There has been limited research addressing whether behavioural change in relation to smoking is maintained throughout pregnancy and the effect on perinatal outcomes. A cohort study addressed lifestyle behaviours of 907 women who booked for antenatal care and delivered in a large urban teaching hospital in 2010–2011. Adverse perinatal outcomes were compared for “non-smokers”, “ex-smokers” and “current smokers”. Of the 907 women, 270 (30%) reported smoking in the six months prior to pregnancy, and of those 160 (59%) had stopped smoking and 110 (41%) continued to smoke at the time of the first antenatal visit. There was virtually no change in smoking behaviour between the first antenatal visit and the third trimester of pregnancy. Factors associated with continuing to smoke included unplanned pregnancy (OR 1.9; 95% CI 1.3, 2.9), alcohol use (OR 3.4; 95% CI 2.1, 6.0) and previous illicit drug use (OR 3.6; 95% CI 2.1, 6.0). Ex-smokers had similar perinatal outcomes to non-smokers. Current smoking was associated with an average reduction in birth weight of 191g (95% CI ？294, ？88) and an increased incidence of intrauterine growth restriction (24% versus 13%, adjusted OR 1.39 (95% CI 1.06, 1.84). Public Health campaigns emphasise the health benefits of quitting smoking in pregnancy. The greatest success appears to be pre-pregnancy and during the first trimester where women are largely self-motivated to quit.
References
[1]
Committee on Health Care for Underserved Women; Committee on Obstetric Practice. Committee opinion No. 471: Smoking cessation during pregnancy. Obstet Gynecol 2010, 116, 1241–1244, doi:10.1097/AOG.0b013e3182004fcd.
[2]
Barros, F.C.; Bhutta, Z.A.; Batra, M.; Victora, C.G.; Rubens, C.E.; GAPPS Review Group. Global report on preterm birth and stillbirth (3 of 7): Evidence for effectiveness of interventions. BMC Pregnancy Childbirth 2010, 10, doi:10.1186/1471-2393-10-S1-S3.
[3]
Schneider, S.; Maul, H.; Freerksen, N.; Potschke-Langer, M. Who smokes during pregnancy? An analysis of the German Perinatal Quality Survey 2005. Public Health 2008, 122, 1210–1216, doi:10.1016/j.puhe.2008.02.011.
[4]
Hayashi, K.; Matsuda, Y.; Kawamichi, Y.; Shiozaki, A.; Saito, S. Smoking during pregnancy increases risks of various obstetric complications: A case-cohort study of the Japan Perinatal Registry Network database. J. Epidemiol. 2011, 21, 61–66, doi:10.2188/jea.JE20100092.
[5]
Lumley, J.; Chamberlain, C.; Doswell, T.; Oliver, S.; Oakley, L.; Watson, L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst. Rev. 2009, 3, CD001055, doi:10.1002/14651858.CD001055.pub3.
[6]
Gray, R.; Bonellie, S.R.; Chalmers, J.; Greer, I.; Jarvis, S.; Kurinczuk, J.J.; Willians, C. Contribution of smoking during pregnancy to inequalities in stillbirth and infant death in Scotland 1994–2003: Retrospective population based study using hospital maternity records. BMJ 2009, 339, b3754, doi:10.1136/bmj.b3754.
[7]
Erickson, A.C.; Arbour, L.T. Heavy smoking during pregnancy as a marker for other risk factors of adverse birth outcomes: A population-based study in British Columbia, Canada. BMC Public Health 2012, 12, 102, doi:10.1186/1471-2458-12-102.
[8]
National Institute for Health and Clinical Excellence. Antenatal Care: Routine Care for the Healthy Pregnant Woman; NICE: London, UK, 2008.
[9]
Murphy, D.J.; Mullally, A.; Cleary, B.J.; Fahey, T.P.; Barry, J. Behavioural change in relation to alcohol exposure in early pregnancy and impact on perinatal outcomes—A prospective cohort study. BMC Pregnancy Childbirth 2013, 138, 8, doi:10.1186/1471-2393-13-8.
[10]
GROW Customised Centile Calculator. Gestation Network. Available online: www.gestation.net (accessed on 19 August 2013).
[11]
Seybold, D.J.; Broce, M.; Siegel, E.; Findley, J; Calhoun, B.C. Smoking in pregnancy in West Virginia: Does cessation/reduction improve perinatal outcomes? Mat. Child Health J. 2012, 16, 133–138, doi:10.1007/s10995-010-0730-4.
[12]
McCowan, L.M.E.; Dekker, G.A,; Chan, E.; Stewart, A.; Chappell, L.L.; Hunter, M.; Moss-Morris, R.; North, R.A. Spontaneous preterm birth and small for gestational age infants in women who cease smoking in pregnancy: A prospective cohort study. BMJ 2009, 338, b1081, doi:10.1136/bmj.b1081.
[13]
Quinn, V.P.; Mullen, P.D.; Ershoff, D.H. Women who stop smoking spontaneously prior to prenatal care and predictors of relapse before delivery. Addict. Behav. 1991, 16, 29–40, doi:10.1016/0306-4603(91)90037-I.
Odendaal, H.J.; Steyn, D.W.; Elliott, A.; Burd, L. Combined effects of cigarette smoking and alcohol consumption on perinatal outcome. Gynecol. Obstet. Investig. 2009, 67, 1–8, doi:10.1159/000150597.
[16]
Campbell, R.; Murphy, D.J. Smoking in pregnancy: Severe adverse effects can be avoided if smoking is stopped early. BMJ 2009, 338, b2188, doi:10.1136/bmj.b2188.
[17]
Crozier, S.R.; Borland, S.E.; Godfrey, K.M.; Cooper, C.; Inskip, H.M. Do women change their health behaviours in pregnancy? Findings from the Southampton women’s survey. Paediatr. Perinat. Epidemiol. 2009, 23, 446–453, doi:10.1111/j.1365-3016.2009.01036.x.
World Health Organization. International Consultation on Environmental Tobacco Smoke (ETS) and Child Health; WHO: Geneva, Switzerland, 1999.
[20]
National Institute for Health and Clinical Excellence. Mass-Media and Point-of-Sales Measures to Prevent the Uptake of Smoking by Children and Young People; NICE: London, UK, 2008.
