The effects of smoking cessation and a programme intervention on birth and other perinatal outcomes among rural pregnant smokers.

OBJECTIVE: The purpose of this study was to evaluate the perinatal outcomes of rural pregnant smokers enrolled in the Smoke Free Baby & Me trial. METHODS: Data on smoking status and other pre-natal variables were collected during pregnancy. Outcomes were retrieved from a review of hospital records of 161 singleton births (79 from the control group, 82 from the intervention group). RESULTS: The results show that, after adjusting for gender and gestational age, the more self-reported cigarettes at the first pre-natal visit, the less the infant birth weight (p = 0.033), the less maternal weight gain (p = 0.042) and the shorter the labour length (p = 0.041). Infants of women with positive urinary cotinine at the first pre-natal visit in the intervention group had higher 1 minute Apgar scores than those with negative cotinine (p = 0.022). Smokers also had a preponderance of male infants (64% vs 36%), while non-smokers had more females (59% vs 41%) (p = 0.006). CONCLUSIONS: Smoking during pregnancy affects perinatal outcomes. Assuming a foetal origin of chronic disease morbidity, implementing smoking cessation during pregnancy would not only improve maternal and foetal health, but also might contribute to an improvement in the incidence of adult chronic disease morbidity.

Comparison of self-reported smoking and urinary cotinine levels in a rural pregnant population.

OBJECTIVES: (a) to assess the accuracy of self-reported smoking status in pregnant women from rural and small metropolitan statistical areas who stated they were smokers at the onset of pregnancy, (b) to compare the characteristics of these women who self-reported a nonsmoker status at the first prenatal visit with those who reported a smoker status, and (c) to determine the characteristics that predict self-reported smoking status and positive/negative urinary cotinine assays. SETTING: Seven private obstetric offices serving rural and small metropolitan statistical areas in upstate New York. PARTICIPANTS: A convenience sample of 94 pregnant women who stated they were smokers at the onset of their pregnancies. Their mean age was 23 years and mean level of education was 11.9 years; 95% were White, 65% were single, and 65% were Medicaid-funded. DESIGN: Descriptive correlational design. At the first prenatal visit, the sensitivity and specificity of smoking and nonsmoking status were determined by comparing self-reports of smoking status with urinary cotinine assays. Data were also analyzed for relationships among demographic variables and for predictors of smoking status and urinary cotinine. RESULTS: The discordance rate between self-reports of smoking status and urinary cotinine assays at the first prenatal visit for the total sample was 16.6%, significant at p < .001, chi-square = 27.80, df = 1. Based on biochemical assays of >200 ng/ml of cotinine indicating active smoking, 34.7% of women who denied smoking (specificity of 65.3%) and 10.4% of women who stated that they smoked (sensitivity of 89.5%) inaccurately reported their status (significant at p < .001). The number of cigarettes smoked per day was positively correlated with age, gravidity, parity, and number of smokers in the household. Gravidity and the number of smokers in the household were significant predictors of positive self-report of smoking status and of positive urinary cotinine assay. CONCLUSION: These results substantiate the unreliability of self-report on smoking status in the pregnant population and in women who are recent quitters. Such findings have implications for clinical practice, such as (a) changes are necessary in how the prenatal interview assesses past and present tobacco use, (b) pregnant smokers who are multigravidae and who live with other smokers need more tailored interventions, and (c) more research is needed on how self-report can be ethically and efficiently validated.