Postpartum return to smoking: Identifying different groups to tailor interventions

Thyrian, Jochen René; Hannöver, Wolfgang; Röske, K.; Rumpf, Hans‐Jürgen; John, Ulrich; Hapke, Ulfert

doi:10.1016/j.addbeh.2005.12.016

Cited by 17 publications

(20 citation statements)

References 32 publications

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“…In addition, this dose of nicotine resulted in serum cotinine concentrations of 26 ng/ml in the nicotineexposed offspring at birth (Holloway et al 2006), which is also within the range (5-30 ng/ml) observed in infants nursed by smoking mothers (Luck & Nau 1985). Although 15-20% of pregnant women smoke (Andres & Day 2000, Okuyemi et al 2000, many women attempt to stop smoking during pregnancy and then relapse following parturition (McBride & Pirie 1990, Castrucci et al 2006, Thyrian et al 2006, resulting in nicotine exposure at conception and during lactation only. The influence this pattern may have on offspring health is unknown, as the developmental stages of fetal and neonatal development, which are susceptible to nicotine exposure, have not been determined.…”

Section: Discussionmentioning

confidence: 99%

“…The b-cell loss, impaired glucose tolerance, and hyperinsulinemia observed in the nicotine-exposed offspring from this animal model closely represent symptoms associated with type 2 diabetes in humans (Pratley & Weyer 2001, Leahy 2005. However, the heterogeneous nature of smoking behavior and nicotine replacement therapy use in the pregnant and breastfeeding population (McBride & Pirie 1990, Castrucci et al 2006, Thyrian et al 2006) results in nicotine exposures during different windows of development. Epidemiological evidence strongly suggests that cessation or at least reduction of cigarette smoking during pregnancy will ameliorate the damage to a developing fetus (Lindley et al 2000, Pickett et al 2003; however, the effect of smoking cessation on metabolic disturbances in the offspring has not yet been determined.…”

Section: Introductionmentioning

confidence: 99%

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Fetal and neonatal nicotine exposure and postnatal glucose homeostasis: identifying critical windows of exposure

Bruin

Kellenberger

Gerstein³

et al. 2007

Journal of Endocrinology

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Fetal and lactational exposure to nicotine at concentrations comparable with those in women who smoke causes impaired glucose tolerance in male offspring in postnatal life. It remains unknown whether there are critical windows of susceptibility to nicotine exposure. Female nulliparous Wistar rats were given saline vehicle or nicotine bitartrate (1 mg/kg per day) prior to pregnancy, which was then: A) discontinued during pregnancy and lactation; B) continued until parturition; C) continued until weaning; and D) discontinued during pregnancy and restarted from lactation until weaning. At 26 weeks of age, offspring in each group were challenged with an oral glucose load. b-Cell mass, apoptosis, and proliferation were measured at birth, and at 4 and 26 weeks of age. The animals in group C (exposed to nicotine throughout pregnancy and lactation) had reduced b-cell mass from birth through 26 weeks of age and impaired glucose homeostasis at 26 weeks of age. b-Cell mass was also reduced at birth and at 4 weeks of age in animals exposed to nicotine during pregnancy alone (group B). However, enhanced proliferation following weaning led to recovery of this defect to 98% of control levels by week 26. The response to the glucose load in groups A, B, and D did not differ from controls. Continued exposure to nicotine from conception through lactation results in permanent b-cell loss and subsequent impaired glucose tolerance. This model of type 2 diabetes requires that nicotine exposure occurs both in utero and during lactation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fetal and neonatal nicotine exposure and postnatal glucose homeostasis: identifying critical windows of exposure

Bruin

Kellenberger

Gerstein³

et al. 2007

Journal of Endocrinology

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“…It is important to remember that such factors also are markers for low income and lower education. Smoking more cigarettes before quitting or quitting smoking late in pregnancy (in the third trimester) were found to be predictors for daily smoking 12 months postpartum [12,15]. Additionally, some studies indicated that the type of quitting attempt can have a significant impact on smoking relapse [15,20].…”

Section: What Are the Determinants And Time Of Smoking Relapse After mentioning

confidence: 96%

“…Among socio-demographic factors, being young, less educated, unmarried and Black have been identified as risk factors for postpartum relapse [12,15,[16][17][18]. Regarding race, it is important to note that Black women were significantly less likely than White women to smoke before pregnancy and as likely as White women to quit during pregnancy [15].…”

Section: What Are the Determinants And Time Of Smoking Relapse After mentioning

confidence: 97%

“…The attending physician and society in general may influence pregnant women's decisions to quit smoking, which also may have the unexpected effect of causing pregnant women to quit smoking for others rather than for themselves. In addition, pregnant women may quit smoking during pregnancy to reduce nausea, and pregnancy may cause them to lose their taste for tobacco [12]. After delivery, these factors no longer come into play; thereby further decreasing motivation to remain abstinent.…”

Section: Introductionmentioning

confidence: 95%

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How to Prevent Postpartum Relapse to Smoking

Polańska¹,

Wojciech

2011

CPR

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In view of the fact that smoking cessation is more likely during pregnancy than at other times, interventions to maintain quitting postpartum may provide the best opportunity for a long-term abstinence. Pediatricians, more than any other professional, see mothers of the infants and small children on a frequent basis, and pediatric well-care visits offer a unique opportunity for relapse prevention messages. The most important determinants of postpartum smoking relapse, such as having smoking partners or friends, the return to smoking as a way of coping with stressful situations, relapsing following weaning from breast-feeding, and concern about weight gain, need to be addressed during postpartum visits. The effective intervention would require pediatricians to be knowledgeable about tobacco use and how to stop, issues concerning postpartum relapse, and intervention strategies, such as role playing, problem solving and behavioral contracting.

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Interventions for promoting smoking cessation during pregnancy

Lumley

Chamberlain

Dowswell

et al. 2009

Cochrane Database of Systematic Reviews

701

652

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Background Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies. Smoking in pregnancy is decreasing in high-income countries and increasing in low- to middle-income countries and is strongly associated with poverty, low educational attainment, poor social support and psychological illness. Objectives To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (June 2008), the Cochrane Tobacco Addiction Group’s Trials Register (June 2008), EMBASE, PsycLIT, and CINAHL (all from January 2003 to June 2008). We contacted trial authors to locate additional unpublished data. Selection criteria Randomised controlled trials where smoking cessation during pregnancy was a primary aim of the intervention. Data collection and analysis Trials were identified and data extracted by one person and checked by a second. Subgroup analysis was conducted to assess the effect of risk of trial bias, intensity of the intervention and main intervention strategy used. Main results Seventy-two trials are included. Fifty-six randomised controlled trials (over 20,000 pregnant women) and nine cluster-randomised trials (over 5000 pregnant women) provided data on smoking cessation outcomes. There was a significant reduction in smoking in late pregnancy following interventions (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.96), an absolute difference of six in 100 women who stopped smoking during pregnancy. However, there is significant heterogeneity in the combined data (I2 > 60%). In the trials with the lowest risk of bias, the interventions had less effect (RR 0.97, 95% CI 0.94 to 0.99), and lower heterogeneity (I2 = 36%). Eight trials of smoking relapse prevention (over 1000 women) showed no statistically significant reduction in relapse. Smoking cessation interventions reduced low birthweight (RR 0.83, 95% CI 0.73 to 0.95) and preterm birth (RR 0.86, 95% CI 0.74 to 0.98), and there was a 53.91g (95% CI 10.44 g to 95.38 g) increase in mean birthweight. There were no statistically significant differences in neonatal intensive care unit admissions, very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power. Authors’ conclusions Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and preterm birth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported.

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Postpartum return to smoking: Identifying different groups to tailor interventions

Cited by 17 publications

References 32 publications

Fetal and neonatal nicotine exposure and postnatal glucose homeostasis: identifying critical windows of exposure

Fetal and neonatal nicotine exposure and postnatal glucose homeostasis: identifying critical windows of exposure

How to Prevent Postpartum Relapse to Smoking

Interventions for promoting smoking cessation during pregnancy

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