Cigarette smoking during pregnancy in rural Nepal. Risk factors and effects of β-carotene and vitamin A supplementation

Abstract

Objective: We examined risk factors of smoking and the association between smoking and pregnancy-related and 6-month infant mortality in rural Nepal, where 30% women reported smoking during pregnancy. Design: Cross-sectional analysis of risk factors associated with smoking status and health consequences of smoking, using prospective data collected as part of a randomized community trial to examine the effect of maternal vitamin A or b-carotene supplementation on maternal mortality. Setting: Rural, southeastern plains of Nepal. Subjects and methods: A total of 17 767 women contributed at least one pregnancy during 3.5 y of the study. Data on cigarette or bidi (rolled tobacco) smoking were collected using a 7-day recall, twice during pregnancy. Associations between smoking status and maternal diet, morbidity profile, household socioeconomic status and serum concentration of retinol, carotenoids and tocopherols were examined. Further, relative risk (RR) and 95% confidence intervals (CI) were calculated to estimate supplement effects on pregnancy-related mortality, stratified by smoking status during pregnancy. Results: Smokers were more likely to be older, illiterate and poor compared to nonsmokers. Fruit and vegetable consumption among smokers and nonsmokers did not vary. However, smokers were more likely to consume meat/fish/eggs and less likely to consume milk than nonsmokers. They were also more likely to report symptoms of vaginal bleeding, edema, severe headache and convulsions during pregnancy relative to nonsmokers. Mortality per 100 000 pregnancies appeared to be higher among smokers than nonsmokers in the placebo group (915 vs 584, RR ¼ 1.57, 95% CI: 0.80-3.08). b-Carotene supplementation reduced pregnancy-related mortality both among smokers (RR ¼ 0.31 95% CI: 0.11-0.89) and nonsmokers (RR ¼ 0.41, 95% CI: 0.19-0.89). Similar results obtained with vitamin A supplementation were not statistically significant. Infant mortality up to 6 months was B30% higher among smokers compared to nonsmokers in the placebo group both before and after adjusting for confounding factors. Neither supplement given to women reduced infant mortality. Conclusions: Cigarette smoking during pregnancy is associated with an increased risk of maternal and infant mortality in rural Nepal. b-Carotene and to some extent vitamin A may reduce the risk of pregnancy-related mortality, but not infant mortality, among both smokers and nonsmokers.

Prevalence of Stress among Pregnant Women Attending Antenatal Care in a Tertiary Maternity Hospital in Kathmandu

“…as the birth order increases [26]. Smoking rate was significantly lower in comparison to findings of other studies done in Nepal [1,[27][28][29][30].…”

“…This was higher than the rate of alcohol consumption among Nepalese women in Eastern Nepal [27,[29][30].…”

Tobacco Use during Pregnancy and Its Associated Factors in a Mountain District of Eastern Nepal: A Cross-Sectional Questionnaire Survey

“…The sample size was calculated based on the assumption that prevalence of tobacco use during pregnancy was 30% (17). The population living in 33 Village Development Committee (VDC) was considered to represent rural population while population living in the only municipality of the district was considered to represent urban population.…”

Gender differences in dietary intake among adults of Hindu communities in lowland Nepal: assessment of portion sizes and food consumption frequencies

“…The 24-week infant mortality rate in this area was 70.8 per 1000 live births (Katz et al, 2000), more than 10 times higher than that in the developed world. Katz et al (2003) pointed out that maternal undernutrition during pregnancy was strongly associated with infant mortality and Christian et al (2004) revealed potential effects of intervention by means of supplementation of micronutrients on improvement of maternal and infant health and survival. Nutritional status of women is worse in the Terai than in other areas of Nepal.…”