Maternal tobacco, alcohol and caffeine consumption during the perinatal period: A prospective cohort study in Greece during the COVID-19 pandemic.

INTRODUCTION: Low-level knowledge of problematic substance use during the perinatal period may lead to numerous adverse outcomes. We sought to determine maternal tobacco, alcohol and caffeine consumption during the perinatal period during the COVID-19 pandemic. METHODS: This prospective cohort study recruited women from five Greek maternity hospitals between January and May 2020. Data were collected with a structured questionnaire initially completed by postpartum women during their hospitalization and re-administered via telephone interview in the first, third and sixth month postpartum. RESULTS: The study sample consisted of 283 women. Smoking rates decreased during pregnancy (12.4%) compared to the pre-pregnancy period (32.9%, p<0.001) and during lactation (5.6%) compared to the antenatal period (p<0.001). The smoking rate increased again after breastfeeding cessation (16.9%) compared to the rate during lactation (p<0.001), but remained lower than the pre-pregnancy rate (p=0.008). Only 1.4% of the women reported breastfeeding cessation due to smoking, whereas those who smoked more during pregnancy were more likely to cease breastfeeding (OR=1.24; 95% CI: 1.05-1.48, p=0.012). Regarding alcohol consumption, it was significantly lower during pregnancy (5.7%), lactation (5.5%) and after breastfeeding cessation (5.2%) compared to the pre-pregnancy period (21.9%, p<0.001 for all correlations). Women who consumed alcohol during lactation were less likely to wean (OR=0.21; 95% CI: 0.05-0.83, p=0.027). Caffeine intake decreased during pregnancy compared to preconception period (p<0.001), while in lactating women it remained at low rates until the 3rd month of follow-up. Caffeine consumption at one month postpartum (ß=0.09; SE=0.04, p=0.045) was positively associated with longer duration of breastfeeding. CONCLUSIONS: Tobacco, alcohol and caffeine consumption decreased in the perinatal period compared to the preconception period. The pandemic may have contributed to the downtrend in smoking and alcohol consumption due to COVID-related restrictions and fear of potential illness. Nevertheless, smoking was associated with reduced duration of breastfeeding and breastfeeding cessation.

Medication Intake as a Factor for Non-Initiation and Cessation of Breastfeeding: A Prospective Cohort Study in Greece during the COVID-19 Pandemic.

Pharmacological treatment may become a barrier for a mother's breastfeeding goals. We aimed to investigate maternal medication intake as a factor for non-initiation and cessation of breastfeeding and the effect of professional counseling on maternal decision-making. Throughout 2020, 847 women were recruited from five healthcare institutions. Information was gathered prospectively with an organized questionnaire through interview during hospitalization and through telephone at 1, 3 and 6 months postpartum. Results revealed that from the 57 cases of breastfeeding cessation due to medication intake, only 10.5% received evidence-based counseling from a physician. Unfortunately, 68.4% (n = 39/57) of the participants ceased breastfeeding due to erroneous professional advice. The compatibility of medicines with breastfeeding was examined according to the Lactmed and Hale classification systems, which showed discrepancy in 8 out of 114 medicines used, while 17.5% and 13.2% of the medicines, respectively, were not classified. Educational level, employment at six months postpartum, mode of delivery, previous breastfeeding experience, medication intake for chronic diseases, physician's recommendation and smoking before pregnancy were factors significantly correlated with breastfeeding discontinuation due to medication intake. The COVID-19 restrictions protected women from ceasing breastfeeding due to medication intake. Maternal and lactation consultancy should be strictly related to evidence-based approaches.

Shared decision-making about medication intake during lactation: A prospective longitudinal study in Greece.

INTRODUCTION: The need for medication intake during lactation may affect women's decision on breastfeeding initiation, duration or cessation. We investigated shared decision-making about medication intake (MI) during lactation by breastfeeding women. METHODS: The study was conducted in five maternity hospitals in Greece (January-August 2020). A total of 283 mothers participated in the study. Data were obtained through a self-designed questionnaire. Mothers answered the questionnaire before discharge and were followed up by phone interviewing at one, three and six months postpartum. Information about breastfeeding status, reasons for cessation and MI during lactation were gathered. RESULTS: In total, 30.7% of the mothers were receiving medication due to a pre-pregnancy chronic condition but only 23.7% maintained it during lactation; 48.4% of mothers stated that they would avoid MI during lactation as a personal attitude and 45.2% were satisfied with the information provided by healthcare professionals (HPs) concerning MI during lactation. But, 66.1% of the mothers indicated the necessity of further guidance. Mothers with higher education, Greek ethnicity and vaginal delivery participated significantly in the decision-making process concerning MI during lactation (p=0.001, p=0.001 and p=0.01, respectively). Mothers who shared decision-making, primarily consulted a pediatrician (p=0.02) and were more likely to maintain full and mixed breastfeeding for one month postpartum, rather than cease breastfeeding (p=0.005). Breastfeeding duration of all indicators was for a mean of 110 days (SD: 74.58). CONCLUSIONS: Advancing HPs' evidence-based knowledge, communication skills, confidence and competence in breastfeeding management will contribute favorably to breastfeeding indicators and maternal satisfaction regarding professional counseling.

Investigation of Healthcare Professionals' Knowledge of Evidence-Based Clinical Practices for Preterm Neonatal Skin Care-A Pilot Study.

Neonatal skin care practices are considered crucial for a neonate's survival and are closely related to healthcare professionals' (HPs) knowledge and skills in delivering scientifically valid neonatal care interventions. In this descriptive cross-sectional pilot study, conducted in 2022, we aimed to assess HPs' basic theoretical knowledge of neonatal vernix caseosa, skin microbiota, and bathing as well as knowledge regarding evidence-based clinical practices (referred to as "clinical knowledge") for preterm neonatal skin care. Eligible participants were neonatologists, pediatricians, obstetricians, midwives and nurses working in the Greek setting. The research instrument was an online questionnaire designed by the research team. Finally, 123 HPs took part in the study. The theoretical, clinical and total knowledge scores were all significantly associated with age, healthcare profession and the sources used for education. Participants' theoretical and clinical knowledge scores were compared and found not to differ significantly (p = 0.566). A significant and positive correlation was found between theoretical and clinical knowledge scores. Thus, it is concluded that HPs should be updated with the latest evidence-based knowledge and clinical guidelines in order to provide neonatal skin care with high-quality standards.

Frequency and Determinants of Breastfeeding in Greece: A Prospective Cohort Study during the COVID-19 Pandemic.

Breastfeeding is considered to be the cornerstone of child health. In Europe however, overall breastfeeding rates remain low. The present study aimed at estimating the frequency of breastfeeding in Greece during the COVID-19 pandemic period and comparing findings with the latest national study in order to identify a potential impact of the pandemic. Additionally, possible correlations of socio-cultural and demographic characteristics with breastfeeding indicators were investigated. This prospective cohort study included 847 women from five tertiary maternity hospitals, between January and December 2020. Data were collected by a structured questionnaire via interview during hospitalization and via telephone in the first, third and sixth month postpartum. Results showed that all breastfeeding indicators improved over the last three years. Full breastfeeding reached 7.2%, contrary to 0.78% of the latest national study at six months postpartum. Employment, marital status, educational level, mode of delivery, type of maternity hospital, body mass index before pregnancy, previous breastfeeding experience of the mother and infant's birth weight correlated significantly with breastfeeding indicators at different time periods. The COVID-19 pandemic seems to have favorably influenced breastfeeding initiation and duration in Greece due to lockdowns, home confinement and teleworking.

Knowledge of Critical Issues in the Intrapartum Period: a Cross-sectional Study Among Undergraduate Final Year Midwifery Students.

Background: Dealing with critical issues in the intrapartum period requires comprehensive knowledge and a full understanding of the basic principles and skills involved, as complications during labor and birth occur unexpectedly.. Objective: The aim of this study was to evaluate the knowledge of critical issues in the intrapartum period among undergraduate final year midwifery students. Methods: This is a descriptive observational cross-sectional study conducted between February-July 2017. Final year undergraduate midwifery students were recruited from one institution and four public hospitals. The research instrument was a questionnaire designed by the research team. Statistical significance was set at p<0.05 and analyses were performed using the IBM SPSS Statistics version 22. Results: The final study sample consisted of 100 participants. The 36.0% of the students had started their final year internship, with a mean duration of 4.3 months. Only 2% of the participants had obtained a bachelor degree from another department, 76% had attended general high school, 17% had pre-graduate work experience and 48.0% had attended a seminar on critical issues in the intrapartum period. Participants' final scores ranged from 5% to 90%, with mean value being 49.7% (SD=16.5%). The knowledge score was found to be significantly higher in midwifery students who had started the internship. However, it was not significantly correlated with other educational characteristics. Finally, no significant correlation was observed between knowledge score and age (r= -0.15, p=0.138) or knowledge score and months of internship (r=0.27, p=0.114). Conclusion: In the core midwifery curriculum, the design and integration of didactic and clinical courses focusing on emergency management in midwifery practice is considered of paramount importance. However, teachers should provide midwifery students with guidance on independent learning ability and implement effective strategies to enhance students' self-study skills.

Serum glial fibrillary acidic protein as a biomarker of brain injury in premature neonates.

Neonatal brain injury is a serious adverse outcome of prematurity. Early detection of high risk premature neonates to develop neonatal brain injury is not currently feasible. The predictive value of many biomarkers has been tested, but none is used currently in clinical practice. The purpose of this study was to determine the levels and predictive value of serum glial fibrillary acidic protein (GFAP) in a prospective longitudinal case-control study during the first three days of life in premature neonates (<34 weeks of gestation) that later developed either intraventricular hemorrhage or periventricular leukomalacia. Each case (n=29) was matched according to birth weight and gestational age to one neonate with normal head ultrasound scans. No significant difference on GFAP levels was observed between the groups. Nevertheless, neonates with brain injury presented more frequently GFAP levels above the lowest detection limit (0.056 ng/ml) and this trend was significantly different during all days. The effectiveness of GFAP as an early biomarker of neonatal brain injury in premature neonates seems to be limited.

Breast cancer and social relationship coping efficacy: validation of the Greek version.

The Social Relationship Coping Efficacy scale (SRCE) was designed to assess cancer patients' efficacy for maintaining social support and social relationships. The purpose of the study was to confirm the psychometric quality and utility of a Greek-language version of the (SRCE) scale. The study included 116 women with breast cancer, who underwent surgery at a public hospital In Greece. The SRCE scale was translated using standard procedures and then culturally adapted for use in Greece. Psychometric evaluation of the SRCE-Greek scale included reliability, structural validity and convergent validity analyses. The SRCE-Greek scale demonstrated strong internal consistency (Cronbach a 0.87), and split-half reliability (Spearman-Brown, 0.747; Guttman, 0.742). The structural construct validity was confirmed with factor analysis using principal axis factor analysis. Construct validity was further supported with convergent validity with the Family Crisis Oriented Personal Evaluation Scales (F-COPES) (Acquiring Social Support, Reframing) and Family Support scale. The Greek language SRCE has strong internal consistency reliability and construct validity, as well as satisfactory convergent validity. Results provide support for the use of the SRCE-GR as a research and clinical instrument for the assessment of breast cancer patient's self-efficacy with regard to maintaining and enhancing close social relationships and social support.

Serum Activin A as Brain Injury Biomarker in the First Three Days of Life. A Prospective Case-Control Longitudinal Study in Human Premature Neonates.

Disruption of normal intrauterine brain development is a significant consequence of premature birth and may lead to serious complications, such as neonatal brain injury (NBI). This prospective case-control longitudinal study aimed at determining the levels and prognostic value of serum activin A during the first three days of life in human premature neonates which later developed NBI. It was conducted in a single tertiary hospital and eligible participants were live-born premature (<34 weeks) neonates. Each case (n = 29) developed NBI in the form of an intraventricular haemorrhage, or periventricular leukomalacia, and was matched according to birth weight and gestational age to one neonate with normal head ultrasound scans. Serum activin A levels in both groups showed a stable concentration during the first three days of life as no difference was observed within the two groups from the first to the third day. Neonates diagnosed with NBI had significantly higher activin A levels during the first two days of life compared to control neonates and its levels correlated to the severity of NBI during the second and third day of life. Although serum activin A on the second day was the best predictor for neonates at risk to develop NBI, the overall predictive value was marginally fair (area under the ROC-curve 69.2%). Activin A, in combination with other biomarkers, may provide the first clinically useful panel for the early detection of premature neonates at high risk of NBI.

S100B as a biomarker of brain injury in premature neonates. A prospective case - control longitudinal study.

BACKGROUND: Neonatal brain injury (NBI) is a serious adverse outcome in premature neonates. We sought to determine the levels and prognostic value of serum S100B during the first three days of life in premature neonates (<34 weeks) that later developed NBI in the form of either intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL). METHODS: This is a prospective case - control longitudinal study. Each case (n = 29) was matched according to birthweight and gestational age to one neonate with normal head ultrasound scans. RESULTS: Neonates with NBI, had significantly higher S100B concentration during the first three days of life. In both groups S100B was significantly higher on the first day when compared to the next two days of life showing a downwards trend. Serum S100B on the first day was the best predictor for adverse neonatal outcome such as death or II-IV IVH grade. A cut-off value of 10.51 ng/ml serum S100B performed a sensitivity of 100% and a specificity of 93.9% to predict adverse neonatal outcome. CONCLUSION: Further research on the predictive value of serum S100B regarding NBI in premature neonates is of great interest and may provide the first clinically useful biomarker for early detection of neonates at high risk.

Data on advanced glycation end-products concentrations and haemodynamic parameters following caffeine and nicotine consumption in nursing students.

This work presents data from a non-invasive interventional trial investigating the early effects of caffeine and nicotine on both the concentrations of advanced glycation end-products (AGEs) and haemodynamic parameters in 178 healthy nursing students aged between 18 and 40. These students were allocated into four groups (A, B, C and D) and the concentrations of AGEs as well as haemodynamic parameters were measured non-invasively using the AgeReader and the Finometer devices, respectively. The haemodynamic parameters that were measured included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, inter-beat interval, stroke volume, cardiac output, ventricular ejection time, total peripheral resistance, ascending aorta impedance and total arterial compliance. According to our protocol, each beverage contained 100 mg of caffeine each cigarette contained 1.5 mg of nicotine. The present data reveal the combined effect of smoke and caffeine consumption to several hemodynamic parameters that may be related to the onset of elevated blood pressure during smoking and following caffeine consumption.

The Development and Psychometric Evaluation of the Electronic Fetal Monitoring Knowledge Scale.

BACKGROUND: The aim of this study was to develop and assess the psychometric properties of the Electronic Fetal Monitoring Knowledge Scale (EFMKS), a self-report and short instrument measuring knowledge concerning Electronic Fetal Monitoring (EFM). Methods. The EFMKS was developed in a three-phase process by using an integrated mixed-methods approach that included literature reviews, professional focus groups, expert consultations and a psychometric survey evaluation. The psychometric evaluation was conducted by recruiting a sample of 128 professionals (midwives and doctors). Content validity, exploratory factor analysis, discriminant and construct validity, test-retest reliability and internal consistency were explored. RESULTS: The expert panel determined that the content validity was satisfactory. The final 10-item scale consisted of three factors explaining 73% of the total variance in the data. Discriminant validity was satisfactory. Internal consistency reliability (α = 0.89) and test-retest reliability (0.85) were satisfactory. The majority of the midwives and the obstetricians had a good level of knowledge while approximately one third of them had a low level of knowledge in EFM. CONCLUSION: The EFMK demonstrated good content validity, an easily interpretable three-factor structure, high internal consistency, high test-retest reliability, and satisfactory discriminant and construct validity with sample characteristics. The EFMKS may be used for evaluating the EFM knowledge of health professionals and for identifying the areas of their knowledge gap. Based on study findings, an annual multi-professional CTG training is necessary for all intrapartum staff and in particular for the midwives and doctors with shorter clinical experience in the labor ward.

Perinatal Cultural Aspects of African Refugee Women Resettled in Greece: Providing Culturally-sensitive Midwifery Care.

INTRODUCTION: African refugee women constitute a growing group of maternity service users in Greece. Being a refugee is considered a risk factor in itself for poorer maternal and neonatal health outcomes. These women additionally, are at high risk of perinatal complications, often due to misconceptions or absence of interpretation between providers and patients through different cultural concepts. Consequently, midwives may feel uncertainly experienced when provide perinatal care for a culturally diverse patient population. AIM: The aim of the study was to investigate perinatal cultural aspects and practices of African refugee pregnant women in Greece, in order to increase cultural awareness and improve midwifery care in a culturally-sensitive way. METHODS: Forty-two (n=42) African pregnant women who lived in a "Reception and Identification Center" on a greek island named "Samos", were included in the study. Women were selected by "simple random sampling" and asked to complete anonymously, with assistance of interpreters, a questionnaire that was devised by the authors with open-ended and closed-ended questions. RESULTS: Women were aged between 19-38 years old. The 50% (n=21) of them were from the Democratic Republic of the Congo, 28.6% (n=12) from Ghana and 21.4% (n=9) from Cameroon. Major themes emerging from the data analysis were: presence of antenatal care in African countries, potentiality of abortions, complications in previous pregnancy, supplement receipt in previous pregnancy after healthcarers' consultation, decision of birth place, support of traditional birth attendants' during pregnancy and birth, consumption of culturally acceptable food during pregnancy and birth, culturally accepted disposal of placenta, postpartum ceremonies for the baby and newborn's navel care. CONCLUSION: Increased understanding of the pluralistic African perinatal cultural aspects is essential. Inclusion of cultural insight and/or family members in decision making and implementation of training programmes culturally-oriented for midwives, can fulfil women's health, social needs and expectations.

Postpartum human breast milk levels of neutrophil gelatinase-associated lipocalin (NGAL) and matrix metalloproteinase-9 (MMP-9)/NGAL complex in normal and pregnancies complicated with insulin-dependent gestational diabetes mellitus. A prospective pilot case-control study.

Neutrophil gelatinase-associated lipocalin (NGAL) and its complex with matrix metalloproteinase-9 (MMP-9) are present in a variety of human tissues and extracellular fluids. The aim of this pilot prospective case-control study was to detect NGAL and MMP-9/NGAL complex in human breast milk postpartum in women with normal and pregnancies that developed insulin-depended gestational diabetes mellitus (iGDM). We detected both biomarkers in human breast milk and concentrations were determined at the first day of colostrum secretion and two days after, in 22 normal pregnancies and 13 pregnancies with iGDM. Mean NGAL concentration decreased significantly from the first to the second sample, in both groups. Mean MMP-9/NGAL complex concentration decreased also significantly from the first to the second sample in normal pregnancies. Mean complex concentration was significantly higher in diabetic pregnancies compared to normal ones in the second sample.IMPACT STATEMENTWhat is already known on this subject? There is limited information on the presence of Neutrophil gelatinase-associated lipocalin (NGAL) in human milk and its physiological role.What the results of this study add? It is the first time that MMP-9/NGAL complex is detected in human milk in both normal and pregnancies complicated with insulin-depended gestational diabetes mellitus (iGDM). We confirm the presence of NGAL in colostrum of normal pregnancies and for the first time we detected NGAL in milk of pregnancies with iGDM. Concentrations of NGAL and MMP-9/NGAL complex tend to lessen postpartum in both groups. Pregnancies with iGDM compared to normal ones showed significantly higher concentration of MMP-9/NGAL complex two days after the beginning of lactation.What the implications are of these findings for clinical practice and/or further research? Further studies are necessary to determine the levels of NGAL and MMP-9/NGAL complex in human milk postpartum in normal and pathological pregnancies. Taking into consideration the well-established NGAL's ability to act as a bacteriostatic agent and its mucosal healing activity in gastrointestinal track, early breastfeeding of neonates is a logical recommendation. Finally, new studies on the actual physiological role of milk NGAL in neonates are necessary.

Blood groups type linked to breast cancer in a Greek cohort of women - a case control study.

PURPOSE: To investigate the possible association between ABO blood types and breast cancer in Greek women. METHODS: 202 female patients with breast cancer and 139 healthy women as control group were examined clinically and with breast ultrasound and those older than 40 years, also with bilateral digital mammography. RESULTS: In the case-group, 26.7% had blood group O, 5.5% had blood group B, 61.9% had blood group A and 5.9% had blood group AB. In the control-group, 47.5% had blood group O, 13.7% had blood group B, 31.6% had blood group A and 7.2% had blood group AB. Usage of diagrams with the percentages of frequency, the average control, Pearson, Spearman, Student's t-tests analyzed with SPSS statistical software showed a significant correlation between breast cancer and blood group A (p<0.01). CONCLUSIONS: Although in the literature it is controversial whether ABO/Rh blood groups have association with breast cancer, the results of our study show a significant correlation between breast cancer and blood group A.

Reliability and Validity of the Greek Version of the Iowa Infant Feeding Attitude Scale Among Pregnant Women.

INTRODUCTION: A modifiable factor related to breastfeeding is breastfeeding attitudes. The Iowa Infant Feeding Attitude Scale (IIFAS) is used to evaluate this factor. Although the breastfeeding rates in Greece are declined there is not available any validated instrument to evaluate infant feeding attitudes. AIM: to determine the psychometric properties of the Greek adaptation of the IIFAS in a sample of pregnant women. MATERIALS AND METHODS: Pregnant women (N=203) from a University Hospital in Athens, Greece, were administered the Greek version of the IIFAS, while being in hospital, and their infant feeding mode at six months postpartum was recorded by telephone. The reliability of the scale was assessed by using corrected item-total correlations and Cronbach's alpha. Construct validity of the scale was assessed by using confirmatory factor analysis and predictive validity by using t-tests. Multiple linear regression analyses in a stepwise method (p for removal was set at 0.1 and p for entry was set at .05) was performed in order to find variables independently associated with IIFAS total score. RESULTS: The mean IIFAS score was 70.0 (SD=7.6). The corrected item-total correlation ranged from 0.22 to 0.51. Cronbach's alpha was equal to 0.71. The confirmatory factor analysis indicated an adequate fit of the one-factor model. Concerning the predictive validity of IIFAS it was significant for breastfeeding at six months. The mean IIFAS score was significantly greater (p=0.001) for women that had exclusive breastfeeding at six months (mean (SD): 68.4(6.6)) as compared with those that did not (mean (SD): 64.0(7.5)). Higher IIFAS scores were found in older women, with higher educational level and in those that had breastfed children in their social environment. CONCLUSION: The Greek version of the IIFAS demonstrated satisfying reliability and validity for measuring women's infant feeding attitudes in the Greek context. Also, the results of the present study provide further evidence of the international applicability of the IIFAS.

Measuring the Effectiveness of a Midwife-led Education Programme in Terms of Breastfeeding Knowledge and Self-efficacy, Attitudes Towards Breastfeeding, and Perceived Barriers of Breastfeeding Among Pregnant Women.

INTRODUCTION: Exclusive breastfeeding is the optimal mode of feeding for the first six months of a child's life. Modifiable factors associated with increased breastfeeding, may be addressed through antenatal breastfeeding education. In Greece, the rates of exclusive breastfeeding remain rather low. AIM: The aim of the current study was to evaluate the effectiveness of a structured in-hospital midwife-led antenatal breastfeeding educational programme on breastfeeding knowledge and self-efficacy, attitudes towards breastfeeding and perceived-barriers of breastfeeding. PATIENTS AND METHODS: This was a quasi-experimental study with two study groups: an intervention group (following a four-hour midwife-led antenatal breastfeeding programme) and a control group. All nulliparous women attending antenatal care at the tertiary hospital in Athens, Greece during May 2016-January 2017 were invited to participate, of which 203 nulliparous pregnant women took part. Demographic data forms, the Breastfeeding Self-efficacy Scale, the Iowa Infant Feeding Attitude Scale, the Breast Feeding Knowledge Questionnaire and the Perceived Breast Feeding Barriers Questionnaire were used for data collection. RESULTS: Post-intervention, women in the intervention group had a more positive attitude towards breastfeeding (73.5% versus 66.1%, p<0.001), greater knowledge (14.6% versus 13.1%, p<0.001) and more breastfeeding self-efficacy (51.4% versus 45.6%, p<0.001) compared to the control group. Furthermore, they had significantly less perceived barriers regarding breastfeeding (27.4% versus 31.0%, p<0.001). CONCLUSION: The four-hour antenatal breastfeeding education intervention which occurred and was evaluated for the first time in the Greek female population was effective in increasing breastfeeding knowledge, self-efficacy and a positive attitude towards breastfeeding. The intervention was furthermore effective in lowering perceived breastfeeding barriers. This midwife-led antenatal breastfeeding education programme could be suitable for integration to routine antenatal care in health care services in Greece.

Exposure to active and passive smoking among Greek pregnant women.

BACKGROUND: Active smoking and exposure to passive smoke are responsible for numerous adverse pregnancy outcomes for women and their infants. The aim of this study was to explore the perceptions, attitudes, patterns of personal tobacco use and exposure to environmental smoke among a sample of pregnant women in Greece. METHOD: A cross sectional survey was undertaken of 300 women identified from the perinatal care records of the Maternity Departments of two hospitals in Athens between February 2013 and May 2013. Data on active and passive maternal smoking status in the first, second, and third trimesters of pregnancy, fetal and neonatal tobacco related complications, exposure to environmental tobacco smoke during pregnancy, quit attempts, behaviors towards avoiding passive smoking and beliefs towards smoking cessation during pregnancy were collected using self-administered questionnaires on the 3rd postnatal day. Women also completed the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Of 300 women recruited to the study 48 % reported tobacco use during the first trimester of pregnancy. Amongst participants who were tobacco users, 83.3 % reported making an attempt to quit but less than half (45.1 %) were successful. Among women who continued to smoke during pregnancy the majority (55.8 %) reported that they felt unable to quit, and 9.3 % reported that they considered smoking cessation was not an important health issue for them. Participants who continued to smoke during pregnancy were more likely to report fetal (χ2 = 11.41; df = 5; p < 0.05) and newborn complications (χ2 = 6.41; df = 2; p < 0.05), including preterm birth and low birth weight. Participants who reported that their partners were smokers were more likely to smoke throughout their pregnancy (χ2 = 14.62; df = 1; p < 0.001). High rates of second-hand smoke exposure were reported among both smoking and non-smoking women. Pregnant smokers had significantly higher levels of postnatal depressive and anxiety symptomatology, as measured using the EPDS, than non-smokers. CONCLUSION: Our data supports the importance of ensuring that pregnant women, their partners and close relatives are educated on the health risks of active and passive smoking and how these could have an adverse effect to their fetus and infants, as well as the pregnant women themselves.

Childbirth efficacy: Validating the childbirth self-efficacy inventory in a Greek sample of pregnant women.

OBJECTIVE: childbirth self-efficacy has been found to be a factor that influences women's decision about their choice of delivery. Greece is a country with a high caesarean section rate and the validation of the Childbirth Self-Efficacy Inventory (CBSEI) would help explore Greek pregnant women's emotional preparation of childbirth. The aim of the study was to translate the CBSEI to Greek and to examine its psychometric properties. DESIGN: a cross-sectional study. SETTING: private hospital in Athens, Greece. PARTICIPANTS: 145 pregnant women, in late pregnancy, attending routine antenatal visit between April 2014 and June 2014. MEASUREMENTS: the CBSEI was 'forward-backward' translated from English to Greek language. Descriptive statistics and non-parametric tests were used to describe and compare the scales. Factor structure was investigated using principal axis factoring. Measures of self-esteem and optimism were used to assess the convergent validity of the CBSEI. Cronbach's α was used to measure internal consistency reliability. FINDINGS: the factor analysis suggested the existence of a three-factor structure with meaningful groupings. Greek women were able to distinguish between outcome expectancy and self-efficacy expectancy and between the two labour stages, active phase of the first stage and the second stage of labour. Construct validity was confirmed by computing correlations between the CBSEI subscales and conceptually similar constructions of self-esteem and optimism. Internal consistency reliability was satisfactory. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: the Greek version of the CBSEI is a reliable and valid measure. The clinical use of CBSEI may enable midwives and other health care professionals to identify pregnant women with low childbirth self-efficacy. The clinical use of CBSEI may also give the opportunity to provide information and support for preparing and empowering women for childbirth in order to improve their childbirth experience.