Maternal smoking and the risk of polyhydramnios

The Effectiveness of Tobacco Dependence Education in Health Professional Students' Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The objective of this study was to perform a systematic review to examine the effectiveness of tobacco dependence education versus usual or no tobacco dependence education on entry-level health professional student practice and client smoking cessation. Sixteen published databases, seven grey literature databases/websites, publishers’ websites, books, and pertinent reference lists were searched. Studies from 16 health professional programs yielded 28 RCTs with data on 4343 healthcare students and 3122 patients. Two researchers independently assessed articles and abstracted data about student knowledge, self-efficacy, performance of tobacco cessation interventions, and patient smoking cessation. All forms of tobacco were included. We did not find separate interventions for different kinds of tobacco such as pipes or flavoured tobacco. We computed effect sizes using a random-effects model and applied meta-analytic procedures to 13 RCTs that provided data for meta-analysis. Students’ counseling skills increased significantly following the 5As model (SMD = 1.03; 95% CI 0.07, 1.98; p < 0.00001, I² 94%; p = 0.04) or motivational interviewing approach (SMD = 0.90, 95% CI 0.59, 1.21; p = 0.68, I² 0%; p < 0.00001). With tobacco dependence counseling, 78 more patients per 1000 (than control) reported quitting at 6 months (OR 2.02; 95% CI 1.49, 2.74, I² = 0%, p = 0.76; p < 0.00001), although the strength of evidence was moderate or low. Student tobacco cessation counseling improved guided by the above models, active learning strategies, and practice with standardized patients.

The association between polyhydramnios and the risk of placenta abruption: a meta-analysis

Background: The results of studies about the effect of polyhydramnios on the risk of placental abruption are a controversy. This study was conducted to determine the association between polyhydramnios and the risk of placental abruption.Methods: PubMed, Scopus, and Web of Science were searched in September 2017 along with references from meta-analyses and reviews. We assessed publication bias using the rank correlation test (Begg's test) and the regression asymmetry test (Egger's test). The studies' heterogeneity was measured by the Q-statistic and I-squared (I²) tests. The random-effects model was conducted to obtain pooled odds ratio (OR) as a measure of the association between polyhydramnios and the risk of placental abruption.Results: A total of 10 studies were included in this meta-analysis with a sample of 198,359 participants. There was a significant association between polyhydramnios and the risk of placental abruption [OR: 1.93 (95% CI: 1.23-2.63)].Conclusions: The present study is the first meta-analysis that reported polyhydramnios is a risk factor for placental abruption.

A review of women and tobacco: have we come such a long way?

The trends in smoking by women over the past century parallel social and economic changes. The crumbling of the double standard spurred the tobacco industry to launch advertising campaigns that target women, juxtaposing images of liberation and feminism with glamour and slimness. As a result, in the 1990s, smoking initiation and prevalence is higher among teenage females than males. Tobacco-related mortality and morbidity among women and their children continue to rise. Women's health care providers must be integral players in a multitiered, broad-based approach to decreasing tobacco use among women. Research is needed on socially isolated women and on the efficacy of nursing interventions related to tobacco use.

A morphometric study of maternal smoking on apoptosis in the syncytiotrophoblast

OBJECTIVES

To study syncytiotrophoblast apoptosis in the placenta of smoking and non-smoking pregnant women.

METHODS

Twelve neonates, pregnancies and placentas were available for study. Eight mothers smoked during pregnancy and the remaining four were non-smokers used as control subjects. The main outcome measure was the apoptotic syncytiotrophoblast index for each group. Apoptosis was detected by immunohistochemistry using the TUNEL method and quantitatively measured using a Merz grid. The apoptotic syncytiotrophoblast index was calculated as the ratio of mean apoptotic labeling to percent terminal villus area using high-power field microscopy.

RESULTS

Significant differences in apoptotic syncytiotrophoblast index were observed between the control group (15.06+/-3.72) and the smoker group (1.66+/-1.74) (P < 0.0001, Mann-Whitney test), but no differences were detected in clinical or morphometric data between groups.

CONCLUSIONS

The human placental syncytiotrophoblast undergoes apoptosis and this process is associated with inhibition of apoptosis by the smoking habit. The same way as the presence of trophoblast apoptosis is associated with modifications of the maternal-fetal exchange, the inhibitory effect of the smoking habit on syncytiotrophoblast could be responsible for the poor prognosis of pregnancy in the presence of maternal smoking.

Maternal smoking during pregnancy: social, medical, and legal perspectives on the conception of a human being

The social, medical, and legal aspects of maternal smoking during pregnancy are examined. Increasing social awareness of the fetus as a human being is described as emanating largely from modern prenatal screening technologies. Medical findings concerning the harms of maternal smoking to the fetus and developing child are then reviewed. The legal literature is considered within the context of women's rights. Two major trends are identified. The first is the prosecution of harmful maternal behaviors, and the second is extensive public education. It is asserted that despite repeated calls for action, actual attempts to help pregnant women quit smoking are meager. This finding is interpreted as resulting from the unclear status of both the fetus and smoking in general and from increased awareness of women's rights.

Study of isolated apparent amniogenic limb deficiency in Hungary, 1975-1984

A population-based and validated data set of 206 cases with apparent amniogenic limb deficiency was ascertained in Hungary between 1975 and 1984. Such limb defects frequently (36%) associated with nonlimb abnormalities. In 134 cases with isolated defects typically more limbs are affected, upper and lower limbs, right and left sides, and both sexes are equally affected. Case-control analysis of such isolated cases indicates a lower socioeconomic status of parents, a higher parity, more frequent unwanted pregnancies, preterm birth, and a higher rate of threatened abortion. Familial occurrence was not found in 415 first-degree relatives.