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Crosland BA, Garg B, Bandoli GE, Mandelbaum AD, Hayer S, Ryan KS, Shorey-Kendrick LE, McEvoy CT, Spindel ER, Caughey AB, Lo JO. Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure. JAMA Netw Open 2024; 7:e2410151. [PMID: 38713462 PMCID: PMC11077393 DOI: 10.1001/jamanetworkopen.2024.10151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 05/08/2024] Open
Abstract
Importance The prevalence of cannabis use in pregnancy is rising and is associated with adverse perinatal outcomes. In parallel, combined prenatal use of cannabis and nicotine is also increasing, but little is known about the combined impact of both substances on pregnancy and offspring outcomes compared with each substance alone. Objective To assess the perinatal outcomes associated with combined cannabis and nicotine exposure compared with each substance alone during pregnancy. Design, Setting, and Participants This retrospective population-based cohort study included linked hospital discharge data (obtained from the California Department of Health Care Access and Information) and vital statistics (obtained from the California Department of Public Health) from January 1, 2012, through December 31, 2019. Pregnant individuals with singleton gestations and gestational ages of 23 to 42 weeks were included. Data were analyzed from October 14, 2023, to March 4, 2024. Exposures Cannabis-related diagnosis and prenatal nicotine product use were captured using codes from International Classification of Diseases, Ninth Revision, Clinical Modification, and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification. Main Outcome and Measures The main outcomes were infant and neonatal death, infants small for gestational age, and preterm delivery. Results were analyzed by multivariable Poisson regression models. Results A total of 3 129 259 pregnant individuals were included (mean [SD] maternal age 29.3 [6.0] years), of whom 23 007 (0.7%) had a cannabis-related diagnosis, 56 811 (1.8%) had a nicotine-use diagnosis, and 10 312 (0.3%) had both in pregnancy. Compared with nonusers, those with cannabis or nicotine use diagnoses alone had increased rates of infant (0.7% for both) and neonatal (0.3% for both) death, small for gestational age (14.3% and 13.7%, respectively), and preterm delivery (<37 weeks) (12.2% and 12.0%, respectively). Moreover, risks in those with both cannabis and nicotine use were higher for infant death (1.2%; adjusted risk ratio [ARR], 2.18 [95% CI, 1.82-2.62]), neonatal death (0.6%; ARR, 1.76 [95% CI, 1.36-2.28]), small for gestational age (18.0%; ARR, 1.94 [95% CI, 1.86-2.02]), and preterm delivery (17.5%; ARR, 1.83 [95% CI, 1.75-1.91]). Conclusions and Relevance These findings suggest that co-occurring maternal use of cannabis and nicotine products in pregnancy is associated with an increased risk of infant and neonatal death and maternal and neonatal morbidity compared with use of either substance alone. Given the increasing prevalence of combined cannabis and nicotine use in pregnancy, these findings can help guide health care practitioners with preconception and prenatal counseling, especially regarding the benefits of cessation.
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Affiliation(s)
- B. Adam Crosland
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Bharti Garg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | | | - Ava D. Mandelbaum
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Sarena Hayer
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Kimberly S. Ryan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | | | - Cindy T. McEvoy
- Division of Neonatology, Department of Pediatrics, Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland
| | - Eliot R. Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton
| | - Aaron B. Caughey
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Jamie O. Lo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
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Mallinson DC, Kuo HHD, Kirby RS, Wang Y, Berger LM, Ehrenthal DB. Maternal opioid use disorder and infant mortality in Wisconsin, United States, 2010-2018. Prev Med 2024; 181:107914. [PMID: 38408650 PMCID: PMC10947857 DOI: 10.1016/j.ypmed.2024.107914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The difference in infant health outcomes by maternal opioid use disorder (OUD) status is understudied. We measured the association between maternal OUD during pregnancy and infant mortality and investigated whether this association differs by infant neonatal opioid withdrawal syndrome (NOWS) or maternal receipt of medication for OUD (MOUD) during pregnancy. METHODS We sampled 204,543 Medicaid-paid births from Wisconsin, United States (2010-2018). The primary exposure was any maternal OUD during pregnancy. We also stratified this exposure on NOWS diagnosis (no OUD; OUD without NOWS; OUD with NOWS) and on maternal MOUD receipt (no OUD; OUD without MOUD; OUD with <90 consecutive days of MOUD; OUD with 90+ consecutive days of MOUD). Our outcome was infant mortality (death at age <365 days). Demographic-adjusted logistic regressions measured associations with odds ratios (OR) and 95% confidence intervals (CI). RESULTS Maternal OUD was associated with increased odds of infant mortality (OR 1.43; 95% CI 1.02-2.02). After excluding infants who died <5 days post-birth (i.e., before the clinical presentation of NOWS), regression estimates of infant mortality did not significantly differ by NOWS diagnosis. Likewise, regression estimates did not significantly differ by maternal MOUD receipt in the full sample. CONCLUSIONS Maternal OUD is associated with an elevated risk of infant mortality without evidence of modification by NOWS nor by maternal MOUD treatment. Future research should investigate potential mechanisms linking maternal OUD, NOWS, MOUD treatment, and infant mortality to better inform clinical intervention.
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Affiliation(s)
- David C Mallinson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America.
| | - Hsiang-Hui Daphne Kuo
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Russell S Kirby
- The Chiles Center, College of Public Health, University of South Florida, Tampa, FL, United States of America
| | - Yi Wang
- Silberman School of Social Work, Hunter College, New York, NY, United States of America
| | - Lawrence M Berger
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Deborah B Ehrenthal
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States of America; Social Science Research Institute, The Pennsylvania State University, University Park, PA, United States of America
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3
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de Souza Sá ÁR, Santos Branco DK. Social fund and infant mortality: Evidence from an anti-poverty policy in Northeast Brazil. HEALTH ECONOMICS 2024; 33:674-695. [PMID: 38148733 DOI: 10.1002/hec.4785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 12/28/2023]
Abstract
This paper evaluates the effects of a social fund that meets the needs of the poor in Northeast Brazil, the Fundos Estaduais de Combate e Erradicação da Pobreza (FECEP). The program could have improved infant health by reducing poverty and improving access to health care, sanitation, food, and housing. Using a difference-in-differences approach robust to heterogeneous treatment effects, we confirm that the program has effectively reduced poverty in treated areas. Furthermore, we document that this poverty reduction is associated with a significant decline in infant mortality. These findings provide consistent evidence that targeted public investments can improve living conditions in vulnerable regions.
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Hu L, Wu S, Zhang Y, Xia X, Shu Y, He Q, Manshan H, Kuo Z, Zhao Y, Wang P, Li Y, Wang C, Su K, Han H, Yuan J, Xiang J, Xia B. Associations of maternal and personal smoking with all-cause and cause-specific mortality risk and life expectancy: a prospective cohort study. Public Health 2024; 229:144-150. [PMID: 38442596 DOI: 10.1016/j.puhe.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the individual and combined effects of maternal smoking during pregnancy (MSDP) and personal smoking on mortality and life expectancy. STUDY DESIGN A prospective cohort study based on the UK Biobank, with a median follow-up of 12.47 years. METHODS This study employed multivariate Cox regression to determine the relative risks of mortality from all causes and specific diseases according to maternal and/or personal smoking status and pack-years of smoking (0, 1-20, 21-30, >30). Additionally, this study estimated the additive interaction between the two exposures. Life table analyses were performed using the estimated age-specific mortality rates to forecast life expectancy. RESULTS Results indicated that MSDP elevated the risk of all-cause mortality (HR = 1.12, 95% CI: 1.09-1.15) and mortality due to neoplasms (HR = 1.10, 95% CI: 1.06-1.12), circulatory (HR = 1.13, 95% CI: 1.06-1.19), respiratory (HR = 1.27, 95% CI: 1.16-1.40) and digestive system diseases (HR = 1.22, 95% CI: 1.08-1.38). Notably, both multiplicative and additive interactions were observed between maternal and personal smoking, with Relative Excess Risk due to Interaction (RERI) values for mortality from all causes, neoplasms, circulatory, and respiratory diseases being 0.21, 0.22, 0.16, and 0.76, respectively. This study also found a trend towards shorter gained life expectancy when maternal smoking and increasing pack-years of personal smoking were combined. CONCLUSIONS In this cohort study of UK Biobank, MSDP was associated with an increased risk of all-cause mortality and reduced life expectancy, suggesting that quitting smoking during pregnancy might have health and longevity benefits for both generations.
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Affiliation(s)
- Linmin Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Siqing Wu
- School of Medicine, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Yunhui Zhang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xuedan Xia
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China
| | - Yuelong Shu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China; Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Pekina Union Medical School, Beijing, China
| | - Qiangsheng He
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Chinese Health Risk Management Collaboration (CHRIMAC), Shenzhen, Guangdong 518107, China
| | - Huang Manshan
- Department of Stomatology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China
| | - Zicong Kuo
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China
| | - Yingya Zhao
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pengpeng Wang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yanfei Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Chunliang Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Kai Su
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Hengyi Han
- School of Medicine, Tsinghua University, Beijing, China
| | - Jinqiu Yuan
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Chinese Health Risk Management Collaboration (CHRIMAC), Shenzhen, Guangdong 518107, China; Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China.
| | - Jianbang Xiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China.
| | - Bin Xia
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Chinese Health Risk Management Collaboration (CHRIMAC), Shenzhen, Guangdong 518107, China.
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Erck Lambert AB, Shapiro-Mendoza CK, Parks SE, Cottengim C, Faulkner M, Hauck FR. Characteristics of Sudden Unexpected Infant Deaths on Shared and Nonshared Sleep Surfaces. Pediatrics 2024; 153:e2023061984. [PMID: 38374785 PMCID: PMC11117443 DOI: 10.1542/peds.2023-061984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Describe characteristics of sudden unexpected infant deaths (SUID) occurring on shared or nonshared sleep surfaces. METHODS We examined SUID among residents of 23 US jurisdictions who died during 2011 to 2020. We calculated frequencies and percentages of demographic, sleep environment, and other characteristics by sleep surface sharing status and reported differences of at least 5% between surface sharing and nonsharing infants. RESULTS Of 7595 SUID cases, 59.5% were sleep surface sharing when they died. Compared with nonsharing infants, sharing infants were more often aged 0 to 3 months, non-Hispanic Black, publicly insured, found supine, found in an adult bed or chair/couch, had a higher number of unsafe sleep factors present, were exposed to maternal cigarette smoking prenatally, were supervised by a parent at the time of death, or had a supervisor who was impaired by drugs or alcohol at the time of death. At least 76% of all SUID had multiple unsafe sleep factors present. Among surface-sharing SUID, most were sharing with adults only (68.2%), in an adult bed (75.9%), and with 1 other person (51.6%). Surface sharing was more common among multiples than singletons. CONCLUSIONS Among SUID, surface sharing and nonsharing infants varied by age at death, race and ethnicity, insurance type, presence of unsafe sleep factors, prenatal smoke exposure, and supervisor impairment. Most SUID, regardless of sleep location, had multiple unsafe sleep factors present, demonstrating the need for comprehensive safe sleep counseling for every family at every encounter.
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Affiliation(s)
- Alexa B. Erck Lambert
- Centers for Disease Control and Prevention, Division of
Reproductive Health, Atlanta, Georgia
- DB Consulting Group, Inc., Silver Springs, Maryland
| | | | - Sharyn E. Parks
- Centers for Disease Control and Prevention, Division of
Reproductive Health, Atlanta, Georgia
| | - Carri Cottengim
- Centers for Disease Control and Prevention, Division of
Reproductive Health, Atlanta, Georgia
| | - Meghan Faulkner
- Michigan Public Health Institute, Center for National
Prevention Initiatives, Okemos, Michigan
| | - Fern R. Hauck
- Unversity of Virginia, Department of Family Medicine,
Charlottesville, Virginia
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Zaganjor I, Kramer RD, Kofie JN, Sawdey MD, Cullen KA. Trends in Smoking Before, During, and After Pregnancy in the United States from 2000 to 2020: Pregnancy Risk Assessment Monitoring System. J Womens Health (Larchmt) 2024; 33:283-293. [PMID: 38153374 DOI: 10.1089/jwh.2023.0641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objectives: This study used 2000-2020 Pregnancy Risk Assessment Monitoring System data to estimate trends in smoking before, during, and after pregnancy, as well as quitting smoking during pregnancy. Materials and Methods: Weighted prevalence and 95% confidence intervals (CIs) were calculated by year for each smoking-related measure. Annual percent change (APC) and average annual percent change (AAPC) in prevalence were estimated using Joinpoint regression to characterize trends over time. Results: Between 2000 and 2020, significant decreases in the prevalence of smoking before (23.0% to 14.0%; AAPC = -2.3% [95% CI = -2.9% to -1.7%]), during (13.2% to 6.5%; AAPC = -3.4% [95% CI = -4.0% to -2.7%]), and after pregnancy (18.9% to 8.8%; AAPC = -3.6% [95% CI = -4.3% to -2.9%]) were observed. For each measure, the fastest declines occurred largely throughout the 2010s (before: APC = -5.5% [2012-2020]; during: APC = -5.1% [2009-2020]; and after: APC = -6.4% [2012-2020]). The proportion of people who quit smoking during pregnancy significantly increased from 43.2% in 2000 to 53.7% in 2020 (AAPC = 1.0%; 95% CI = 0.2%-1.9%); however, Joinpoint regression detected relatively no change in quitting during pregnancy between 2010 and 2020 (APC = 0.0%; 95% CI = -0.4% to 0.5%). Conclusions: The prevalence of smoking before, during, and after pregnancy has reduced dramatically in the United States between 2000 and 2020, with the fastest declines occurring throughout the second decade of the twenty-first century. However, prevention and cessation efforts are still needed since approximately half of people who smoked before pregnancy continue to smoke during pregnancy.
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Affiliation(s)
- Ibrahim Zaganjor
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Renee D Kramer
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Justina N Kofie
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael D Sawdey
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Karen A Cullen
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Shorey-Kendrick LE, McEvoy CT, Milner K, Harris J, Brownsberger J, Tepper RS, Park B, Gao L, Vu A, Morris CD, Spindel ER. Improvements in lung function following vitamin C supplementation to pregnant smokers are associated with buccal DNA methylation at 5 years of age. Clin Epigenetics 2024; 16:35. [PMID: 38413986 PMCID: PMC10900729 DOI: 10.1186/s13148-024-01644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND We previously reported in the "Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function" randomized clinical trial (RCT) that vitamin C (500 mg/day) supplementation to pregnant smokers is associated with improved respiratory outcomes that persist through 5 years of age. The objective of this study was to assess whether buccal cell DNA methylation (DNAm), as a surrogate for airway epithelium, is associated with vitamin C supplementation, improved lung function, and decreased occurrence of wheeze. METHODS We conducted epigenome-wide association studies (EWAS) using Infinium MethylationEPIC arrays and buccal DNAm from 158 subjects (80 placebo; 78 vitamin C) with pulmonary function testing (PFT) performed at the 5-year visit. EWAS were performed on (1) vitamin C treatment, (2) forced expiratory flow between 25 and 75% of expired volume (FEF25-75), and (3) offspring wheeze. Models were adjusted for sex, race, study site, gestational age at randomization (≤ OR > 18 weeks), proportion of epithelial cells, and latent covariates in addition to child length at PFT in EWAS for FEF25-75. We considered FDR p < 0.05 as genome-wide significant and nominal p < 0.001 as candidates for downstream analyses. Buccal DNAm measured in a subset of subjects at birth and near 1 year of age was used to determine whether DNAm signatures originated in utero, or emerged with age. RESULTS Vitamin C treatment was associated with 457 FDR significant (q < 0.05) differentially methylated CpGs (DMCs; 236 hypermethylated; 221 hypomethylated) and 53 differentially methylated regions (DMRs; 26 hyper; 27 hypo) at 5 years of age. FEF25-75 was associated with one FDR significant DMC (cg05814800), 1,468 candidate DMCs (p < 0.001), and 44 DMRs. Current wheeze was associated with 0 FDR-DMCs, 782 candidate DMCs, and 19 DMRs (p < 0.001). In 365/457 vitamin C FDR significant DMCs at 5 years of age, there was no significant interaction between time and treatment. CONCLUSIONS Vitamin C supplementation to pregnant smokers is associated with buccal DNA methylation in offspring at 5 years of age, and most methylation signatures appear to be persistent from the prenatal period. Buccal methylation at 5 years was also associated with current lung function and occurrence of wheeze, and these functionally associated loci are enriched for vitamin C associated loci. Clinical trial registration ClinicalTrials.gov, NCT01723696 and NCT03203603.
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Affiliation(s)
- Lyndsey E Shorey-Kendrick
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA.
| | - Cindy T McEvoy
- Department of Pediatrics, Pape Pediatric Research Institute, Oregon Health and Science University, Portland, OR, USA
| | - Kristin Milner
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Julia Harris
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Julie Brownsberger
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Robert S Tepper
- Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Byung Park
- Biostatistics Shared Resources, Knight Cancer Institute, Bioinformatics and Biostatistics Core, Oregon National Primate Research Center, Oregon Health and Science University, Portland State University School of Public Health, Portland, OR, USA
| | - Lina Gao
- Biostatistics Shared Resources, Knight Cancer Institute, Bioinformatics and Biostatistics Core, Oregon National Primate Research Center, Oregon Health and Science University, Portland State University School of Public Health, Portland, OR, USA
| | - Annette Vu
- Oregon Clinical & Translational Research Institute, Oregon Health and Science; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Cynthia D Morris
- Oregon Clinical & Translational Research Institute, Oregon Health and Science; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Eliot R Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
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8
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Hu L, Wu S, Shu Y, Su K, Wang C, Wang D, He Q, Chen X, Li W, Mi N, Xie P, Zhao J, Zhang S, Yuan J, Xiang J, Xia B. Impact of Maternal Smoking, Offspring Smoking, and Genetic Susceptibility on Crohn's Disease and Ulcerative Colitis. J Crohns Colitis 2023:jjad200. [PMID: 38038665 DOI: 10.1093/ecco-jcc/jjad200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND AND AIMS The long-term impact of maternal smoking during pregnancy (MSDP) on adult offspring's risk of Crohn's disease (CD) and ulcerative colitis (UC) remains uncertain. Our study aims to investigate the individual and combined effects of early life exposure (MSDP), offspring personal behavior (smoking), and genetic risk on the development of CD and UC in adult offspring. METHODS We conducted a prospective cohort study using UK Biobank data, including 334,083 participants recruited between 2006-2010, with follow-up until December 31, 2021. Multivariable Cox regression models were used to evaluate the associations of genetic factors, maternal and personal smoking, and their combination with CD and UC. RESULTS Participants exposed to MSDP had an 18% increased risk of CD compared to those without MSDP (hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.01-1.39). However, no significant association was found between MSDP and the UC risk (HR = 1.03, 95%CI = 0.92-1.16). Personal smoking increased the risk of CD and UC, and had a numerically amplified effect with MSDP. Participants with high genetic risk and MSDP had a 2.01-fold (95%CI = 1.53-2.65) and a 2.45-fold (95%CI = 2.00-2.99) increased risk of CD and UC, respectively, compared to participants without MSDP and with low genetic risk. CONCLUSIONS Our prospective cohort study provides evidence that MSDP increases the risk of CD in adult offspring, whereas no evidence supports their causal association. Additionally, smoking and genetic susceptibility had a numerically amplified effect with MSDP on CD and UC, but the interaction lacked statistical significance.
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Affiliation(s)
- Linmin Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Siqing Wu
- School of Medicine, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Yuelong Shu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences &Pekina Union Medical School, Beijing, China
| | - Kai Su
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Chunliang Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Danni Wang
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Qiangsheng He
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
- Chinese Health Risk Management Collaboration (CHRIMAC), Shenzhen, Guangdong, 518107, China
| | - Xinyu Chen
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, No.628, Zhenyuan Road, Xinhu Street, Guangming District Shenzhen, 518107 PR China
| | - Wenjing Li
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Ningning Mi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Peng Xie
- Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Jinyu Zhao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Shiyong Zhang
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080 China
| | - Jinqiu Yuan
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
- Chinese Health Risk Management Collaboration (CHRIMAC), Shenzhen, Guangdong, 518107, China
- Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Jianbang Xiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Bin Xia
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
- Chinese Health Risk Management Collaboration (CHRIMAC), Shenzhen, Guangdong, 518107, China
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9
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Duka S, Rahman S, Hansen SE, Esernio-Jenssen D. The Effect of Maternal Adverse Childhood Experiences (ACEs) on Substance Use During Pregnancy. Matern Child Health J 2023; 27:153-165. [PMID: 37733152 PMCID: PMC10691987 DOI: 10.1007/s10995-023-03768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES To analyze adverse childhood experiences (ACEs) among mothers of newborns referred to a hospital's child protection team (CPT) for suspected substance exposure. Researchers hypothesized that a higher prevalence of these mothers have ≥ 4 ACEs than female counterparts in the general population. The study team also explored whether associations existed between type of maternal ACEs and substance use in pregnancy. METHODS Retrospective review of infant referrals to the CPT in the 3 years after adding an ACEs questionnaire to the consultation process. Bivariate analyses and multivariate logistic regression models examined associations between prenatal substance use and maternal ACEs prevalence, controlling for demographics. RESULTS Data from 222 infants (four sets of twins) and 218 mothers were analyzed. Half (50.0%) the infants had withdrawal symptoms. Most (67.0%) women had positive toxicology screens, while 85.0% reported prenatal substance use. Half (50.9%) the mothers reported ≥ 4 ACEs and these individuals had significantly higher odds of cannabinoid use [adjusted odds ratio (aOR), 3.7; 95%CI 2.0, 6.9, p < 0.001) than those with < 4 ACEs. A significant association was found between substance use and ACEs in the household challenges category (p = 0.03), especially parental separation/divorce (p < 0.001). CONCLUSIONS FOR PRACTICE As hypothesized, a higher prevalence of mothers referred to the CPT had ≥ 4 ACEs than women in the general population (50.9% vs. 15.2%), and a large proportion had used substances while pregnant. Routine prenatal ACEs screening and universal, nonpunitive toxicology testing of infants and mothers at birth may provide opportunities for intervention while reducing the transgenerational impact of ACEs.
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Affiliation(s)
- Shae Duka
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, USA
- Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Sadeea Rahman
- Department of Pediatrics, Jacobi Medical Center, New York, USA
| | - Susan E Hansen
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, USA
- Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Debra Esernio-Jenssen
- Morsani College of Medicine, University of South Florida, Tampa, USA.
- Department of Pediatrics, Lehigh Valley Health Network, Allentown, USA.
- Lehigh Valley Reilly Children's Hospital, Cedar Crest Boulevard and I-78, Allentown, PA, 18103, USA.
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Ahlers-Schmidt CR, Okut H, Jacobson LT, Hervey A, Schunn C, Torres M, Kuhlmann Z. Characteristics Associated with Sudden Unexpected Infant Death in a Rural Hispanic Population: A Case-Control Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01854-5. [PMID: 37947954 DOI: 10.1007/s40615-023-01854-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Sudden unexpected infant death (SUID) is the leading cause of death among U.S. infants aged 28 days to 1 year. In Kansas, Hispanic infant mortality is nearly 50% higher than non-Hispanic White. Further, the SUID rate did not change between 2005-2018, while rates for non-Hispanic Black and White infants decreased significantly. This study sought to identify characteristics and behaviors of Hispanic birthing persons related to SUID. METHODS Linked Kansas birth/death vital statistics data (2005-2018) identified Hispanic birthing persons with a singleton birth who experienced SUID. To reduce confounding effects, greedy nearest neighbor matching paired each SUID case sequentially with the four nearest controls based on age, race, payor source and parity. Matching procedures, likelihood-ratio χ2, Fisher exact test and multiple logistic regression model with Firth's penalized maximum likelihood estimation were computed. RESULTS Of 86,052 Hispanic singleton births, 66 involved SUID and were matched with 264 controls. No differences were related to marital status, population density of residence, education level, language spoken, prenatal BMI, weight gained during pregnancy, adequacy of prenatal care, enrollment in WIC, or state immunization registry participation (all p>0.05). However, tobacco use during pregnancy contributed to a three times greater risk of SUID (OR=3.208; 95% CI=1.438 to 7.154). Multivariable models for behavioral variables revealed low predictive accuracy with area under the ROC curve=0.6303. CONCLUSION This study suggests SUID deaths to rural Hispanic families are likely multifaceted. Study results inform educational programs on the importance of addressing tobacco cessation in SUID risk reduction interventions for Hispanic families.
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Affiliation(s)
- Carolyn R Ahlers-Schmidt
- Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA.
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA.
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
| | - Lisette T Jacobson
- Department of Population Health, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
| | - Ashley Hervey
- Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA
| | - Christy Schunn
- Kansas Infant Death and SIDS (KIDS) Network, 300 W. Douglas, Suite 145, Wichita, KS, 67202, USA
| | - Maria Torres
- Kansas Infant Death and SIDS (KIDS) Network, 300 W. Douglas, Suite 145, Wichita, KS, 67202, USA
| | - Zachary Kuhlmann
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
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11
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Silva E Oliveira F, Mota DDFDC, Guimarães JV, Cavalcante AMRZ, Vieira FVM. Symptoms of Depression in the Postpartum Period: Targeting Maternal Mental Health in the Perinatal Period. Issues Ment Health Nurs 2023; 44:1133-1141. [PMID: 37643360 DOI: 10.1080/01612840.2023.2243332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
This cross-sectional study aimed to examine the relationship between postpartum depression symptoms, anxiety, and stress during the postpartum period. A total of 101 women were assessed using the Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) within 14 days after delivery. Multivariate regression analysis revealed that paid work, tobacco use, and stress symptoms were significantly associated with a higher incidence of postpartum depression symptoms. These results underscore the importance of comprehensive prenatal care and effective postpartum follow-up to address maternal mental health and prevent adverse outcomes for both mothers and children.
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12
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Kock LS, Erath TG, Coleman SRM, Higgins ST, Heil SH. Contingency management interventions for abstinence from cigarette smoking in pregnancy and postpartum: A systematic review and meta-analysis. Prev Med 2023; 176:107654. [PMID: 37532032 PMCID: PMC10828115 DOI: 10.1016/j.ypmed.2023.107654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Abstract
Contingency management is one of the most effective treatments for substance use disorders in not-pregnant people. The most recent quantitative review of its efficacy among pregnant and postpartum women who smoke cigarettes concluded with moderate certainty that those receiving contingent financial incentives were twice as likely to be abstinent compared with controls. We aimed to update and extend previous reviews. Five databases were systematically searched for randomized controlled trials (RCTs) published before December 2022 that assessed the effectiveness of incentives for abstinence from substance use. Data from trials of smoking abstinence were pooled using a random-effects meta-analysis model (restricted maximum likelihood). Results are reported as risk-ratios (RRs) with 95% confidence intervals (CIs). This study is registered with PROSPERO, CRD42022372291. Twelve RCTs (3136) pregnant women) were included. There was high certainty evidence that women receiving incentives were more likely to be abstinent than controls at the last antepartum assessment (12 RCTs; RR = 2.43, 95% CI 2.04-2.91, n = 2941, I2 = 0.0%) and moderate certainty evidence at the longest postpartum assessment while incentives were still available (five RCTs; RR = 2.72, 1.47-5.02, n = 659, I2 = 44.5%), and at the longest postpartum follow-up after incentives were discontinued (six RCTs; RR = 1.93, 1.08-3.46, n = 1753, I2 = 51.8%). Pregnant women receiving incentives are twice as likely to achieve smoking abstinence during pregnancy suggesting this intervention should be standard care for pregnant women who smoke. The results also demonstrate that abstinence continues into the postpartum period, including after incentives are discontinued, but more trials measuring outcomes in the postpartum period are needed to strengthen this conclusion.
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Affiliation(s)
- Loren S Kock
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States.
| | - Tyler G Erath
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Sulamunn R M Coleman
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
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13
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Xie S, Monteiro K, Gjelsvik A. The association between adverse birth outcomes and smoking cessation during pregnancy across the United States-43 States and New York City, 2012-2017. Arch Gynecol Obstet 2023; 308:1207-1215. [PMID: 36175683 DOI: 10.1007/s00404-022-06792-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/09/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This cross-sectional study aimed to estimate the risks of adverse birth outcomes among pregnant smokers and the benefits of smoking cessation during pregnancy on birth outcomes across the United States. METHODS We performed an analysis of 203,437 pregnant women using data collected by the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2012 to 2017. PRAMS uses questionnaires and birth certificates to collect information about the socio-demographic characteristics of pregnant women, smoking status before and during pregnancy, and birth outcomes. We assessed the relationship between self-reported smoking status during pregnancy and preterm birth, low birth weight, and small-for-gestational-age using multivariable logistic regression models. RESULTS In our study population, 80.43% of pregnant women never smoked, 10.55% of pregnant women quit smoking during pregnancy, and 9.02% continued smoking during pregnancy. Puerto Rico had the highest prevalence of non-smokers (94.12%), while West Virginia had the lowest prevalence of non-smokers (60.54%). Pregnant women who had a higher education level, were married, had less than 5 types of stress, and had government or private insurance before pregnancy had a higher prevalence of smokers who quit during pregnancy (quit smokers) than those that continued smoking (continuous smokers). Compared to non-smokers, continuous smokers had a significantly higher risk of low birth weight (AOR: 1.91, 95% CI 1.80, 2.03), preterm birth (AOR: 1.31, 95% CI 1.21, 1.41), and small-for-gestational-age (AOR: 2.22, 95% CI 2.07, 2.39). However, the relationships between quitting smoking and preterm birth and small-for-gestational-age were not significant. CONCLUSION Our models suggest that smoking cessation during pregnancy can prevent adverse birth outcomes by significantly reducing the risk of preterm birth and small-for-gestational-age to almost comparable to not smoking.
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Affiliation(s)
- Shuai Xie
- School of Public Health, Brown University, Providence, Rhode Island, USA.
| | - Karine Monteiro
- Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Annie Gjelsvik
- School of Public Health, Brown University, Providence, Rhode Island, USA
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14
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Shirwani A, Kuller JA, Dotters-Katz SK, Addae-Konadu K. Nicotine Use During Pregnancy: Cessation and Treatment Strategies. Obstet Gynecol Surv 2023; 78:589-597. [PMID: 37976314 DOI: 10.1097/ogx.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Abstract The use of tobacco and nicotine products during pregnancy is known to increase the risk of adverse effects on the fetus. Increased education and research have resulted in greater rates of smoking cessation during pregnancy, with a decline from 13.2% of pregnant individuals smoking in 2006 to 7.2% in 2016. However, smoking while pregnant still proves to be a prevalent issue that is associated with numerous adverse outcomes, including low birth weight, preterm birth, and developmental delays. Smoking cessation before or during pregnancy can help mitigate these effects, but the appropriate treatment can be challenging to ascertain. Accordingly, clinicians should look to provide individualized care composed of behavioral counseling in conjunction with pharmacotherapies when indicated, combined with ongoing support and education.
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Affiliation(s)
- Avan Shirwani
- Medical Student, Campbell University School of Osteopathic Medicine, Lillington, NC
| | - Jeffrey A Kuller
- Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Sarah K Dotters-Katz
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Kateena Addae-Konadu
- Private Practice, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Southeast Permanente Medical Group, Atlanta, GA
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15
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Li H, Zheng C, Zhang Y, Yang H, Li J. The directed acyclic graph helped identify confounders in the association between coronary heart disease and pesticide exposure among greenhouse vegetable farmers. Medicine (Baltimore) 2023; 102:e35073. [PMID: 37746981 PMCID: PMC10519556 DOI: 10.1097/md.0000000000035073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
To explore the causal pathways associated with coronary heart disease (CHD) and pesticide exposure using a directed acyclic graph (DAG) analysis and to investigate the potential benefits of DAG by comparing it with logistic regression. This cross-sectional study enrolled 1368 participants from April 2015 to May 2017. Trained research investigators interviewed farmers using a self-administered questionnaire. Logistic regression and DAG models were used to identify the associations between CHD and chronic pesticide exposure. A total of 150 (11.0%) of the 1368 participants are characterized as having CHD. High pesticide exposure (odds ratio = 2.852, 95% confidence intervals: 1.951-4.171) is associated with CHD when compare with low pesticide exposure by both DAG and logistic analyses. After adjusting for the additional potential influence of factors identified by the DAG analysis, there is no significant association, such as the results in logistic regression: ethnicity, education level, settlement time, and mixed pesticide status. Specifically, age, meal frequency, and consumption of fresh fruit, according to the DAG analysis, are independent factors for CHD. High pesticide exposure is a risk factor for CHD as indicated by both DAG and logistic regression analyses. DAG can be a preferable improvement over traditional regression methods to identify sources of bias and causal inference in observational studies, especially for complex research questions.
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Affiliation(s)
- Honghui Li
- Department of Occupational and Environmental Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Cheng Zheng
- Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Yue Zhang
- Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Huifang Yang
- Department of Occupational and Environmental Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Jiangping Li
- Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
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16
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Świątkowski W, Budzyńska B, Maciąg M, Świątkowska A, Tylżanowski P, Rahnama-Hezavah M, Stachurski P, Chałas R. Nicotine and Cytisine Embryotoxicity in the Experimental Zebrafish Model. Int J Mol Sci 2023; 24:12094. [PMID: 37569468 PMCID: PMC10419251 DOI: 10.3390/ijms241512094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Tobacco smoking is one of the most serious health problems. Potentially lethal effects of nicotine for adults can occur with as little as 30 to 60 mg, although severe symptoms can arise with lower doses. Furthermore, the route of administration also influences the toxicity. Cytisine is one of the most popular medications in nicotinism treatment. Like nicotine, cytisine is a plant alkaloid, signaling through nicotinic acetylcholine receptors. Our study evaluated the effects of cytisine in nicotine-induced embryotoxic effects using zebrafish larvae. We examined the teratogenicity of nicotine and cytisine alone or in combination. Nicotine increased mortality and delayed hatching of zebrafish larvae in a dose-dependent manner. Cytisine did not affect mortality in a wide range of concentrations, and hatching delay was observed only at the highest concentrations, above 2 mM. Administering compounds together partially reduced the adverse teratogenic effect induced by nicotine alone. The protective effect of cytisine against the nicotine effect, observed in zebrafish, will contribute to future studies or treatments related to nicotine addiction or prenatal nicotine exposure in humans.
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Affiliation(s)
- Wojciech Świątkowski
- Department of Oral Surgery, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Barbara Budzyńska
- Independent Laboratory of Behavioral Studies, Medical University of Lublin, 20-059 Lublin, Poland; (B.B.); (M.M.)
| | - Monika Maciąg
- Independent Laboratory of Behavioral Studies, Medical University of Lublin, 20-059 Lublin, Poland; (B.B.); (M.M.)
| | - Agnieszka Świątkowska
- Department of Jaw Orthopaedics, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Przemko Tylżanowski
- Laboratory of Molecular Genetics, Department of Biomedical Sciences, Medical University of Lublin, 20-059 Lublin, Poland;
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, 3000 Leuven, Belgium
| | | | - Piotr Stachurski
- Department of Developmental Dentistry, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Renata Chałas
- Department of Oral Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
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Lavezzi AM, Mehboob R, Piscioli F, Pusiol T. Involvement of the Superior Colliculus in SIDS Pathogenesis. Biomedicines 2023; 11:1689. [PMID: 37371784 DOI: 10.3390/biomedicines11061689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this study was to investigate the involvement of the mesencephalic superior colliculus (SC) in the pathogenetic mechanism of SIDS, a syndrome frequently ascribed to arousal failure from sleep. We analyzed the brains of 44 infants who died suddenly within the first 7 months of life, among which were 26 infants with SIDS and 18 controls. In-depth neuropathological investigations of serial sections of the midbrain showed the SC layered cytoarchitectural organization already well known in animals, as made up of seven distinct layers, but so far never highlighted in humans, albeit with some differences. In 69% of SIDS cases but never in the controls, we observed alterations of the laminar arrangement of the SC deep layers (precisely, an increased number of polygonal cells invading the superficial layers and an increased presence of intensely stained myelinated fibers). Since it has been demonstrated in experimental studies that the deep layers of the SC exert motor control including that of the head, their developmental disorder could lead to the failure of newborns who are in a prone position to resume regular breathing by moving their heads in the sleep-arousal phase. The SC anomalies highlighted here represent a new step in understanding the pathogenetic process that leads to SIDS.
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Affiliation(s)
- Anna M Lavezzi
- "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Riffat Mehboob
- Lahore Medical Research Center and LMRC Laboratories, LLP, Lahore 54000, Pakistan
| | - Francesco Piscioli
- Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, 38068 Rovereto, Italy
| | - Teresa Pusiol
- Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, 38068 Rovereto, Italy
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18
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Chowdhury SR, Islam MN, Sheekha TA, Kader SB, Hossain A. Prevalence and determinants of non-communicable diseases risk factors among reproductive-aged women: Findings from a nationwide survey in Bangladesh. PLoS One 2023; 18:e0273128. [PMID: 37294806 PMCID: PMC10256164 DOI: 10.1371/journal.pone.0273128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/23/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Knowing the risk factors like smoking status, overweight/obesity, and hypertension among women of reproductive age could allow the development of an effective strategy for reducing the burden of non-noncommunicable diseases. We sought to determine the prevalence and determinants of smoking status, overweight/obesity, hypertension, and cluster of these non-noncommunicable diseases risk factors among Bangladeshi women of reproductive age. METHODS This study utilized the Bangladesh Demographic and Health Survey (BDHS) data from 2017-2018 and analyzed 5,624 women of reproductive age (age 18-49 years). This nationally representative cross-sectional survey utilized a stratified, two-stage sample of households. Poisson regression models with robust error variance were fitted to find the adjusted prevalence ratio (APR) for smoking, overweight/obesity, hypertension, and for the clustering of non-noncommunicable diseases risk factors across demographic variables. RESULTS The average age of 5,624 participants was 31 years (SD = 9.1). The prevalence of smoking, overweight/obesity, and hypertension was 9.6%, 31.6%, and 20.3%, respectively. More than one-third of the participants (34.6%) had one non-noncommunicable diseases risk factor, and 12.5% of participants had two non-noncommunicable diseases risk factors. Age, education, wealth index, and geographic location were significantly associated with smoking status, overweight/obesity, and hypertension. Women between 40-49 years had more non-noncommunicable diseases risk factors than 18-29 years aged women (APR: 2.44; 95% CI: 2.22-2.68). Women with no education (APR: 1.15; 95% CI: 1.00-1.33), married (APR: 2.32; 95% CI: 1.78-3.04), and widowed/divorced (APR: 2.14; 95% CI: 1.59-2.89) were more likely to experience multiple non-noncommunicable diseases risk factors. Individuals in the Barishal division, a coastal region (APR: 1.44; 95% CI: 1.28-1.63) were living with a higher number of risk factors for non-noncommunicable diseases than those in the Dhaka division, the capital of the country. Women who belonged to the richest wealth quintile (APR: 1.82; 95% CI: 1.60-2.07) were more likely to have the risk factors of non-noncommunicable diseases. CONCLUSIONS The study showed that non-noncommunicable diseases risk factors are more prevalent among women from older age group, currently married and widowed/divorced group, and the wealthiest socio-economic group. Women with higher levels of education were more likely to engage in healthy behaviors and found to have less non-noncommunicable diseases risk factors. Overall, the prevalence and determinants of non-noncommunicable diseases risk factors among reproductive women in Bangladesh highlight the need for targeted public health interventions to increase opportunities for physical activity and reduce the use of tobacco, especially the need for immediate interventions in the coastal region.
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Affiliation(s)
- Saifur Rahman Chowdhury
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Md. Nazrul Islam
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tasbeen Akhtar Sheekha
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shirmin Bintay Kader
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ahmed Hossain
- Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Global Health Institute, North South University, Dhaka, Bangladesh
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Wojcik MH, Poduri AH, Holm IA, MacRae CA, Goldstein RD. The fundamental need for unifying phenotypes in sudden unexpected pediatric deaths. Front Med (Lausanne) 2023; 10:1166188. [PMID: 37332751 PMCID: PMC10273404 DOI: 10.3389/fmed.2023.1166188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
A definitive, authoritative approach to evaluate the causes of unexpected, and ultimately unexplained, pediatric deaths remains elusive, relegating final conclusions to diagnoses of exclusion in the vast majority of cases. Research into unexplained pediatric deaths has focused primarily on sudden infant deaths (under 1 year of age) and led to the identification of several potential, albeit incompletely understood, contributory factors: nonspecific pathology findings, associations with sleep position and environment that may not be uniformly relevant, and the elucidation of a role for serotonin that is practically difficult to estimate in any individual case. Any assessment of progress in this field must also acknowledge the failure of current approaches to substantially decrease mortality rates in decades. Furthermore, potential commonalities with pediatric deaths across a broader age spectrum have not been widely considered. Recent epilepsy-related observations and genetic findings, identified post-mortem in both infants and children who died suddenly and unexpectedly, suggest a role for more intense and specific phenotyping efforts as well as an expanded role for genetic and genomic evaluation. We therefore present a new approach to reframe the phenotype in sudden unexplained deaths in the pediatric age range, collapsing many distinctions based on arbitrary factors (such as age) that have previously guided research in this area, and discuss its implications for the future of postmortem investigation.
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Affiliation(s)
- Monica H. Wojcik
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Annapurna H. Poduri
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, United States
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ingrid A. Holm
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Calum A. MacRae
- Harvard Medical School, Boston, MA, United States
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Richard D. Goldstein
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
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20
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Vincent A, Chu NT, Shah A, Avanthika C, Jhaveri S, Singh K, Limaye OM, Boddu H. Sudden Infant Death Syndrome: Risk Factors and Newer Risk Reduction Strategies. Cureus 2023; 15:e40572. [PMID: 37465778 PMCID: PMC10351748 DOI: 10.7759/cureus.40572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
Sudden infant death syndrome (SIDS) continues to be one of the top causes of infant death in the U.S. Despite significant public health initiatives focused on high-risk populations to enhance sleep environments and techniques. The SIDS rate has remained stable in recent years. Risk factors and newer risk reduction strategies for SIDS are the focus of this review article. We conducted a comprehensive literature search on Medline, Cochrane, Embase, and Google Scholar until July 2022. The following search strings and Medical Subject Heading (MeSH) terms were used: "SIDS," "Sudden Infant Death" and "SUID". We explored the literature on SIDS for its epidemiology, pathophysiology, the role of various etiologies and their influence, associated complications leading to SIDS, and preventive and treatment modalities. Despite a more than 50% drop-in rates since the start of the "Back to Sleep" campaign in 1994, sudden infant death syndrome (SIDS) continues to be the top cause of post-neonatal mortality in the United States, despite continued educational initiatives that support safe sleep and other risk reduction strategies. The new American Academy of Pediatrics guidelines for lowering the risk of SIDS include a lot of emphasis on sleeping habits, bedding, and environment but also include elements that are frequently ignored (i.e., prenatal care, smoking, alcohol and drug use, and childhood vaccinations). This study highlights these less-frequently discussed aspects and identifies treatments that have produced beneficial behavioral shifts that benefit newborns as well as their mothers' health and wellbeing.
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Affiliation(s)
- Anita Vincent
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Ngan Thy Chu
- Paediatrics, City Children's Hospital, Ho Chi Minh city, VNM
| | - Aashka Shah
- Paediatrics and Child Health, Pramukhswami Medical College, Karamsad, Anand, IND
| | - Chaithanya Avanthika
- Pediatrics, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Sharan Jhaveri
- Medicine and Surgery, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College (NHLMMC), Ahmedabad, IND
| | - Kunika Singh
- Paediatrics, Xinjiang Medical University, Xinjiang, CHN
| | - Om M Limaye
- Paediatrics, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, IND
| | - Himasaila Boddu
- Paediatrics, Dr. Pinnamaneni Siddartha Institute of Medical Sciences and Research Foundation, Krishna, IND
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21
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Osei-Poku GK, Mwananyanda L, Elliott PA, MacLeod WB, Somwe SW, Pieciak RC, Hamapa A, Gill CJ. Qualitative assessment of infant sleep practices and other risk factors of sudden infant death syndrome (SIDS) among mothers in Lusaka, Zambia. BMC Pediatr 2023; 23:245. [PMID: 37202764 DOI: 10.1186/s12887-023-04051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/30/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND There is very little information on the beliefs and perceptions of mothers about SIDS and its related risk factors in Africa. To better understand parental decisions about infant sleep practices and other risk factors for SIDS, we conducted focus group discussions (FGDs) with mothers of infants in Lusaka, Zambia. METHODS FGDs involved 35 purposively sampled mothers aged 18-49 years. FGDs were conducted using a semi-structured interview guide in the local language, Nyanja. These were translated, transcribed verbatim into English, and then coded and analyzed using thematic analysis in NVivo 12. RESULTS Six FGDs were conducted with 35 mothers in April-May 2021 across two study sites. FGD Participants were generally aware of sudden unexplained infant deaths, with several describing stories of apparent SIDS in the community. The side sleeping position was preferred and perceived to be safer for the infant with most believing the supine position posed an aspiration or choking risk to the infant. Bedsharing was also preferred and perceived to be convenient for breastfeeding and monitoring of the infant. Experienced family members such as grandmothers and mothers-in-law, and health care workers were frequently cited as sources of information on infant sleep position. A heightened awareness of the infant's sleeping environment was suggested as a mechanism to prevent SIDS and smothering. CONCLUSIONS Decisions about bedsharing and infant sleep position were guided by maternal beliefs and perceptions about what is convenient for breastfeeding and safer for the infant. These concerns are vital to designing tailored interventions to address sleep-related sudden infant losses in Zambia. Public health campaigns with tailored messages that address these concerns are likely to be effective at ensuring optimal uptake of safe sleep recommendations.
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Affiliation(s)
- Godwin K Osei-Poku
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, Boston, MA, 02118, USA.
| | - Lawrence Mwananyanda
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, Boston, MA, 02118, USA
| | - Patricia A Elliott
- Department of Community Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th Floor, Boston, MA, 02118, USA
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, Boston, MA, 02118, USA
| | - Somwe Wa Somwe
- Department of Pediatrics, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Rachel C Pieciak
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, Boston, MA, 02118, USA
| | - Arnold Hamapa
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Christopher J Gill
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, Boston, MA, 02118, USA
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22
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Self-Brown S, Perry EW, Recinos M, Cotner MA, Guastaferro K, Owolabi S, Spears CA, Whitaker DJ, Huang J, Kegler MC. Systematic braiding of Smoke-Free Home SafeCare to address child maltreatment risk and secondhand smoke exposure: findings from a pilot study. Pilot Feasibility Stud 2023; 9:81. [PMID: 37173799 PMCID: PMC10175921 DOI: 10.1186/s40814-023-01303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Exposure to secondhand tobacco smoke (SHS) and child maltreatment are preventable threats to child health. Few evidence-based interventions target both SHS and child maltreatment risk. The purpose of this paper is to describe the systematic braiding process of two evidence-based programs to address child SHS in the home and maltreatment perpetration risk, and present results from the formative work and pilot study. METHODS The first 4 steps of the systematic braiding process were completed, including the following: (1) the identification of core elements of both programs, (2) the development of an initial draft of the braided curriculum (Smoke-Free Home SafeCare - SFH-SC), (3) an acceptability and feasibility pilot of SFH-SC with caregivers of young children who reported a smoker living in the home (N = 8), and (4) feedback collection on the braided curriculum from SafeCare Providers (N = 9). RESULTS Experts identified common pedagogical and theoretical underpinnings for the two programs and braided Smoke-Free Homes: Some Things Are Better Outside into two SafeCare modules. Caregiver feedback from the pilot demonstrated that participants were engaged with SFH-SC and felt supported and comfortable discussing SHS intervention content with the SFH-SC Provider. Caregiver self-reports indicated a slight increase in smoke-free home rules from baseline to follow-up and a notable reduction in parent stress on the Parent Stress Index of 5.9 points (SD = 10.2). SafeCare Provider feedback following intensive review of the curriculum indicated high feasibility for SFH-SC delivery. CONCLUSIONS Parent and Provider findings suggest SFH-SC is a viable intervention that has potential to reduce the public health impact of SHS and child maltreatment for at-risk families. PROTOCOL The protocol for the pilot is not published elsewhere; however, the full protocol for the hybrid trial can be found here: https://clinicaltrials.gov/ct2/show/NCT05000632 . TRIAL REGISTRATION NCT, NCT05000632. Registered 14 July 2021, there is not a separate registration number for the pilot.
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Affiliation(s)
- Shannon Self-Brown
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA.
| | - Elizabeth W Perry
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Manderley Recinos
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Michaela A Cotner
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Kate Guastaferro
- New York University - School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Shadé Owolabi
- Emory University - Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, USA
| | - Claire A Spears
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Daniel J Whitaker
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Jidong Huang
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Michelle C Kegler
- Emory University - Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, USA
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23
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Sun J, Liu X, Zhao M, Magnussen CG, Xi B. Dose-response association between maternal smoking during pregnancy and the risk of infant death: a nationwide, population-based, retrospective cohort study. EClinicalMedicine 2023; 57:101858. [PMID: 36879656 PMCID: PMC9984774 DOI: 10.1016/j.eclinm.2023.101858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Association of timing and intensity of maternal smoking during pregnancy with all-cause and cause-specific infant death remains inconclusive. We aimed to examine the dose-response association of maternal smoking during each of the three trimesters of pregnancy with all-cause and cause-specific infant death. METHODS In this nationwide, population-based, retrospective cohort study, data were extracted from the U.S. National Vital Statistics System, 2015-2019. We included mother-infant pairs after excluding twin or multiple births, newborns with gestation age <37 weeks and those with low birthweight, mothers aged <18 years or ≥50 years, mothers with pre-existing hypertension or diabetes, and those with missing values for variables of interest. Poisson regression models were used to examine the association of different intensities and doses of maternal smoking during each of the three trimesters of pregnancy with all-cause and cause-specific infant death attributed to congenital anomalies, preterm birth, other perinatal conditions, sudden unexpected infant death, and infection. FINDINGS A total of 13,524,204 mother-infant pairs were included in our analyses. Maternal smoking during the entire pregnancy was associated with infant all-cause death (relative risk [RR] 1.88, 95% confidence interval [95% CI] 1.79-1.97), cause-specific death due to preterm birth (1.57, 1.25-1.98), perinatal conditions excluding preterm birth (1.35, 1.10-1.65), sudden unexpected infant death (2.56, 2.40-2.73), and infection (1.51, 1.20-1.88). The risk of infant all-cause death (RR values from 1.80 to 2.15) and cause-specific infant death by preterm birth (RR values from 1.42 to 1.74), perinatal conditions excluding preterm birth (RR values from 1.46 to 1.53), sudden unexpected infant death (RR values from 2.37 to 3.04), and infection (RR values from 1.48 to 2.69) increased with the intensity of maternal cigarette use during the entire pregnancy from 1-5 to ≥11 cigarettes. Compared with mothers who smoked during their entire pregnancy, those who smoked in the first trimester and then quit smoking in the second or third trimesters of pregnancy had a reduced risk of infant all-cause death (0.71, 0.65-0.78) and sudden unexpected infant death (0.64, 0.57-0.72). INTERPRETATION There was a dose-response association of maternal cigarette use during each of the three trimesters of pregnancy with all-cause and cause-specific infant death. In addition, mothers who are smokers in the first trimester and then quit smoking in the subsequent two trimesters are at decreased risk of infant all-cause mortality and sudden unexpected infant death compared with those who smoked during the entire pregnancy. These findings suggest that there is no safe level of maternal smoking in any trimester of pregnancy and maternal smokers should stop smoking during pregnancy to improve the survival of infants. FUNDING Youth Team of Humanistic and Social Science and the Innovation Team of the "Climbing" Program of Shandong University (20820IFYT1902).
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Affiliation(s)
- Jiahong Sun
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xue Liu
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Costan G. Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Corresponding author. Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan 250012, Shandong, China.
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24
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Gunnerbeck A, Lundholm C, Rhedin S, Mitha A, Chen R, D'Onofrio BM, Almqvist C. Association of maternal snuff use and smoking with Sudden Infant Death Syndrome: a national register study. Pediatr Res 2023:10.1038/s41390-022-02463-4. [PMID: 36755185 PMCID: PMC10382311 DOI: 10.1038/s41390-022-02463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/03/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND The aim was to study whether non-combustible nicotine (Swedish snuff) use in pregnancy is associated with elevated risk of post neonatal mortality, Sudden Infant Death Syndrome (SIDS), and Sudden Unexpected Infant Death (SUID) and to study how cessation before the antenatal booking influenced these risks. METHODS This was a population-based register study of all infants with information on tobacco exposure in early pregnancy born in Sweden 1999-2019, n = 2,061,514. Self-reported tobacco use in early pregnancy was categorized as nonuse, snuff use, and moderate and heavy smoking. Multiple logistic regression models were used to estimate crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS Maternal snuff use was associated with increased risks of post neonatal mortality, SIDS, and SUID. The risks of snuff use and moderate smoking were of similar magnitude. Heavy smoking was associated with the highest risks. Cessation of smoking and snuff use before the antenatal booking was associated with lower risks of SIDS and SUID compared to that of continuous usage. CONCLUSIONS Maternal snuff use was associated with increased risks of post neonatal mortality, SIDS, and SUID. Nicotine is the common substance in cigarette smoke and snuff. These findings support the hypothesis that nicotine contributes to an elevated risk of SIDS. IMPACT Maternal snuff use and smoking in early pregnancy were associated with increased risks of post neonatal mortality, SIDS, and SUID. Cessation of smoking and snuff use before the first antenatal visit was associated with reduced risks of SIDS and SUID. The common substance in cigarette smoke and snuff is nicotine. Our findings suggest that nicotine contributes to an elevated risk of SIDS and SUID. The implication of our findings is that all forms of nicotine should be avoided in pregnancy.
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Affiliation(s)
- Anna Gunnerbeck
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden. .,Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Samuel Rhedin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Sach's Children and Youth Hospital, Stockholm, Sweden
| | - Ayoub Mitha
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Paris, France
| | - Ruoqing Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China.,Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
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25
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Mitchell EA, Taylor BJ, Milne BJ. Regional variation in sudden unexpected death in infancy in New Zealand. J Paediatr Child Health 2023; 59:319-327. [PMID: 36511387 PMCID: PMC10108071 DOI: 10.1111/jpc.16293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/10/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
AIM To estimate the relative risk of sudden unexpected death in infancy (SUDI) by district health board (DHB) in New Zealand after adjustment for socio-economic deprivation, ethnicity and other demographic factors. METHODS We conducted a population-based cohort study using data from the Integrated Data Infrastructure, a large research database containing linked data from a range of government agencies. The study population was all live births and their mothers in New Zealand from 2012 to 2018. The exposure of interest was DHB. The outcome was SUDI. RESULTS There were 418 068 live births in New Zealand from 2012 to 2018, and of these 415 401 (99.4%) had valid DHB data. There was considerable variation in the proportion of infants in each DHB living in the most deprived decile varying from 4.5% in Nelson, West Coast and Canterbury to 29.7% in Counties Manukau. There were 267 SUDI cases, giving an overall rate of 0.64/1000 live births during the study period (2012-2018). The SUDI rate varied from 1.11/1000 in Northland to 0.30/1000 in Waitemata and Auckland. Counties Manukau had the largest number of deaths (n = 54; rate = 1.08/1000). Five DHB regions had increased risk of SUDI compared to the reference group but, after adjustment, no DHB was significantly increased. CONCLUSIONS This study found that there is marked variation in SUDI risk by DHB, but this is explained by socio-economic and demographic variation within DHBs. This study emphasises the importance of the contribution of social determinants of health to SUDI.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Barry J Taylor
- Women's and Children's Health, The University of Otago, Dunedin, New Zealand
| | - Barry J Milne
- Centre of Methods and Policy Application in the Social Sciences, The University of Auckland, Auckland, New Zealand
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26
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Data harnessing to nurture the human mind for a tailored approach to the child. Pediatr Res 2023; 93:357-365. [PMID: 36180585 DOI: 10.1038/s41390-022-02320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/06/2022] [Accepted: 09/12/2022] [Indexed: 11/08/2022]
Abstract
Big data in pediatrics is an ocean of structured and unstructured data. Big data analysis helps to dive into the ocean of data to filter out information that can guide pediatricians in their decision making, precision diagnosis, and targeted therapy. In addition, big data and its analysis have helped in the surveillance, prevention, and performance of the health system. There has been a considerable amount of work in pediatrics that we have tried to highlight in this review and some of it has been already incorporated into the health system. Work in specialties of pediatrics is still forthcoming with the creation of a common data model and amalgamation of the huge "omics" database. The physicians entrusted with the care of children must be aware of the outcome so that they can play a role to ensure that big data algorithms have a clinically relevant effect in improving the health of their patients. They will apply the outcome of big data and its analysis in patient care through clinical algorithms or with the help of embedded clinical support alerts from the electronic medical records. IMPACT: Big data in pediatrics include structured, unstructured data, waveform data, biological, and social data. Big data analytics has unraveled significant information from these databases. This is changing how pediatricians will look at the body of available evidence and translate it into their clinical practice. Data harnessed so far is implemented in certain fields while in others it is in the process of development to become a clinical adjunct to the physician. Common databases are being prepared for future work. Diagnostic and prediction models when incorporated into the health system will guide the pediatrician to a targeted approach to diagnosis and therapy.
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27
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Beltrán-Castillo S, Bravo K, Eugenín J. Impact of Prenatal Nicotine Exposure on Placental Function and Respiratory Neural Network Development. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1428:233-244. [PMID: 37466776 DOI: 10.1007/978-3-031-32554-0_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Smoking during pregnancy is associated with multiple undesirable outcomes in infants, such as low birth weight, increased neonatal morbidity and mortality, and catastrophic conditions like sudden infant death syndrome (SIDS). Nicotine, the most addictive and teratogenic substance in tobacco smoke, reaches and crosses the placenta and can be accumulated in the amniotic fluid and distributed by fetal circulation, altering the cholinergic transmission by acting on the nicotinic acetylcholine receptors (nAChRs) expressed from very early gestational stages in the placenta and fetal tissue. Because nAChRs influence the establishment of feto-maternal circulation and the emergence of neuronal networks, prenatal nicotine exposure can lead to multiple alterations in newborns. In this mini-review, we discuss the undeniable effects of nicotine in the placenta and the respiratory neural network as examples of how prenatal nicotine and smoking exposition can affect brain development because dysfunction in this network is involved in SIDS etiology.
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Affiliation(s)
- Sebastián Beltrán-Castillo
- Centro integrativo de Biología y Química Aplicada (CIBQA), Universidad Bernardo O'Higgins, Santiago, Chile.
| | - Karina Bravo
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile
- Facultad de Ingeniería, Universidad Autónoma de Chile, Santiago, Chile
| | - Jaime Eugenín
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile.
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28
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Bandoli G, Delker E, Schumacher BT, Baer RJ, Kelly AE, Chambers CD. Prenatal cannabis use disorder and infant hospitalization and death in the first year of life. Drug Alcohol Depend 2023; 242:109728. [PMID: 36516553 PMCID: PMC10363398 DOI: 10.1016/j.drugalcdep.2022.109728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether maternal cannabis use disorder is associated with infant hospitalization or death in the first year of life. METHODS We queried an administrative birth cohort derived from the hospital discharge database maintained by the California Office of Statewide Health Planning and Development and linked with vital statistics files. We included singleton, live-birth deliveries between 2011 and 2018. Pregnancies with cannabis use disorder were classified from International Classification of Disease codes. Outcomes included infant emergency department visits and hospital admissions identified from health records, and infant deaths identified from death records. Models were adjusted for sociodemographic variables, psychiatric comorbidities and other substance use disorders. RESULTS There were 34,544 births (1.0 %) with a cannabis use disorder diagnosis in pregnancy, with increasing prevalence over the study period. The incidence of infant death in the first year of life was greater among those with a maternal cannabis use disorder diagnosis than those without (1.0 % vs 0.4 %; adjusted risk ratio 1.4 95 % CI: 1.2-1.6). When examining specific causes of death, the increased risk estimates were attributable to perinatal conditions and sudden unexpected infant death. After adjustment, there was no increased risk of infant hospitalizations or emergency department visits. CONCLUSIONS These findings warrant further investigation into the underlying mechanisms of maternal prenatal CUD on infant outcomes, and add to a rapidly expanding body of literature supporting the need for effective treatment options for pregnant individuals with cannabis use disorders.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, USA.
| | - Erin Delker
- Department of Pediatrics, University of California San Diego, USA
| | - Benjamin T Schumacher
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, USA; Department of Epidemiology, School of Public Health, University of Pittsburgh, USA
| | - Rebecca J Baer
- Department of Pediatrics, University of California San Diego, USA
| | - Ann E Kelly
- Department of Pediatrics, University of California San Diego, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, USA
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29
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Weatherly M, Trivedi A, Chembrolu R, Gupta S, Ramirez JM, Lavista Ferres JM, Anderson TM, Mitchell EA. Maternal infections in pregnancy and the risk of sudden unexpected infant death in the offspring in the U.S., 2011-2015. PLoS One 2023; 18:e0284614. [PMID: 37083949 PMCID: PMC10121007 DOI: 10.1371/journal.pone.0284614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Infection is thought to play a part in some infant deaths. Maternal infection in pregnancy has focused on chlamydia with some reports suggesting an association with sudden unexpected infant death (SUID). OBJECTIVES We hypothesized that maternal infections in pregnancy are associated with subsequent SUID in their offspring. SETTING All births in the United States, 2011-2015. DATA SOURCE Centers for Disease Control and Prevention (CDC) Birth Cohort Linked Birth-Infant Death Data Files. STUDY DESIGN Cohort study, although the data were analysed as a case control study. Cases were infants that died from SUID. Controls were randomly sampled infants that survived their first year of life; approximately 10 controls per SUID case. EXPOSURES Chlamydia, gonorrhea and hepatitis C. RESULTS There were 19,849,690 live births in the U.S. for the period 2011-2015. There were 37,143 infant deaths of which 17,398 were classified as SUID cases (a rate of 0.86/1000 live births). The proportion of the control mothers with chlamydia was 1.7%, gonorrhea 0.2% and hepatitis C was 0.3%. Chlamydia was present in 3.8% of mothers whose infants subsequently died of SUID compared with 1.7% of controls (unadjusted OR = 2.35, 95% CI = 2.15, 2.56; adjusted OR = 1.08, 95% CI = 0.98, 1.19). Gonorrhea was present in 0.7% of mothers of SUID cases compared with 0.2% of mothers of controls (OR = 3.09, (2.50, 3.79); aOR = 1.20(0.95, 1.49)) and hepatitis C was present in 1.3% of mothers of SUID cases compared with 0.3% of mothers of controls (OR = 4.69 (3.97, 5.52): aOR = 1.80 (1.50, 2.15)). CONCLUSIONS The marked attenuation of SUID risk after adjustment for a wide variety of socioeconomic and demographic factors suggests the small increase in the risk of SUID of the offspring of mothers with infection with hepatitis C in pregnancy is due to residual confounding.
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Affiliation(s)
- Maggie Weatherly
- Master of Science in Data Science, University of Washington, Seattle, Washington, United States of America
| | - Anusua Trivedi
- AI for Good Lab, Microsoft, Redmond, Washington, United States of America
| | - Ratna Chembrolu
- Master of Science in Data Science, University of Washington, Seattle, Washington, United States of America
| | - Sanjana Gupta
- Master of Science in Data Science, University of Washington, Seattle, Washington, United States of America
| | - Jan-Marino Ramirez
- Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, Washington, United States of America
| | | | - Tatiana M Anderson
- AI for Good Lab, Microsoft, Redmond, Washington, United States of America
| | - Edwin A Mitchell
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Tarasi B, Cornuz J, Clair C, Baud D. Cigarette smoking during pregnancy and adverse perinatal outcomes: a cross-sectional study over 10 years. BMC Public Health 2022; 22:2403. [PMID: 36544092 PMCID: PMC9773571 DOI: 10.1186/s12889-022-14881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It has been shown that active exposure to tobacco is associated with adverse pregnancy outcomes including, but not limited to, intrauterine fetal death, reduced fetal weight, and higher risk of preterm birth. We want to investigate these effects in a high-income country. METHODS This cross-sectional study examined 20,843 pregnant women who delivered over 10 years at the Maternity Hospital of the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland. The objective was to evaluate a dose-response relationship between daily cigarette use during pregnancy and possible adverse perinatal outcomes. The social and clinical characteristics as well as obstetric and neonatal outcomes were compared between the smoking and the non-smoking groups. Adjusted odds ratios (aOR) and trend analyses (ptrend) were calculated. RESULTS Nineteen thousand five hundred fifty-four pregnant women met the inclusion criteria and 2,714 (13.9%) of them were smokers. Even after adjusting for confounding factors, smoking during pregnancy was associated with preterm birth, birthweight < 2500 g, intrauterine growth restriction, neonatal respiratory and gastrointestinal diseases, transfer to the neonatal intensive care unit, and neonatal intensive care unit admissions > 7 days. Intrauterine death and neonatal infection were associated with heavy smoking (≥ 20 cigarettes/day). Smoking appeared to be a protective factor for pre-eclampsia and umbilical cord arterial pH below 7.1. A significant trend (ptrend < 0.05) was identified for preterm birth, intrauterine growth restriction, birthweight < 2500 g, umbilical cord arterial pH below 7.1, transfers to our neonatal intensive care unit, and neonatal intensive care unit admissions more than 7 days. CONCLUSION Cigarette smoking is associated with several adverse perinatal outcomes of pregnancy with a dose-dependent effect.
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Affiliation(s)
- Baptiste Tarasi
- grid.8515.90000 0001 0423 4662Materno-Fetal and Obstetric Research Unit, Woman-Mother-Child Department, University Hospital of Lausanne, CHUV, 1011 Lausanne, Switzerland
| | - Jacques Cornuz
- grid.9851.50000 0001 2165 4204Department of Ambulatory Care, Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland
| | - Carole Clair
- grid.9851.50000 0001 2165 4204Department of Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland
| | - David Baud
- grid.8515.90000 0001 0423 4662Materno-Fetal and Obstetric Research Unit, Woman-Mother-Child Department, University Hospital of Lausanne, CHUV, 1011 Lausanne, Switzerland
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Gutvirtz G, Sheiner E. Airway pollution and smoking in reproductive health. Best Pract Res Clin Obstet Gynaecol 2022; 85:81-93. [PMID: 36333255 DOI: 10.1016/j.bpobgyn.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
Environmental exposure refers to contact with chemical, biological, or physical substances found in air, water, food, or soil that may have a harmful effect on a person's health. Almost all of the global population (99%) breathe air that contains high levels of pollutants. Smoking is one of the most common forms of recreational drug use and is the leading preventable cause of morbidity and mortality worldwide. The small particles from either ambient (outdoor) pollution or cigarette smoke are inhaled to the lungs and quickly absorbed into the bloodstream. These substances can affect virtually every organ in our body and have been associated with various respiratory, cardiovascular, endocrine, and also reproductive morbidities, including decreased fertility, adverse pregnancy outcomes, and offspring long-term morbidity. This review summarizes the latest literature reporting the reproductive consequences of women exposed to ambient (outdoor) air pollution and cigarette smoking.
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Affiliation(s)
- Gil Gutvirtz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center (SUMC), Department of Obstetrics and Gynecology B, Beer-Sheva, Israel.
| | - Eyal Sheiner
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center (SUMC), Department of Obstetrics and Gynecology B, Beer-Sheva, Israel
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Shepard DS, Slade EP, Nighbor TD, DeSarno MJ, Roemhildt ML, Williams RK, Higgins ST. Economic analysis of financial incentives for smoking cessation during pregnancy and postpartum. Prev Med 2022; 165:107079. [PMID: 35533885 DOI: 10.1016/j.ypmed.2022.107079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
Higgins and colleagues' recently-completed randomized controlled trial and pooled data with 4 related trials of smoking cessation in pregnant women in Vermont (USA) showed that abstinence-contingent financial incentives (FI) increased abstinence over control conditions from early pregnancy through 24-weeks postpartum. Control conditions were best practices (BP) alone in the recent trial and payments provided independent of smoking status (noncontingently) in the others. This paper reports economic analyses of abstinence-contingent FI. Merging trial results with maternal and infant healthcare costs from all Vermont Medicaid deliveries in 2019, we computed incremental cost-effectiveness ratios (ICERs) for quality-adjusted life years (QALYs) and compared them to established thresholds. The healthcare sector cost (±standard error) of adding FI to BP averaged $634.76 ± $531.61 per participant. Based on this trial, the increased probability per BP + FI participant of smoking abstinence at 24-weeks postpartum was 3.17%, the cost per additional abstinent woman was $20,043, the incremental health gain was 0.0270 ± 0.0412 QALYs, the ICER was $23,511/QALY gained, and the probabilities that BP + FI was very cost-effective (ICER≤$65,910) and cost-effective (ICER≤$100,000) were 67.9% and 71.0%, respectively. Based on the pooled trials, the corresponding values were even more favorable-8.89%, $7138, 0.0758 ± 0.0178 QALYs, $8371/QALY, 98.6% and 99.3%, respectively. Each dollar invested in abstinence-contingent FI over control smoking-cessation programs yielded $4.20 in economic benefits in the recent trial and $11.90 in the pooled trials (very favorable benefit-cost ratios). Medicaid and commercial insurers may wish to consider covering financial incentives for smoking abstinence as a cost-effective service for pregnant beneficiaries who smoke. Trial Registration: ClinicalTrials.gov identifier: NCT02210832.
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Affiliation(s)
- Donald S Shepard
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Heller School for Social Poilcy and Management, MS 035, Brandeis University, Waltham, MA 02454-9110 USA.
| | - Eric P Slade
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Johns Hopkins University School of Nursing, USA
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
| | - Michael J DeSarno
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Department of Medical Biostatistics, University of Vermont, USA
| | | | | | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
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Higgins ST, Nighbor TD, Kurti AN, Heil SH, Slade EP, Shepard DS, Solomon LJ, Lynch ME, Johnson HK, Markesich C, Rippberger PL, Skelly JM, DeSarno M, Bunn J, Hammond JB, Roemhildt ML, Williams RK, O'Reilly DM, Bernstein IM. Randomized Controlled Trial Examining the Efficacy of Adding Financial Incentives to Best practices for Smoking Cessation Among pregnant and Newly postpartum Women. Prev Med 2022; 165:107012. [PMID: 35248683 PMCID: PMC9440164 DOI: 10.1016/j.ypmed.2022.107012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/21/2022]
Abstract
We report results from a single-blinded randomized controlled trial examining financial incentives for smoking cessation among 249 pregnant and newly postpartum women. Participants included 169 women assigned to best practices (BP) or BP plus financial incentives (BP + FI) for smoking cessation available through 12-weeks postpartum. A third condition included 80 never-smokers (NS) sociodemographically-matched to women who smoked. Trial setting was Burlington, Vermont, USA, January, 2014 through January, 2020. Outcomes included 7-day point-prevalence abstinence antepartum and postpartum, and birth and other infant outcomes during 1st year of life. Reliability and external validity of results were assessed using pooled results from the current and four prior controlled trials coupled with data on maternal-smoking status and birth outcomes for all 2019 singleton live births in Vermont. Compared to BP, BP + FI significantly increased abstinence early- (AOR = 9.97; 95%CI, 3.32-29.93) and late-pregnancy (primary outcome, AOR = 5.61; 95%CI, 2.37-13.28) and through 12-weeks postpartum (AOR = 2.46; CI,1.05-5.75) although not 24- (AOR = 1.31; CI,0.54-3.17) or 48-weeks postpartum (AOR = 1.33; CI,0.55-3.25). There was a significant effect of trial condition on small-for-gestational-age (SGA) deliveries (χ2 [2] = 9.01, P = .01), with percent SGA deliveries (+SEM) greatest in BP, intermediate in BP + FI, and lowest in NS (17.65 + 4.13, 10.81 + 3.61, and 2.53 + 1.77, respectively). Reliability analyses supported the efficacy of financial incentives for increasing abstinence antepartum and postpartum and decreasing SGA deliveries; external-validity analyses supported relationships between antepartum cessation and SGA risk. Adding financial incentives to Best Practice increases smoking cessation among antepartum and postpartum women and improves other maternal-infant outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02210832.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America.
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Allison N Kurti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Eric P Slade
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Johns Hopkins University School of Nursing, United States of America
| | - Donald S Shepard
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Heller School for Social Policy and Management, Brandeis University, United States of America
| | - Laura J Solomon
- Department of Family Medicine, Psychology Emerita, University of Vermont, United States of America
| | - Mary Ellen Lynch
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Harley K Johnson
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Catherine Markesich
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Peter L Rippberger
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Joan M Skelly
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Michael DeSarno
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Janice Bunn
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | | | | | | | - Deirdre M O'Reilly
- Department of Pediatrics, University of Vermont, United States of America
| | - Ira M Bernstein
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, United States of America
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Bandoli G, Baer RJ, Owen M, Kiernan E, Jelliffe-Pawlowski L, Kingsmore S, Chambers CD. Maternal, infant, and environmental risk factors for sudden unexpected infant deaths: results from a large, administrative cohort. J Matern Fetal Neonatal Med 2022; 35:8998-9005. [PMID: 34852708 PMCID: PMC9310558 DOI: 10.1080/14767058.2021.2008899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/07/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Many studies of sudden unexpected infant death (SUID) have focused on individual domains of risk factors (maternal, infant, and environmental), resulting in limited capture of this multifactorial outcome. The objective of this study was to examine the geographic distribution of SUID in San Diego County, and assess maternal, infant, and environmental risk factors from a large, administrative research platform. STUDY DESIGN Births in California between 2005 and 2017 were linked to hospital discharge summaries and death files. From this retrospective birth cohort, cases of SUID were identified from infant death files in San Diego County. We estimated adjusted hazard ratios (aHRs) for infant, maternal, and environmental factors and SUID in multivariable Cox regression analysis. Models were adjusted for maternal sociodemographic characteristics and prenatal nicotine exposure. RESULTS There were 211 (44/100,000 live births; absolute risk 0.04%) infants with a SUID among 484,905 live births. There was heterogeneity in geographic distribution of cases. Multiparity (0.05%; aHR 1.4, 95% confidence interval (CI) 1.1, 1.9), maternal depression (0.11%; aHR 1.8, 95% CI 1.0, 3.4), substance-related diagnoses (0.27%; aHR 2.3, 95% CI 1.3, 3.8), cannabis-related diagnosis (0.35%; aHR 2.7, 95% CI 1.5, 5.0), prenatal nicotine use (0.23%; aHR 2.5, 95% CI 1.5, 4.2), preexisting hypertension (0.11%; aHR 2.3, 95% CI 1.2, 4.3), preterm delivery (0.09%; aHR 2.1, 95% CI 1.5, 3.0), infant with a major malformation (0.09%; aHR 2.0, 95% CI 1.1, 3.6), respiratory distress syndrome (0.12%; aHR 2.6, 95% CI 1.5, 4.6), and select environmental factors were all associated with SUID. CONCLUSIONS Multiple risk factors were confirmed and expanded upon, and the geographic distribution for SUID in San Diego County was identified. Through this approach, prevention efforts can be targeted to geographies that would benefit the most.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Rebecca J Baer
- California Preterm Birth Initiative, University of California San Francisco, La Jolla, CA, USA
| | - Mallory Owen
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | - Elizabeth Kiernan
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | | | | | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Browning KO, DeSarno MJ, Davis DR, Streck JM, Bergeria CL, Harfmann RF, Parker MA, Heil SH, Sigmon SC, Gaalema DE, Tidey JW, Lee DC, Tetreault HJ, Higgins ST. Relating individual differences in the reinforcing value of smoking and dependence severity to nicotine exposure levels in vulnerable populations. Prev Med 2022; 165:107312. [PMID: 36272516 PMCID: PMC9986960 DOI: 10.1016/j.ypmed.2022.107312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/02/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
Cigarette smoking is overrepresented in populations with psychiatric conditions and socioeconomic disadvantage. Greater understanding of the role of reinforcement and nicotine dependence in smoking among vulnerable populations may facilitate development of better targeted interventions to reduce smoking. Prior research demonstrated that individual differences in the reinforcing value of smoking and nicotine-dependence severity predicted total nicotine-exposure in vulnerable populations. The present study uses multivariate regression to address two aims: (1) Quantify the degree to which the reinforcing value of smoking, assessed using the Cigarette Purchase Task (CPT), and dependence severity assessed using the Fagerström Test of Nicotine Dependence and Brief Wisconsin Inventory of Smoking Dependence Motives (B-WISDM) each account for individual differences in cotinine-plus-3'-hydroxycotinine (COT+3HC) levels. (2) Explore whether there is overlap in the variance accounted for by the CTP, FTND, and B-WISDM. Participants were 628 adults with co-morbid psychiatric conditions or socioeconomic disadvantage who smoked daily. The CPT, FTND, and B-WISDM models accounted for 23.76%, 32.45%, and 29.61% of the variance in COT+3HC levels, respectively. Adding CPT to the FTND model failed to increase the variance accounted for and adding it to the B-WISDM model did so by only 1.2% demonstrating considerable overlap in the variance in nicotine exposure levels accounted for by these three instruments. These results provide new knowledge on the relationship between individual differences in the reinforcing value of smoking and nicotine-exposure levels and suggest differences in reinforcing value may underpin a considerable portion of the variance in nicotine exposure accounted for by dependence severity.
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Affiliation(s)
- Kaitlyn O Browning
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Michael J DeSarno
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Danielle R Davis
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, CT, United States of America
| | - Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Cecilia L Bergeria
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Roxanne F Harfmann
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Maria A Parker
- School of Public Health, Indiana University, Bloomington, IN, United States of America
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Dustin C Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Haley J Tetreault
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America.
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Hegyi T, Ostfeld BM. Sudden unexpected infant death risk profiles in the first month of life. J Matern Fetal Neonatal Med 2022; 35:10444-10450. [PMID: 36195459 DOI: 10.1080/14767058.2022.2128662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Limited improvement in current SUID rates requires further identification of its characteristics, including age-specific risk patterns. OBJECTIVE Compare SUID risk factors in the first week versus the remainder in the first month of life. DESIGN/METHODS We compared maternal and infant data from New Jersey databases for SUID from 2000 to 2015 in infants ≥ 34 weeks GA in the two groups. RESULTS In the period studied, 123 died in the first 27 days, 24 before seven. Deaths in the first week had a higher percentage of mothers with post-High School education (OR 3.50, CI: 1.38-8.87) and a primary Cesarean section delivery (OR 4.0, CI: 1.39-11.49), and a smaller percentage with inadequate prenatal care (OR 0.36, CI: 0.14, 0.94). A smaller percentage of first-week deaths had mothers who smoked during pregnancy or identified as Black, non-Hispanic, but these findings did not reach significance (p < .08 and p < .09, respectively). CONCLUSIONS SUID in the first week and the first month of life is rare. However, despite a limited sample size, data suggest that even within the first month of life, there are differences in risk patterns for SUID based on age at death. Age-specific profiles may lead to new hypotheses regarding causality and more refined risk-reduction guidelines and warrant further study.
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Affiliation(s)
- Thomas Hegyi
- Division of Neonatology, Department of Pediatrics and SIDS Center of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Barbara M Ostfeld
- Division of Neonatology, Department of Pediatrics and SIDS Center of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Weiss S. Protecting Infants from Sudden Unexpected Infant Death: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S83-S92. [PMID: 36480671 DOI: 10.1111/jmwh.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
With 300-400 annual deaths in France, sudden unexpected infant death (SUID) is the leading cause of mortality in France among infants from the end of their first through their 12th month of life. These clinical practice guidelines aim to identify strategies for (future) parents to prevent avoidable SUIDs. They are based on a narrative literature review and an analysis of the existing reports and guidelines available on the topic in 2019-2020. In summary, it is recommended that parents ensure that their infants sleep on their back on a firm, empty surface in a sufficiently ventilated environment, share the parental bedroom, and be breastfed and vaccinated. All of these actions create protective factors against SUID. Conversely, parents should know that several factors increase the risk of SUID: unsafe sleep, maternal smoking, passive smoking after birth, exposure to alcohol or other psychoactive substances, and excessive heat. Precis: Sudden Unexpected Infant Death prevention includes infants being breastfed and vaccinated, sleeping on their back, on a firm, empty surface, near parents, and that they are not overheated.
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Affiliation(s)
- Stephanie Weiss
- Savoie Metropolitan Area Hospital Center, Place Lucien Biset, Chambéry
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Xu J, Li X, Zhou Q. Nationwide-free preconception care strategy: Experience from China. Front Public Health 2022; 10:934983. [PMID: 36339191 PMCID: PMC9626826 DOI: 10.3389/fpubh.2022.934983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/23/2022] [Indexed: 01/25/2023] Open
Abstract
Preconception care has emerged as a developing field in maternal and child healthcare worldwide. This care type provides couples of reproductive age with the opportunity for early detection and management of biomedical, behavioral, and social health problems. In 2010, the Chinese government launched a nationwide preconception care program as a welfare project. During the past decade, this project has received international attention, and experiences from the project have been published in the literature. In this review, we summarize the history, implementation, and evaluation of preconception care services in China, and its related maternal and children's health service initiatives, to thereby provide knowledge for policymakers and clinicians in other countries.
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Affiliation(s)
- Jinghui Xu
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaotian Li
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
- Institutes of Biochemical Sciences, Fudan University, Shanghai, China
| | - Qiongjie Zhou
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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Zubcevic J, Watkins J, Lin C, Bautista B, Hatch HM, Tevosian SG, Hayward LF. Nicotine Exposure during Rodent Pregnancy Alters the Composition of Maternal Gut Microbiota and Abundance of Maternal and Amniotic Short Chain Fatty Acids. Metabolites 2022; 12:metabo12080735. [PMID: 36005607 PMCID: PMC9414314 DOI: 10.3390/metabo12080735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/28/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Tobacco smoking is the leading cause of preventable death. Numerous reports link smoking in pregnancy with serious adverse outcomes, such as miscarriage, stillbirth, prematurity, low birth weight, perinatal morbidity, and infant mortality. Corollaries of consuming nicotine in pregnancy, separate from smoking, are less explored, and the mechanisms of nicotine action on maternal–fetal communication are poorly understood. This study examined alterations in the maternal gut microbiome in response to nicotine exposure during pregnancy. We report that changes in the maternal gut microbiota milieu are an important intermediary that may mediate the prenatal nicotine exposure effects, affect gene expression, and alter fetal exposure to circulating short-chain fatty acids (SCFAs) and leptin during in utero development.
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Affiliation(s)
- Jasenka Zubcevic
- Department of Physiology and Pharmacology, University of Toledo College of Medicine, Toledo, OH 43614, USA
- Correspondence: (J.Z.); (S.G.T.)
| | - Jacqueline Watkins
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL 32610, USA
| | - Cindy Lin
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL 32610, USA
| | - Byrell Bautista
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL 32610, USA
| | - Heather M. Hatch
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL 32610, USA
| | - Sergei G. Tevosian
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL 32610, USA
- Correspondence: (J.Z.); (S.G.T.)
| | - Linda F. Hayward
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL 32610, USA
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Moon RY, Carlin RF, Hand I. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics 2022; 150:188305. [PMID: 35921639 DOI: 10.1542/peds.2022-057991] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Every year in the United States, approximately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca F Carlin
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, New York
| | - Ivan Hand
- Department of Pediatrics, SUNY-Downstate College of Medicine, NYC Health + Hospitals, Kings County, Brooklyn, New York
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A proof-of-concept study to construct Bayesian network decision models for supporting the categorization of sudden unexpected infant death. Sci Rep 2022; 12:9773. [PMID: 35697924 PMCID: PMC9192651 DOI: 10.1038/s41598-022-14044-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/31/2022] [Indexed: 02/06/2023] Open
Abstract
Sudden infant death syndrome (SIDS) remains a leading cause of infant death in high-income countries. Supporting models for categorization of sudden unexpected infant death into SIDS/non-SIDS could reduce mortality. Therefore, we aimed to develop such a tool utilizing forensic data, but the reduced number of SIDS cases renders this task inherently difficult. To overcome this, we constructed Bayesian network models according to diagnoses performed by expert pathologists and created conditional probability tables in a proof-of-concept study. In the diagnostic support model, the data of 64 sudden unexpected infant death cases was employed as the training dataset, and 16 known-risk factors, including age at death and co-sleeping, were added. In the validation study, which included 8 new cases, the models reproduced experts’ diagnoses in 4 or 5 of the 6 SIDS cases. Next, to confirm the effectiveness of this approach for onset prediction, the data from 41 SIDS cases was employed. The model predicted that the risk of SIDS in 0- to 2-month-old infants exposed to passive smoking and co-sleeping is eightfold higher than that in the general infant population, which is comparable with previously published findings. The Bayesian approach could be a promising tool for constructing SIDS prevention models.
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Abstract
The use of tobacco during pregnancy is the leading preventable cause of pregnancy complications and adverse birth outcomes. In high-income countries, around one in 10 pregnant women smokes tobacco, while smokeless tobacco is the primary form of tobacco used in many low- and middle-income countries. Although the risk of tobacco-related harms can be reduced substantially if mothers cease smoking in the first trimester of pregnancy, the proportion of women who successfully quit smoking during pregnancy remains modest. Psychosocial interventions are first-line treatment, with some high-quality evidence showing that counselling is effective in promoting smoking cessation among pregnant women. There is insufficient evidence regarding the efficacy and safety of smoking cessation pharmacotherapies when used during pregnancy, although in some countries nicotine replacement therapy is recommended for pregnant women who have been unable to quit without pharmacological assistance. E-cigarettes are increasingly being used as a smoking cessation aid in the general population of smokers, but more research is needed to determine if e-cigarettes are a safe and effective treatment option for pregnant women.
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Affiliation(s)
- Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Jonathan James Chandran
- CICADA Adolescent Drug and Alcohol Service, Department of Adolescent Medicine, Sydney Children's Hospital, Sydney, Australia
| | - Ju Lee Oei
- Department of Newborn Care, the Royal Hospital for Women, Randwick, Australia
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
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Layoun V, Ohnona A, Tolosa JE. Pregnancy Outcomes Associated With Use of Tobacco and Marijuana. Clin Obstet Gynecol 2022; 65:376-387. [PMID: 35476623 DOI: 10.1097/grf.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tobacco and marijuana are the most common drugs of abuse among pregnant women. Cigarettes have been extensively studied and increase the risk of miscarriage, preterm birth, premature rupture of membranes, placental dysfunction, low birth rate, stillbirth, and infant mortality. There are sparse data on the specific effects of electronic cigarettes and smokeless tobacco in pregnancy. Literature on marijuana in pregnancy is limited by confounding, bias, and the retrospective nature of studies that do not capture contemporary trends in use. However, several studies suggest an association between marijuana and fetal growth restriction, low birth weight, and neurodevelopmental differences in offspring.
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Affiliation(s)
- Vanessa Layoun
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Ashley Ohnona
- Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jorge E Tolosa
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
- Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, Pennsylvania
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Butyrylcholinesterase is a potential biomarker for Sudden Infant Death Syndrome. EBioMedicine 2022; 80:104041. [PMID: 35533499 PMCID: PMC9092508 DOI: 10.1016/j.ebiom.2022.104041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Autonomic dysfunction has been implicated in the pathophysiology of the Sudden Infant Death Syndrome (SIDS). Butyrylcholinesterase (BChE) is an enzyme of the cholinergic system, a major branch of the autonomic system, and may provide a measure of autonomic (dys)function. This study was undertaken to evaluate BChE activity in infants and young children who had died from Sudden Infant Death or Sudden Unexpected Death. Methods In this case-control study we measured BChE activity and total protein in the eluate of 5μL spots punched from the dried blood spots taken at birth as part of the newborn screening program. Results for each of 67 sudden unexpected deaths classified by the coroner (aged 1 week-104 weeks) = Cases, were compared to 10 date of birth - and gender-matched surviving controls (Controls), with five cases reclassified to meet criteria for SIDS, including the criterion of age 3 weeks to 1 year. Findings Conditional logistic regression showed that in groups where cases were reported as “SIDS death” there was strong evidence that lower BChE specific activity (BChEsa) was associated with death (OR=0·73 per U/mg, 95% CI 0·60-0·89, P=0·0014), whereas in groups with a “Non-SIDS death” as the case there was no evidence of a linear association between BChEsa and death (OR=1·001 per U/mg, 95% CI 0·89-1·13, P=0·99). Interpretation BChEsa, measured in dried blood spots taken 2-3 days after birth, was lower in babies who subsequently died of SIDS compared to surviving controls and other Non-SIDS deaths. We conclude that a previously unidentified cholinergic deficit, identifiable by abnormal -BChEsa, is present at birth in SIDS babies and represents a measurable, specific vulnerability prior to their death. Funding All funding provided by a crowd funding campaign https://www.mycause.com.au/p/184401/damiens-legacy
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Ludorf KL, Benjamin RH, Malik S, Langlois PH, Canfield MA, Agopian AJ. Association between maternal smoking and survival among infants with trisomy 21. Birth Defects Res 2022; 114:249-258. [PMID: 35212191 DOI: 10.1002/bdr2.1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Trisomy 21 (T21) is common, with affected infants having an increased risk of infant mortality (5.9-7.1%). Maternal smoking is associated with infant mortality in the general population, and we evaluated if similar associations were present among infants with T21. METHODS We identified infants with T21 from the Texas Birth Defects Registry, and maternal smoking and infant vital status were obtained from linked birth and death certificate data, respectively. Cox proportional hazards regression models were used to calculate hazard ratios between maternal smoking and death between 0 to ≤ 364 days, 28-364 days, and 0-27 days. RESULTS We found a significant association between maternal smoking and death between 0 to ≤ 364 (unadjusted HR 1.72, 95% CI 1.07, 2.77), which was no longer statistically significant after adjustment for covariates (adjusted HR 1.55, 95% CI 0.94, 2.56). A similar pattern was observed for death between 28-364 days (adjusted HR: 1.68, 95% CI 0.93, 3.03), whereas the association for 0-27 days (adjusted HR: 1.30, 95% CI 0.51, 3.29) was not statistically significant before and after adjustment. CONCLUSIONS The observed magnitudes of associations were similar to previous estimates among the general population. Further work considering the role of other maternal and infant risk factors and social determinants of health is necessary to better understand the observed results.
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Affiliation(s)
- Katherine L Ludorf
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Renata H Benjamin
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Sadia Malik
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Peter H Langlois
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - A J Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
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Osei-Poku GK, Thomas S, Mwananyanda L, Lapidot R, Elliott PA, Macleod WB, Somwe SW, Gill CJ. A systematic review of the burden and risk factors of sudden infant death syndrome (SIDS) in Africa. J Glob Health 2022; 11:04075. [PMID: 35003713 PMCID: PMC8719309 DOI: 10.7189/jogh.11.04075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background While sudden infant death syndrome (SIDS) has long been recognized as a leading preventable cause of infant mortality in high-income countries, little is known about the burden of SIDS in Africa. To address this knowledge gap, we conducted the first systematic review of SIDS-related publications in Africa. Our objective was to assess the prevalence of SIDS and its risk factors in Africa. Methods We systematically searched PubMed, Embase, Web of Science, Cochrane, and Google Scholar to identify studies published until December 26, 2020. Review authors screened titles and abstracts, and selected articles independently for full-text review. Risk of bias was assessed using the Newcastle Ottawa Scale (NOS) or a modification. Data on the proportion of infants who died of SIDS and reported prevalence of any risk factors were extracted using customized data extraction forms in Covidence. Results Our analysis rested on 32 peer-reviewed articles. Nine studies presented prevalence estimates on bedsharing and prone sleeping, suggesting near-universal bedsharing of infants with parents (range, 60 to 91.8%) and frequent use of the prone sleeping position (range, 26.7 to 63.8%). Eleven studies reported on the prevalence of SIDS, suggesting high rates of SIDS in Africa. The prevalence of SIDS ranged from 3.7 per 1000 live births in South Africa, 2.5 per 1000 live births in Niger, and 0.2 per 1000 live births in Zimbabwe. SIDS and other sudden infant deaths accounted for between 2.5 to 21% of infant deaths in South Africa and 11.3% in Zambia. Conclusions Africa may have the highest global rate of SIDS with a high burden of associated risk factors. However, majority of the studies were from South Africa which limits generalizability of our findings to the entire continent. There is an urgent need for higher quality studies outside of South Africa to fill this knowledge gap. Protocol registration Prospero Registration Number: CRD42021257261
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Affiliation(s)
- Godwin K Osei-Poku
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Sanya Thomas
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Lawrence Mwananyanda
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA.,Right to Care - Zambia, Lusaka, Zambia
| | - Rotem Lapidot
- Boston University School of Medicine, Department of Pediatrics, Boston, Massachusetts, USA.,Boston Medical Center, Division of Pediatric Infectious Diseases, Department of Pediatrics, Boston, Massachusetts, USA
| | - Patricia A Elliott
- Boston University School of Public Health, Department of Community Health, Boston, Massachusetts, USA
| | - William B Macleod
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Somwe Wa Somwe
- University of Zambia, School of Medicine, Department of Pediatrics, Lusaka, Zambia
| | - Christopher J Gill
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
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Sequí-Canet JM, Sequí-Sabater JM, Marco-Sabater A, Corpas-Burgos F, Collar del Castillo JI, Orta-Sibú N. Maternal factors associated with smoking during gestation and consequences in newborns: Results of an 18-year study. J Clin Transl Res 2022; 8:6-19. [PMID: 35097236 PMCID: PMC8791242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/06/2021] [Accepted: 11/12/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Tobacco use is one of the most important causes of obstetric and perinatal pathologies. Its frequency during pregnancy is high and could be related to various socioeconomic and cultural characteristics of the mothers. AIM The aim of this study is to determine the trend and prevalence of smoking in pregnant mothers in our area over the years and the socio-cultural or obstetric factors associated with smoking as well as the repercussions on the newborns related to its consumption. METHODS Retrospective study of 18,959 mothers of healthy newborns in the maternity ward of the regional hospital during the years 2002-2019. The variable under study was maternal smoking during pregnancy compared with various maternal, obstetric, and perinatal factors. RESULTS A mean percentage of 20.4% of the mothers smoked, with significantly decreasing percentages over the years. There was a significant association between smoking and mothers' age, origin, level of education, the occurrence of previous abortions, parity, type of breastfeeding at discharge, type of delivery, low birth weight, and need for neonatal resuscitation. CONCLUSIONS This defines a profile of pregnant smokers on whom it is important to act: young, Spanish, with a low level of education, multiparous, and with previous miscarriages. Its repercussions are also evident with a lower birth weight in newborns. Knowledge of these factors will make it possible to design more effective intervention strategies to reduce smoking during pregnancy. RELEVANCE FOR PATIENTS Any effort that reduces smoking habits can improve the health status of mothers and newborns and the first step is to know who are risk pregnants.
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Affiliation(s)
- Jose Miguel Sequí-Canet
- 1Department of Paediatrics, University Hospital “Francisco de Borja”, Gandía, Spain,
Corresponding author: Jose Miguel Sequí-Canet Department of Paediatrics, University Hospital “Francisco de Borja”, Av. de la Medicina 646702-Gandia, Spain. Tel: +34 962849732
| | | | - Ana Marco-Sabater
- 1Department of Paediatrics, University Hospital “Francisco de Borja”, Gandía, Spain
| | - Francisca Corpas-Burgos
- 3Department of Statistics, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Área de Desigualdades en Salud, Spain
| | | | - Nelson Orta-Sibú
- 1Department of Paediatrics, University Hospital “Francisco de Borja”, Gandía, Spain
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Martínez-Valdez L, Richardson V, Bautista-Márquez A, Hernández-Ávila M. Epidemiology of sudden infant death syndrome in Mexico, 2005-2020. Front Pediatr 2022; 10:1001089. [PMID: 36568434 PMCID: PMC9773828 DOI: 10.3389/fped.2022.1001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sudden Infant Death Syndrome (SIDS) constitutes one of the main causes of mortality in children under one year of age in developed countries; it's frequency to varies geographically. In Mexico the real incidence of SIDS is not known. METHODS National databases of deaths in children under one year of age, from 2005 to 2020, were analyzed, due to Sudden Unexpected Infant Death (SUID) [SIDS (R95), accidental suffocation in a sleeping environment (W75), and other ill-defined and unspecified causes of mortality (R99), according to the International Classification of Diseases, tenth revision (ICD 10)]. Mortality rates per year of occurrence due to SUID and their subcategories were calculated. Simple frequencies of SIDS were obtained per year and month of occurrence, state of residence, age, place of death, and access to social security services. RESULTS In the study period 473,545 infant deaths occurred; 7,714 (1.62%) deaths were due to SUID; of these, 6,489 (84%) were due to SIDS, which is among the 10 leading causes of infant death in Mexico. The average mortality rate for SUID was 22.4/100,000 live births, for SIDS was 18.8/100,000 live births. Mortality rates within the states were variable, ranging from 2.4/100,000 to 105.1/100,000 live births. In 81% of SIDS records there was no autopsy; 38% of deaths due to SIDS occurred in infants under one month of age, up to 87% of deaths occurred in families without social security services or it was unknown, and 76.2% of deaths occurred at home. Deaths were more frequent during the last months of autumn and during winter. CONCLUSION In Mexico there is an underregistry of SIDS as cause of death, along with other SUID categories. Health workers need to be trained to improve diagnosis and data registration, including the practice of autopsies; additionally, it is necessary to implement a public health campaign.
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Affiliation(s)
- Libny Martínez-Valdez
- Dirección de Prestaciones Económicas y Sociales, El Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Vesta Richardson
- Dirección de Prestaciones Económicas y Sociales, El Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Aurora Bautista-Márquez
- Dirección de Prestaciones Económicas y Sociales, El Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Mauricio Hernández-Ávila
- Dirección de Prestaciones Económicas y Sociales, El Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Maternal Smoking and Congenital Heart Defects, National Birth Defects Prevention Study, 1997-2011. J Pediatr 2022; 240:79-86.e1. [PMID: 34508749 PMCID: PMC8712361 DOI: 10.1016/j.jpeds.2021.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess associations between maternal smoking and congenital heart defects (CHDs) in offspring. STUDY DESIGN We performed a retrospective case-control study using data for cases of CHD (n = 8339) and nonmalformed controls (n = 11 020) from all years (1997-2011) of the National Birth Defects Prevention Study. Maternal self-reported smoking 1 month before through 3 months after conception was evaluated as a binary (none, any) and categorical (light, medium, heavy) exposure. Multivariable logistic regression was used to estimate aOR and 95% CIs. Stratified analyses were performed for septal defects according to maternal age, prepregnancy body mass index, and maternal race/ethnicity. RESULTS Multiple CHDs displayed modest associations with any level of maternal periconceptional smoking independent of potential confounders; the strongest associations were for aggregated septal defects (OR, 1.5; 95% CI, 1.3-1.7), tricuspid atresia (OR, 1.7; 95% CI, 1.0-2.7), and double outlet right ventricle (DORV) (OR, 1.5; 95% CI, 1.1-2.1). Tricuspid atresia and DORV also displayed dose-response relationships. Among heavy smokers, the highest odds were again observed for tricuspid atresia (aOR 3.0; 95% CI, 1.5-6.1) and DORV (aOR 1.5; 95% CI, 1.1-2.2). Heavy smokers ≥35 years old more frequently had a child with a septal defect when compared with similarly aged nonsmokers (aOR 2.3; 95% CI, 1.4-3.9). CONCLUSIONS Maternal periconceptional smoking is most strongly associated with septal defects, tricuspid atresia, and DORV; the risk for septal defects is modified by maternal age.
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Active and Passive Maternal Smoking During Pregnancy and Birth Outcomes: A Study From a Developing Country. Ann Glob Health 2021; 87:122. [PMID: 34900622 PMCID: PMC8641528 DOI: 10.5334/aogh.3384] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Smoking is one of the modifiable risk factors for adverse maternal and neonatal outcomes and is associated with low birth weight, preterm birth, respiratory, antepartum and intrapartum stillbirth, and perinatal death as well as long-term morbidity in offspring and sudden unexpected infant death. The rate of smoking in low- and middle-income countries is still relevantly high, and Jordan is no exception. Objective: To investigate the effect of active and passive smoking during pregnancy on adverse pregnancy outcomes. Methods: The case-control study was conducted in Jordan in June 2020. Healthy women with full-term singleton pregnancy (n = 180) were interviewed and stratified into three groups: Group I, active smokers; Group II, passive smokers; and Group III, nonsmokers. The study variables included demographic data, current pregnancy history, cotinine level of mothers and newborns, and perinatal outcomes. Statistical analysis was performed using the application package IBM SPSS 25. Various algorithms of statistical analysis were used depending on the type of distribution of feature and data quality. The threshold for statistical significance was set at p < 0.05. Results: Active smokers had significantly lower gestational age at delivery compared to passive and nonsmoking women (p = 0.038 and p = 0.003, respectively). Neonates from active smoking mothers had significantly lower birth weight compared to neonates from passive and nonsmoking women (p = 0.016 and p = 0.019, respectively), significantly lower head and chest circumferences compared to babies from passive smokers (p < 0.001 and p = 0.036, respectively), and significantly lower first-minute Apgar score compared to those from nonsmoking women (p = 0.023). The urine cotinine level was significantly higher in both active and passive smoking women (both p < 0.01), and it was significantly higher in newborns who had been exposed to smoking in utero despite maternal active or passive smoking status (both p < 0.001). There was a weak negative correlation between urine cotinine level and birth weight: r = –0.14 for maternal cotinine level and r = –0.15 for neonate cotinine level. Conclusions: The current study illustrated that smoking during pregnancy leads to offspring with reduced birth weight, birth length, and head and chest circumference; reduces delivery gestational age; and lowers the first-minute Apgar score. Our study findings highlight the need for further research issued to smoking effects on perinatal outcomes, the implementation of actions to develop cessation interventions in the preconception period, and an evaluation of useful interventions to enhance a smoking-free environment during pregnancy.
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