 8 studies, 1 (3.7%) used SAHLPA (Short Assessment of Health Literacy for Portuguese-speaking Adults) (26) , a version (13,21,29,36) in Japan and the Netherlands, and SBSQ (Set of Brief Screening Questions), in 2 articles (7.4%) (16,17) : a study that performed assessments in 15 European countries (16) and a study that involved countries in Europe, Oceania, North and South America (17) . Each one of the other 13 health literacy assessment instruments that were identified in the study was used by 1 article (3.7%).…”