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Smoking in Pregnancy: Causes and consequences

Smoking in Pregnancy: Causes and consequences. Kate E. Pickett, PhD Department of Health Sciences University of York & Hull-York Medical School. Prevalence and Patterns. 32% women smoke in year before pregnancy Half quit just before or during pregnancy 17% are persistent smokers

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Smoking in Pregnancy: Causes and consequences

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  1. Smoking in Pregnancy:Causes and consequences Kate E. Pickett, PhD Department of Health Sciences University of York & Hull-York Medical School

  2. Prevalence and Patterns • 32% women smoke in year before pregnancy • Half quit just before or during pregnancy • 17% are persistent smokers • Most who quit, relapse • Patterns are complex

  3. Changes in smoking status among women who reported any pregnancy smoking in NHIS-S Pickett KE, Wakschlag LS, Leventhal BL. Fluctuations in maternal smoking during pregnancy. Obstetrics and Gynecology 2003;101:140-7.

  4. Fluctuations in self-reported smoking during pregnancy for 4 women in the FHDP Pickett KE, Wakschlag LS, Leventhal BL. Fluctuations in maternal smoking during pregnancy. Obstetrics and Gynecology 2003;101:140-7.

  5. Non-smoker 669 Non-smoker 685 4 18 9 10 Smoker 257 Light smoker 46 Light smoker 45 9 2 14 Moderate smoker 39 Moderate smoker 27 7 5 8 Heavy smoker 172 Heavy smoker 169 13 20 Smoking status at enrollment Smoking status in late pregnancy Fluctuations in smoking intensity in MISSEB Pickett KE, Rathouz PJ, Kasza K,, Wakschlag LS, Wright RJ. Self-reported smoking, cotinine levels and patterns of smoking in pregnancy. Paediatric and Perinatal Epidemiology 1995;19:368–376 .

  6. Marital status Kiernan, K, Pickett KE. Marital status disparities in maternal smoking during pregnancy, breastfeeding and maternal depression. Social Science and Medicine 2006;63:335-346

  7. Interpersonal problems Wakschlag LS, Pickett KE, Middlecamp M, Walton L, Leventhal BLL. Pregnant smokers who quit, pregnant smokers who can’t: Does history of problem behavior make a difference? Social Science and Medicine 2003;56:2449-2460.

  8. Pickett K.E, Wilkinson RG, Wakschlag LS (Forthcoming) The psychosocial context of pregnancy smoking and quitting in the Millennium Cohort Study.

  9. Oddsof smoking during pregnancy 8 6 4 2 0 10 20 30 40 50 60 70 80 90 100 %of neighborhood population with working class occupation Odds ratios for smoking during pregnancy by neighbourhood social class Pickett KE, Wakschlag LS, Rathouz P, Leventhal B, Abrams B. The working class context of pregnancy smoking. Health and Place 2002;8:167-175.

  10. Congenital malformations Cleft lip, cleft palate Limb reductions Genitourinary tract Low birth weight Preterm delivery, RR=1.5-2 Foetal growth restriction ETS also a risk Infant mortality RR=1.4 for first month Risk higher after 1 month and among heavy smokers Sudden Infant Death Syndrome RR=2-3 Consequences: infancy

  11. Lung function and respiratory illness Persists into adulthood RR=1.3-2 for wheezing RR=1.8 for asthma Respiratory tract infections Obesity Higher BMI despite lower birth weight Diabetes Type II, dose response relationship RR=4.5 for heavy smoking Cancer Brain tumours Leukemia Lymphoma Chromosomal instability and damage Consequences: childhood

  12. Understanding the impact of smoking in pregnancy on intellectual development and behaviour of offspring

  13. Population Attributable Risk WAKSCHLAG, L. S., LEVENTHAL, B. L., COOK, E. & PICKETT, K. E. (2000) Intergenerational health consequences of maternal smoking. The Economics of Neuroscience (TEN), 2, 47-54.

  14. Methodological Issues • Randomized controlled trials • Confounding • Domains • Socio-demographic • Parental psychiatric factors • Parenting and quality of home environment • Perinatal and child factors • Causal criteria: temporality, consistency, strength of association, dose-response, biological plausibility WAKSCHLAG, L. S., PICKETT, K. E., COOK, E., JR., BENOWITZ, N. L. & LEVENTHAL, B. L. (2002) Maternal smoking during pregnancy and severe antisocial behavior in offspring: a review. Am J Public Health, 92, 966-74.

  15. Advances in measurement • Comparing recall to prospective measurement • ‘Missed’ smokers vs. smokers • Older • Less likely: to own their own home, be married, have low emotional health, problems with drug use • Significantly lower scores of Conduct Disorder symptoms in offspring • ‘Undisclosed’ smokers vs. non-smokers • More likely: public benefits, low self-rated health, live in violent neighbourhood • Less likely: to own their home, be married • Combined “best estimate” measure • Can detect significant effects of 3rd trimester exposure on brain:body ratio PICKETT, K. E., KASZA, K., BIESECKER, G., WRIGHT, R. J. & WAKSCHLAG, L. S. (Forthcoming) Women who remember, women who don’t: maternal recall of smoking in pregnancy. PICKETT, K. E., RATHOUZ, P. J., DUKIC, V., KASZA, K., NIESSNER, M., WRIGHT, R. J. & WAKSCHLAG, L. S. (In press) The complex enterprise of modelling prenatal exposure to cigarettes: What is “enough”? Paediatr Perinat Epidemiol.

  16. Adjusted effects of smoking on temperament at 9 months OR P=0.01 P=0.02 P=0.01 PICKETT, K. E., WOOD, C., ADAMSON, J., DESOUZA, L. & WAKSCHLAG, L. S. (2008) Meaningful differences in maternal smoking behaviour during pregnancy: implications for infant behavioural vulnerability. J Epidemiol Community Health, 62, 318-24.

  17. Adjusted effects of smoking on behaviour in toddlers WAKSCHLAG, L. S., LEVENTHAL, B. L., PINE, D. S., PICKETT, K. E. & CARTER, A. S. (2006) Elucidating early mechanisms of developmental psychopathology: the case of prenatal smoking and disruptive behavior. Child Dev, 77, 893-906.

  18. Adjusted effects of smoking on behaviour at 3 years OR P<0.05 P<0.05 HUTCHINSON, J., PICKETT, K. E., GREEN, J. & WAKSCHLAG, L. S. (Forthcoming) The effect of smoking in pregnancy on behavioural problems at age 3: an analysis of the UK Millennium Cohort Study by gender.

  19. Adjusted effect of smoking on age at onset of delinquency WAKSCHLAG, L. S., PICKETT, K. E., KASZA, K. E. & LOEBER, R. (2006) Is prenatal smoking associated with a developmental pattern of conduct problems in young boys? J Am Acad Child Adolesc Psychiatry, 45, 461-7.

  20. Interaction of MAOA X Exposure Predicting Conduct Symptoms WAKSCHLAG, L., et al. (Forthcoming) Interaction of prenatal exposure to cigarettes and MAOA genotype in pathways to youth antisocial behavior.

  21. Policy Need to understand how women understand risk Need to understand how policy and practice guidelines incorporate new knowledge Practice Heavy smokers are unlikely to benefit from usual-care antenatal smoking cessation programmes Need more intensive and targeted interventions. Implications

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