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CORK Bibliography: Pregnancy

96 citations. October 2006 to present

Prepared: September 2007

Adeney KL; Williams MA; Schiff MA; Qiu CF; Sorensen TK. Coffee consumption and the risk of gestational diabetes mellitus. Acta Obstetricia et Gynecologica Scandinavica 86(2): 161-166, 2007. (24 refs.)

Background. Coffee consumption has been associated with a decreased risk of type 2 diabetes mellitus. We examined the relationship between coffee consumption and the risk of gestational diabetes mellitus [GDM]. Methods. In this prospective study, 1744 non-diabetic pregnant women were questioned during early gestation about their coffee consumption. We studied the association of coffee consumption before and during pregnancy, and the subsequent risk of GDM. Generalised, linear models were fitted to estimate risk ratios and 95% confidence intervals. Results. Women who reported moderate pre-pregnancy caffeinated coffee intake had a significantly reduced risk of GDM (adjusted RR 0.50; 95% CI 0.29-0.85) compared with non-consumers. No risk reduction was associated with decaffeinated coffee intake. Conclusions. Moderate pre-pregnancy caffeinated coffee consumption may have a protective association with GDM. Prospective studies, including a wider range of consumption habits, are necessary.

Albrecht SA; Caruthers D; Patrick T; Reynolds M; Salamie D; Higgins LW et al. A randomized controlled trial of a smoking cessation intervention for pregnant adolescents. Nursing Research 55(6): 402-410, 2006. (42 refs.)

Background: The smoking prevalence rate among pregnant adolescents has been estimated at 59-62%, and 60-80% of these adolescents continue to smoke throughout their pregnancies. Objectives: The aim of this study was to evaluate the short- and long-term effects. of smoking cessation strategies tailored to the pregnant adolescent to attain and maintain abstinence. The specific aim was to examine differences in short- and long-term smoking behaviors among three groups: Teen FreshStart (TFS), Teen FreshStart Plus Buddy TFS-B, and Usual Care (UC) control. Methods: In this randomized controlled intervention study, a 3-group (TFS, TFS-B, and UC) by 3-occasion (baseline, 8 weeks postrandomization, and 1-year following study entry) design was used. The study included 142 pregnant adolescents who were aged 14 to 19 years. Both self-reported smoking status collected on the Smoking History Questionnaire and saliva cotinine levels were used to identify smoking behaviors. Results: There were no significant differences among the three treatment groups at baseline in terms of the racial, distribution, age, gestational age, age of menses initiation, number in family household, number of family members who smoked, or tobacco use. A significant difference be tween the UC group and the TFS-B group (p = .010) was seen in smoking behaviors measured 8 weeks following treatment initiation. At 1 year following study entry, however, there were no differences between the groups in smoking behaviors. Discussion: The TFS-B intervention was more effective in attaining short-term smoking cessation in the pregnant adolescent than TFS or UC. Findings suggest that the peer-enhanced programming had a limited effect but could not sustain the participant beyond postpartum (1 year following study entry). Future studies should include relapse prevention to sustain smoking abstinence into the postpartum period.

Anderson JE; Ebrahim S; Floyd L; Atrash H. Prevalence of risk factors for adverse pregnancy outcomes during pregnancy and the preconception period - United States, 2002-2004. Maternal and Child Health Journal 10(5 Supplement): s101-s106, 2006. (16 refs.)

Objectives: To assess the prevalence of risk factors for adverse pregnancy outcome during the preconception stage and during pregnancy, and to assess differences between women in preconception and pregnancy. Methods: Data from the 2002 and 2004 Behavioral Risk Factor Surveillance System, United States, were used to estimate the prevalence of selected risk factors among women 18-44 in the preconception period (women who wanted a baby in the next 12 months, and were not using contraception, not sterile and not already pregnant) with women who reported that they were pregnant at the time of interview. Results: Major health risks were reported by substantial proportions of women in the preconceptional period and were also reported by many pregnant women, although pregnant women tended to report lower levels of risk than preconception women. For example, 54.5% of preconception women reported one or more of 3 risk factors (frequent drinking, current smoking, and absence of an HIV test), compared with 32.0% of pregnant women (p < .05). The difference in the prevalence of these three risk factors between preconception and pregnancy was significant for women with health insurance (52.5% in preconception vs. 29.4% in pregnancy, p < .05), but not for women without insurance (63.4% vs. 52.7%, p > .05). Conclusions: Women appear to be responding to messages regarding behaviors that directly affect pregnancy such as smoking, alcohol consumption and taking folic acid, but many remain unaware of the benefits of available interventions to prevent HIV transmission and birth defects. Although it appears that some women reduce their risk for adverse pregnancy outcomes after learning of their pregnancy, the data suggest that a substantial proportion of women do not. Furthermore, if such change occurs it is often too late to affect outcomes, such as birth defects resulting from alcohol consumption during the periconception period. Preconception interventions are recommended to achieve a more significant reduction in risk and further improvement in perinatal outcomes.

Askew JP. Zolpidem addiction in a pregnant woman with a history of second-trimester bleeding. Pharmacotherapy 27(2): 306-308, 2007. (7 refs.)

Whether zolpidem crosses the placenta in humans is unknown. A 30-year-old Caucasian woman with a history of zolpidem abuse underwent spontaneous vaginal delivery at 38 weeks' gestation. Total fetal exposure to zolpidem was unknown, but it was estimated to be at least 1000 mg over at least 1 month. Typical peak plasma concentrations after a single 5- and 10-mg dose of zolpidem are 29-113 ng/ml (mean 59 ng/ml) and 58-272 ng/ml (mean 121 ng/ml), respectively Cord blood was sampled for zolpidem, with a result of 41 ng/ml. Despite the presence of zolpidem in the cord blood sample, the neonate was active and alert after normal delivery. No withdrawal symptoms were noted, and the mother and neonate were discharged home after 48-hour observation. This case report indicates that zolpidem crosses the human placenta, as was exemplified with cord blood sampling. The drug should therefore be used during pregnancy only if clearly necessary.

Bada HS; Reynolds EW; Hansen WF. Marijuana use, adolescent pregnancy, and alteration in newborn behavior: How complex can it get? (editorial). Journal of Pediatrics 149(6): 742-745, 2006. (40 refs.)

Barron J; Petrilli F; Strath L; McCaffrey R. Successful interventions for smoking cessation in pregnancy. American Journal of Maternal-Child Nursing 32(1): 42-47, 2007. (24 refs.)

The purpose of this article is to evaluate research regarding beneficial approaches to smoking cessation interventions during pregnancy. Research about nicotine replacement, nurse-managed counseling sessions, hypnosis, and behavioral modifications are presented. One of the most useful types of program for smoking cessation in pregnancy (as measured by cotinine-validated abstinence) described in the literature thus far has been the nurse-managed smoking cessation program, which includes a 15-minute individualized counseling session combined with a telephone contact 7-10 days after the prenatal visit. More research is needed in this important area of nursing practice.

Barros MCD; Guinsburg R; Peres CD; Mitsuhiro S; Chalem E; Laranjeira RR. Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period. Journal of Pediatrics 149(6): 781-787, 2006. (37 refs.)

Objective: To assess the neurobehavior of full-term neonates of adolescent mothers exposed to marijuana during pregnancy. Study design: This prospective cross-sectional study included full-term infants within 24 to 72 hours of life born to adolescent mothers at a single center in Brazil. Data on sociodemographic and obstetrical and neonatal characteristics were collected. The mothers underwent the Composite International Diagnostic Interview, and the infants were assessed with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Maternal hair and neonatal meconium were analyzed. Neonates exposed in utero to tobacco, alcohol, cocaine, and/or any other drugs except marijuana were excluded. Results: Of 3685 infants born in the study hospital, 928 (25%) were born to adolescent mothers. Of these, 561 infants met the inclusion criteria and were studied. Marijuana exposure was detected in 26 infants (4.6%). Infants exposed (E) or not exposed (NE) to marijuana differed in the following NNNS variables: arousal (E, 4.05 +/- 1.19 vs NE, 3.68 +/- 0.70), regulation (E, 5.75 +/- 0.62 vs NE, 6.04 +/- 0.72), and excitability (E, 3.27 +/- 1.40 vs NE, 2.40 +/- 1.57). After controlling for confounding variables, the effect of marijuana exposure on these scores remained significant. Conclusions: Marijuana exposure during pregnancy alters the neurobehavioral performance of term newborn infants of adolescent mothers.

Bech BH; Autrup H; Nohr EA; Henriksen TB; Olsen J. Stillbirth and slow metabolizers of caffeine: Comparison by genotypes. International Journal of Epidemiology 35(4): 948-953, 2006. (31 refs.)

Background: Cytochrome P4501A2 (CYP1A2) and N-acetyltransferase 2 (NAT2) are key enzymes in the metabolism of caffeine. The polymorphism of these genes facilitates the detection of fast and slow metabolizers, and if caffeine is causally related to stillbirth, we expect slow metabolizers to have a higher risk of stillbirth at any given intake of caffeine. Gluthatione S-transferase alpha 1 (GSTA1) may also be active in the metabolism of caffeine as it conjugates glutathione to aromatic amines. Our study, therefore, included analyses of the association between GSTA1 and stillbirth. Methods A nested case non-case study among women who participated in the Danish National Birth Cohort: 142 cases of singleton stillbirths and 157 controls of singleton live births. Results: Slow oxidizer status (CYP1A2), slow acetylator status (NAT2), and low activity of GSTA1 were not individually associated with the risk of stillbirth [odds ratio (OR) = 1.06, 95% confidence interval (95% CI) 0.67-1.67, OR = 0.95, 95% CI 0.60-1.51, and OR = 1.42, 95% CI 0.88-2.28, respectively]. We did, however, observe that subjects with a combination of slow CYP1A2, slow NAT2, and low GSTA1 genes had almost a 2-fold risk of stillbirth compared with subjects with other combinations of genotypes. Conclusions: We found no link between any single genotype and the risk of stillbirth. An association between a combination of genotypes and stillbirth was discovered. Caffeine may be causally related to stillbirth, but larger studies using Mendelian randomization are needed to verify this.

Bech BH; Obel C; Henriksen TB; Olsen J. Effect of reducing caffeine intake on birth weight and length of gestation: Randomised controlled trial. British Medical Journal 334(7590): 409-412B, 2007. (29 refs.)

Objective: To estimate the effect of reducing caffeine intake during pregnancy on birth weight and length of gestation. Design Randomised double blind controlled trial. Setting: Denmark. Participants: 1207 pregnant women drinking at least three cups of coffee a day, recruited before 20 weeks' gestation. Interventions Caffeinated instant coffee (568 women) or decaffeinated instant coffee (629 women). Main outcome measures: Birth weight and length of gestation. Results Data on birth weight were obtained for 1150 liveborn singletons and on length of gestation for 1153 liveborn singletons. No significant differences were found for mean birth weight or mean length of gestation between women in the decaffeinated coffee group (whose mean caffeine intake was 182 mg lower than that of the other group) and women in the caffeinated coffee group. After adjustment for length of gestation, parity, prepregnancy body mass index, and smoking at entry to the study the mean birth weight of babies born to women in the decaffeinated group was 16 g (95% confidence interval -40 to 73) higher than those born to women in the caffeinated group. The adjusted difference (decaffeinated group-caffeinated group) of length of gestation was -1.31 days (-2.87 to 0.25). Conclusion: A moderate reduction in caffeine intake in the second half of pregnancy has no effect on birth weight or length of gestation.

Bell JF; Zimmerman FJ; Mayer JD; Almgren GR; Huebner CE. Associations between residential segregation and smoking during pregnancy among urban African-American women. Journal of Urban Health 84(3): 372-388, 2007. (77 refs.)

Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born African-American women (n = 403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important socio-demographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

Bracken MB. Cotinine and spontaneous abortion: Might variations in metabolism play a role? (editorial). Epidemiology 17(5): 492-494, 2006. (15 refs.)

Britton GRA; Brinthaupt J; Stehle JM; James GD. The effectiveness of a nurse-managed perinatal smoking cessation program implemented in a rural county. Nicotine & Tobacco Research 8(1): 13-28, 2006. (50 refs.)

The present study (a) examined the effectiveness of a nurse-managed smoking cessation program, that was totally integrated into routine perinatal care, on the cessation rates of pregnant smokers in a rural community, and (b) assessed the subject characteristics associated with smoking cessation success. Data were collected from a convenience sample of 194 pregnant women who stated that they were smokers at the onset of their pregnancies. The study compared the effects of usual care (n=93) versus the Smoke Free Baby & Me program (n=101), which included the American Cancer Society's Make Yours a Fresh Start Family program. Smoking status was measured by self-report and urinary cotinine at four points during pregnancy and postpartum. At the postpartum visit, more women in the experimental group reported that they were not smoking compared with those in the control group (37.3% vs. 16.7%), Pearson's x(2) (n=87)=4.37, p=.037, and they had higher validated (urinary cotinine < 200 ng/ml) smoking cessation rates (n=80, t=2.449, p=.017) if they had quit smoking by the first prenatal visit. Smoking cessation was positively associated with level of education and negatively associated with gravidity, parity, the number of smokers in the household, and the number of cigarettes smoked per day at the first prenatal visit. Significant discordance was found between self-report and urinary cotinine assays at all prevalence points, regardless of group. In conclusion, this nurse-delivered program integrated into perinatal care influenced the smoking behaviors of "recent quitters'' but had no effect on those who reported smoking at the first prenatal visit. Implications for clinical practice are discussed.

Burns, L.; Mattick, RP; Lim, K.; Wallace, C. Methadone in pregnancy: Treatment retention and neonatal outcomes. Addiction 102(2): 264-270, 2007. (41 refs.)

Aim: To examine the association between retention in methadone treatment during pregnancy and key neonatal outcomes. Design: Client data from the New South Wales Pharmaceutical Drugs of Addiction System was linked to birth information from the NSW Midwives Data Collection and the NSW Inpatient Statistics Collection from 1992 to 2002. Measurements Obstetric and perinatal characteristics of women who were retained continuously on methadone maintenance throughout their pregnancy were compared to those who entered late in their pregnancies (less than 6 months prior to birth) and those whose last treatment episode ended at least I year prior to birth. Findings There were 2993 births to women recorded as being on methadone at delivery, increasing from 62 in 1992 to 459 births in 2002. Compared to mothers who were maintained continuously on methadone throughout their pregnancy, those who entered treatment late also presented later to antenatal services, were more likely to arrive at hospital for delivery unbooked, were more often unmarried, indigenous and smoked more heavily. A higher proportion of neonates born to late entrants Were born at less than 3 7 weeks gestation and were admitted to special care nursery more often. Conclusion: Continuous methadone treatment during pregnancy is associated with earlier antenatal care and improved neonatal outcomes. Innovative techniques for early engagement in methadone treatment by pregnant heroin using women or those planning to become pregnant should be identified and implemented.

Centers for Disease Control; Sullentrop K; Morrow B; Williams L; D'Angelo D. Monitoring progress toward achieving maternal and infant Healthy People 2010 Objectives -- 19 states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003. MMWR. Morbidity and Mortality Weekly Report 55(No. SS-9): 1-13, 2006. (42 refs.)

Problem/Conditions: Certain modifiable maternal behaviors and experiences before, during and after pregnancy are associated with adverse health outcomes for the mother and her infants (.e.g. physical abuse, smoking during pregnancy, insufficient folic acid, and improper sleep position.) Information about these behaviors and experiences is needed to monitor trends in maternal and infant health, enhance understanding of the relation between maternal behaviors and infant health outcomes, plan and evaluate maternal and infant health programs, direct policy decisions and monitor progress toward achieving the national Health People 2010 objectives. Reporting Period: 2000-2003. Description of System: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state-and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during and after pregnancy among women who deliver live-born infants. it employs a mixed mode data-collection methodology. the report summarizes data for 2000-2003 from 19 states that measured progress toward achieving HP 2010 objectives for eight perinatal indicators:1) pregnancy intention, 2) multivitamin use, 3) physical abuse, 4) cigarette smoking during pregnancy, 5) cigarette smoking cessation, 6) drinking alcohol during pregnancy, 7) breastfeeding initiation, and 8) infant sleep position. Results: in respect to the alcohol/drug components, in 2003 prevalence of abstinence from smoking during the last 3 months of pregnancy ranged from 72.5% in West Virginia to 96.1% in Utah. In 12003, prevalence of abstinence from alcohol during the last three months of pregnancy ranged from 91/3% in Colorado to 98.0% in Utah. In 2003, all 19 states achieved or exceeded the HP 2010 objective for smoking cessation during pregnancy and 16 states achieved the objectives for abstinence from alcohol in the last three months of pregnancy.

Public Domain

Chambers CD; Kavteladze L; Joutchenko L; Bakhireva LN; Jones KL. Alcohol consumption patterns among pregnant women in the Moscow region of the Russian Federation. Alcohol 38(3): 133-137, 2006. (18 refs.)

Data regarding the prevalence and patterns of alcohol consumption among pregnant women in the Russian Federation is lacking. As part of a longitudinal pregnancy outcome study being conducted in the Moscow Region of Russia, in the 5-month period from January through May 2005, pregnant women in four prenatal care facilities were screened for self-reported alcohol consumption in the month around the time of conception and in the most recent month of pregnancy. Among the 413 respondents, 347 (85.0%) reported some alcohol consumption during one of the two time periods, and 193 (51.9%) of these drinking women reported some alcohol use in the most recent month. Of particular concern was the pattern of drinking, with 75 (20.2%) of drinking women reporting at least one episode of five or more drinks around the time of conception, and 153 (41.1%) of drinking women reporting at least one episode of three or four drinks during that same time period. Furthermore, this same pattern of heavier episodic drinking was reported by 18 (4.8%) and 39 (10.5%) of drinking women, respectively, in the most recent month in pregnancy before the screening interview. These data indicate that pregnant women in these areas of the Moscow Region present an important opportunity for education and intervention for alcohol-related birth outcomes.

Chiaffarino F; Parazzini F; Chatenoud L; Ricci E; Sandretti F; Cipriani S et al. Alcohol drinking and risk of small for gestational age birth. European Journal of Clinical Nutrition 60(9): 1062-1066, 2006. (17 refs.)

Objective: To assess if alcohol drinking is a risk factor for small for gestational age (SGA) birth. Methods: Case-control study. Cases were 555 women (mean age 31 years, range 16-43) who delivered SGA babies at the Clinica Luigi Mangiagalli and the Obstetric and Gynecology Clinic of the University of Verona. The controls were 1966 women (mean age 31 years, range 14-43) who gave birth at term (>= 37 weeks of gestation) to healthy infants of normal weight at the hospitals where cases had been identified. Results: No increase in the risk of SGA birth was observed in women drinking one or two drinks/day in pregnancy, but three or more per day increased the risk: odds ratios (OR) were 3.2 (1.7-6.2) for >= 3 drinks during the first trimester, 2.7 (1.4-5.3) during the second and 2.9 (1.5-5.7) during the third. Conclusions: The study shows an increased risk of SGA births in mothers who drink >= 3 units/day of alcohol in pregnancy.

Coleman T; Thornton J; Britton J; Lewis S; Watts K; Coughtrie MWH et al. Protocol for the Smoking, Nicotine and Pregnancy (SNAP) trial: double-blind, placebo-randomised, controlled trial of nicotine replacement therapy in pregnancy. BMC Health Services Research 7(article 2), 2007. (35 refs.)

Background: Smoking in pregnancy remains a public health challenge. Nicotine replacement therapy (NRT) is effective for smoking cessation in non-pregnant people, but because women metabolise nicotine and cotinine much faster in pregnancy, it is unclear whether this will be effective for smoking cessation in pregnancy. The NHS Health Technology Assessment Programme (HTA)-funded smoking, nicotine and pregnancytrial will investigate whether or not nicotine replacement therapy is effective, cost-effective and safe when used for smoking cessation by pregnant women. Methods/Design: Over two years, in 5 trial centres, 1050 pregnant women who are between 12 and 24 weeks pregnant will be randomised as they attend hospital for ante-natal ultrasound scans. Women will receive either nicotine or placebo transdermal patches with behavioural support. The primary outcome measure is biochemically-validated, self-reported, prolonged and total abstinence from smoking between a quit date ( defined before randomisation and set within two weeks of this) and delivery. At six months after childbirth self-reported maternal smoking status will be ascertained and two years after childbirth, self-reported maternal smoking status and the behaviour, cognitive development and respiratory symptoms of children born in the trial will be compared in both groups. Discussion: This trial is designed to ascertain whether or not standard doses of NRT (as transdermal patches) are effective and safe when used for smoking cessation during pregnancy.

Conners CA; Grant A; Crone CC; Whiteside-Mansell L. Substance abuse treatment for mothers: Treatment outcomes and the impact of length of stay. Journal of Substance Abuse Treatment 31(4): 447-456, 2006. (45 refs.)

This article examines the treatment outcomes of 305 women enrolled in a comprehensive, residential substance abuse treatment program for pregnant and parenting women and their children. The women were assessed at intake and three times in the year after discharge. Analyses focused on change in client functioning over time, and investigating the impact of length of stay in treatment on client outcomes. Comparisons of clients' functioning before and after treatment suggest significant improvements in a number of domains, including substance use, employment, legal involvement, mental health, parenting attitudes, and risky behaviors. For most outcome domains, results suggest that longer treatment stays are associated with more positive outcomes.

Conroy E; Degenhardt L; Day C. Impact of drug market changes on substance-using pregnant women in three key Sydney drug markets. Women & Health 44(4): 93-105, 2006. (27 refs.)

Introduction: In 2001 the supply of heroin was substantially reduced across Australia. Given the child protection concerns associated with the use of substances hy pregnant women, it was pertinent to examine how the reduction in the supply of heroin affected this community of users. This paper aimed to assess the extent of any drug-related problems among pregnant women associated with the reduction in heroin supply in New South Wales (NSW). Method: Two sources of data were used: (1) Data on hospital visits in NSW in which drug and alcohol problems were noted as complicating the pregnancy; and (2) Key informant reports from services targeting substance-using pregnant women across the three main Sydney drug markets. Results: The shortage did not affect the number of hospital separations for substance-using pregnant women, nor the number of women referred to services for substance use in pregnancy. Key informants reported an increase in the use of cocaine among pregnant women and achange in injection sites for some women (including into breast tissue). No substantial change in adverse outcomes was observed to be associated with this change in patterns of drug use. Discussion: The reduction in heroin Supply appeared to have limited impact on the number of substance-using pregnant women as assessed by hospital episodes and key informant reports. The evidence suggested an increase in the injecting of cocaine by pregnant women using drug treatment services, similar to the changes in drug use patterns observed among other groups of injecting drug users. The lack of change observed in the qualitative and statistical data regarding adverse health consequences associated with cocaine injecting suggests the potentially negative impact of maternal cocaine use on infant health may be difficult to detect and monitor.

Cordero DR; Medina C; Helfgott A. Cocaine body packing in pregnancy. Annals of Emergency Medicine 48(3): 323-325, 2006. (25 refs.)

Ingesting multiple packets of drugs ("body packing") is a well-described method of smuggling. Although older reports suggested that body packers were mostly young men, the demographics of this group may be changing because children, older patients, and pregnant women may be involved. Pregnant patients represent a challenge in management, particularly in the event of package rupture. Modification of standard management protocols, which were developed for nonpregnant body packers, may be necessary to address the anatomic and physiologic changes of pregnancy. We report the case of a pregnant cocaine body packer who required a perimortem cesarean section after the rupture of a cocaine packet. The care of the pregnant body packer is discussed.

Crome IB; Kumar MT. Epidemiology of drug and alcohol use in young women. Seminars in Fetal & Neonatal Medicine 12(2): 98-105, 2007. (57 refs.)

An understanding of the epidemiology of alcohol and drug use in young women is important for three main reasons: (1) to appreciate that substance use, misuse, harmful use and dependence are associated with considerable mortality and physical and psychological morbidity; (2) to understand the nature and extent of these problems and the Likely impact on the fetus, neonate and infant through childhood to adolescence; and (3) to utilize this information as part of a needs assessment to develop effective services, which detect problems and deliver appropriate interventions. Although abstention rates are consistently higher among women than men in general, substance misuse is increasing in young women. Simultaneously, there is great variability in prevalence rates in different countries, regions of countries and in different ethnic groups. This can be explained in part by differences in definitions, measurement techniques, availability, price, social acceptability, seizure and arrest policies, and in patterns and modes of use. During pregnancy, up to 15% of women may be using alcohol and about 5% may be using illicit drugs. The proportion of women using substances is less at term than in the early stages of pregnancy. Despite this, substance use rises sharply in the first 6 months postpartum. Detection of substance use in obstetric units is low but perinatal substance misuse intervention reduces adverse neonatal outcomes. On the basis of the relatively high rate of substance use disorders during pregnancy, effective screening and intervention strategies should be implemented.

Datner EM; Wiebe DJ; Brensinger CM; Nelson DB. Identifying pregnant women experiencing domestic violence in an urban emergency department. Journal of Interpersonal Violence 22(1): 124-135, 2007. (17 refs.)

The article describes characteristics of pregnant women presenting to the Emergency Department (ED) who are experiencing current violence and presented a screening tool to identify pregnant women experiencing violence. Women completed an in-person interview regarding violence, socio-demographic factors, health status, and drug use. Fifteen percent of women reported at least one episode of violence during the pregnancy. Young age (OR = 3.37, 95% CI: 1.79-6.36), current alcohol use (OR = 1.53, 95% CI: 1.06-2.19), current marijuana use (OR = 1.96, 95% CI: 1.32-2.92), less than a high school education (OR = 1.46, 95% CI: 1.01-2.12), and a prior diagnosis of trichomonas (OR = 1.81, 95% CI: 1.20-2.72) were significantly related to experiencing current violence. Screening patients using these five characteristics identified 8 out of 10 women reporting violence (sensitivity 75.6%). These results identify a set of predictors that may be helpful in identifying pregnant women who are experiencing current domestic violence.

de Vries H; Bakker M; Mullen PD; van Breukelen G. The effects of smoking cessation counseling by midwives on Dutch pregnant women and their partners. Patient Education and Counseling 63(1-2): 177-187, 2006. (63 refs.)

Objective: Smoking during pregnancy is,an important problem in the Netherlands. We tested the effectiveness of a health counseling method by midwives using a RCT. Methods: Four provinces with 42 practices including 118 midwives were randomly assigned to the experimental or control condition. Midwives in the experimental group provided brief health counseling, self-help materials on smoking cessation during pregnancy and early postpartum, and a partner booklet. Controls received routine care. The main outcome measures were 7-day abstinence, continuous abstinence, and partner smoking at 6 weeks post-intervention (T1) and 6 weeks postpartum (T2). Results: Multi-level analysis revealed significant differences between both conditions at T1 and T2 using intention-to-treat analysis. Nineteen percent of the experimental group reported 7-day abstinence compared to 7% of the control group at T1, and 21 and 12%, respectively, at T2. For continuous abstinence these percentages were 12% in-the experimental group and 3% in the control group. The partner intervention was not successful. Conclusion: The intervention resulted in significant effects on smoking behavior for pregnant women, but not for partner smoking. Practice implications: The program realized short-term effects. An important precondition is that midwives need a proper training.

Dew PC; Guillory VJ; Okah FA; Cai JW; Hoff GL. The effect of health compromising behaviors on preterm births. Maternal and Child Health Journal 11(3): 227-233, 2007. (45 refs.)

Objectives: The objective of our study was to determine whether there were combined effects of smoking, alcohol, and illicit drug use during pregnancy on the frequency of preterm births, and if so, the magnitude of the association after adjusting for confounding factors. Methods: We conducted a retrospective cohort study of singleton live births in Kansas City, Missouri from 1990-2002. We defined health compromising behaviors as the use of cigarettes, alcohol, and illicit drugs. The effect of these behaviors on preterm births was considered for each substance individually, and in combination. The rates of preterm births for these groups were calculated. Using logistic regression, adjusted odds ratios were used to estimate the relative risk of preterm births among these groups. Results: Over 13% of infants born to women who smoked were preterm, compared to 9.6% for non-smokers. Of infants born to women who reported alcohol use, 17.3% were preterm compared to 10.1% for non-drinkers. Smoking and alcohol use in combination was associated with 18.0% preterm births, while alcohol and drug use in combination was associated with 20.8% preterm births. The use of all three substances was associated with 31.4% preterm births. Conclusion: Women who engaged in health compromising behaviors during pregnancy showed an increased proportion of preterm births compared to those who did not. There is significant interaction between these behaviors leading to higher rates of preterm births than predicted by their additive effects. To decrease preterm births, we must deal with the effects of smoking, drinking, and drug use simultaneously.

Donath S. Women and drugs. IN: Hamilton M; KIng T; Ritter A, eds. Drug Use in Australia: Preventing Harm, 2nd Ed.. Oxford: Oxford University Press, 2004. pp. 102-115. (320 book refs.)

This chapter addresses drug use among women in Australia. There is data on the patterns of drug use, with particular attention to tobacco, alcohol, and pharmaceuticals. Special issues related to drug use problems among women are described, including stigmatization, as well as common themes in treatment, such as domestic abuse, comorbidity with other mental-health problems, childhood sexual abuse as a risk factor, and use of drugs during pregnancy. The chapter concludes with consideration of particular treatment needs, as well as the costs to women arising from others' drug problems.

Dornelas EA; Magnavita J; Beazoglou T; Fischer EH; Oncken C; Lando H et al. Efficacy and cost-effectiveness of a clinic-based counseling intervention tested in an ethnically diverse sample of pregnant smokers. Patient Education and Counseling 64(1-3): 342-349, 2006. (69 refs.)

Objective: Rates of cigarette smoking are higher among women who receive obstetric care through publicly funded prenatal clinics. This study compared smoking outcomes for pregnant women (n = 105) who were randomized to receive either usual care (standard cessation advice from the health care provider) or an intervention conducted in the prenatal clinic consisting of 1.5 h of counseling plus telephone follow-up delivered by a masters prepared mental health counselor. Methods: Subjects were 105 low income, predominantly Hispanic, pregnant patients in an urban prenatal clinic. Smoking outcomes were assessed at end of pregnancy and 6 months post-partum. Results: At follow-up, 28.3% and 9.4% of participants in the experimental intervention and 9.6% and 3.8% of patients in usual care were abstinent at end of pregnancy (p = .015) and 6 months post-partum, respectively (p = .25 1). Cost of the intervention was $56 per patient and cost to produce a non-smoker at end of pregnancy was $299. Conclusions: This model for intervention was cost-effective and was associated with significantly lower smoking rates at end of pregnancy. Practical implications: If these findings are replicated, prenatal clinics could offer the option for intensive smoking cessation treatment by training mental health counselors to deliver one extended smoking cessation counseling session.

Dukic VM; Niessner M; Benowitz N; Hans S; Wakschlag L. Modeling the relationship of cotinine and self-reported measures of maternal smoking during pregnancy: A deterministic approach. Nicotine & Tobacco Research 9(4): 453-465, 2007. (20 refs.)

Studies of effects of prenatal exposure to cigarettes frequently acquire both self-report and biological assays of maternal smoking. However, little attention has been paid to methods for combining information from both sources to enhance the precision of exposure measurement. This paper analyzes the relationship between the two commonly used measures of smoking exposure during pregnancy: Maternal self-report and urinary cotinine. We present a deterministic method for combining the two measures and examine its robustness under different assumptions. We apply the method to a dataset from the Family Health and Development Project. In addition, we propose an approach for calibrating the self-report measures for individual women based on both sources of information. Enhancing the quality of exposure measurement may substantially advance studies of the teratological effects of exposure on offspring.

Edwards EM; Werler MM. Alcohol consumption and time to recognition of pregnancy. Maternal and Child Health Journal 10(6): 467-472, 2006. (22 refs.)

Objectives: Despite warnings to abstain from alcohol, American women who are or could become pregnant still drink. This study evaluates whether women who consume alcohol are at an increased risk of recognizing pregnancy later than women who do not, adjusting for confounding factors that have been associated with alcohol consumption during pregnancy. Methods: The sample included 863 control women from a multisite case-control study conducted from 1996 to 2002 in the United States and Canada. Telephone inter-views were conducted with mothers by trained nurse interviewers who administered standardized questionnaires on demographic and reproductive factors, and pregnancy exposures. Results: Alcohol consumption was classified as none (42.0%), occasional (31.9%), regular (15.6%), and heavy (10.5%). Time to recognition of pregnancy was calculated as the date pregnancy was suspected minus the last menstrual period date (median: 31 days; range: 7-227 days). Unadjusted Cox proportional hazard models found that regular drinkers, but not heavy drinkers, had a significantly higher risk of recognizing pregnancy later than non-drinkers. However, this association went away after. adjustment for demographic factors. Among women with unplanned pregnancies, heavy alcohol intake was associated with a 45% increased hazard ratio, compared to 0.80 for women with planned pregnancies; however, this finding was not statistically significant. Conclusions: While time to pregnancy recognition did not vary among drinkers and non-drinkers, results from this study reiterate previous findings that pregnant women consume alcohol, and that drinkers share social and demographic characteristics that could be used to target public health interventions.

Elliott EJ; Payne J; Haan E; Bower C. Diagnosis of foetal alcohol syndrome and alcohol use in pregnancy: A survey of paediatricians' knowledge, attitudes and practice. Journal of Paediatrics and Child Health 42(11): 698-703, 2006. (29 refs.)

Aim: To measure paediatricians' knowledge, attitudes and practices regarding foetal alcohol syndrome (FAS) and alcohol use during pregnancy. Methods: Postal survey of paediatricians in Western Australia in 2004. Of 179 eligible paediatricians, 132 (73.7%) responded (90 consultant paediatricians and 42 paediatric trainees). Results: Of the 132 respondents, 18.9% identified all four essential diagnostic features for FAS. Only 49.2% had previously diagnosed FAS (range 1-30 cases) but 91.7% had seen children diagnosed by others; 76.5% had suspected but not diagnosed FAS; 12.1% had been convinced of but not recorded the diagnosis; and 31.8% had referred children for diagnostic confirmation. Although 79.6% agreed early diagnosis might be advantageous, 69.6% said diagnosis might be stigmatising and 36.4% thought parents might resist referral for assessment and treatment. Although 78.2% agreed avoiding binge drinking may reduce FAS, only 43.9% believed women should abstain from using alcohol in pregnancy. Only 4.5% felt very prepared to deal with a patient with FAS: most wanted educational materials for themselves (69.7%) and child carers (71.2%). Only 23.3% routinely ask about alcohol use when taking a pregnancy history and 4.2% routinely provide information on the consequences of alcohol use. Only 11.4% had read the current Australian National Health Guideline regarding alcohol consumption in pregnancy and 9.1% provided advice consistent with the guideline. Conclusion: Paediatricians identified the need for educational materials about FAS and alcohol use in pregnancy for themselves and their clients. Lack of knowledge about FAS diagnosis and management will limit opportunities for diagnosis, prevention and early intervention.

Fantuzzi G; Aggazzotti G; Righi E; Facchinetti F; Bertucci E; Kanitz S et al. Preterm delivery and exposure to active and passive smoking during pregnancy: A case-control study from Italy. Paediatric and Perinatal Epidemiology 21(3): 194-200, 2007. (23 refs.)

The aim of this study was to assess the relationship between preterm/early preterm delivery and active smoking as well as environmental tobacco smoke (ETS) exposure in a sample of pregnant Italian women. A case-control study was conducted in nine cities in Italy between October 1999 and September 2000. Cases of preterm birth were singleton babies born before the 37th gestational week; babies born before the 35th gestational week were considered early preterm births. Controls were babies with gestational ages >= 37th week. A total of 299 preterm cases (including 105 early preterm) and 855 controls were analysed. A self-administered questionnaire was used to assess active smoking and ETS exposure, as well as potential confounders. Multivariable logistic regression analysis showed a relationship between active smoking during pregnancy and preterm/early preterm delivery [adjusted ORs: 1.53; 95% CI 1.05, 2.21 and 2.00; 95% CI 1.16, 3.45, respectively]. A dose-response relationship was found for the number of cigarettes smoked daily. The adjusted ORs were 1.54 and 1.69 for preterm babies and 1.90 and 2.46 for early preterm babies for 1-10 and > 10 cigarettes/day respectively. ETS exposure was associated with early preterm delivery [adjusted OR 1.56; 95% CI 0.99, 2.46] with a dose-response relationship with the number of smokers in the home. Smoking during pregnancy was strongly associated with preterm delivery with a dose-response effect. ETS exposure in non-smoking women was associated only with early preterm delivery.

Fentiman LC. The new "fetal protection": The wrong answer to the crisis of inadequate health care for women and children. (review). Denver University Law Review 84(2): 537-599, 2006. (244 refs.)

In 1999, Regina McKnight, a homeless, mentally retarded woman who was pregnant and addicted to cocaine, was charged with murder when her child was stillborn. The South Carolina Supreme Court affirmed her murder conviction and upheld the twenty-year sentence imposed. In 2002, a severely mentally disabled woman became pregnant after being raped by the owner of the group home where she lived. The wife of a Florida prosecutor sought to be appointed "guardian of the fetus" in order to prevent the woman from taking prescription drugs necessary to maintain her physical health and mental stability and to prevent the woman from having an abortion. Ultimately, the Florida courts rejected these efforts. In 2004, Melissa Rowland, a pregnant woman with a long history of mental illness, sought assistance at a hospital because she noticed a decrease in fetal movements. Doctors recommended a Caesarean delivery, but Rowland declined, and the hospital offered no other help. When one of the twins she was carrying was stillborn, Rowland was charged with murder, with prosecutors asserting that she had acted with depraved indifference to the value of human life. In roughly two-thirds of the states, women who write advance directives to guide their medical care should they become incompetent may have their directives rendered unenforceable if they become pregnant.

Fitzpatrick JJ, ed. Alcohol Use, Misuse, Abuse and Dependence. Annual Review of Nursing Research, Vol 23. New York: Springer, 2005

This annual review, with 11 chapters and 15 contributors, addresses alcohol use and alcohol disorders relevant to nursing practice. It assembles the essential research to underpin efforts to define evidenced-based clinical practice. The volume is organized into four section. Section I provides perspectives on alcohol use research and measurement issues. The challenges to measuring alcohol consumption are discussed, the relationship of different drinking levels and cardiovascular disease is used as an example of measuremeent challenges. Also, a case is made for alcohol research as a focus for nursing research. Part II examines research in different age-based populations. These include pregnancy, children and adolescents, college students, young and middle adulthood, and the elderly. Part III considers alcohol use among lesbians and gay men, and the relationship of alcohol use to behavior that can compromise health. Part IV considers the research on brief treatment, well suited to a number of clinical settings, especially in primary care.

Flick LH; Cook CA; Homan SM; McSweeney M; Campbell C; Parnell L. Persistent tobacco use during pregnancy and the likelihood of psychiatric disorders. American Journal of Public Health 96(10): 1799-1807, 2006. (57 refs.)

Objectives. We examined the association between psychiatric disorders and tobacco use during pregnancy. Methods. Data were derived from a population-based cohort of 744 pregnant African American and White low-income women living in urban and rural areas. The Diagnostic Interview Schedule was used to assess women for 20 different psychiatric disorders. Results. In comparison with nonusers, persistent tobacco users (women who had used tobacco after confirmation of their pregnancy) and nonpersistent users (women who had used tobacco but not after pregnancy confirmation) were 2.5 and 2 times as likely to have a psychiatric disorder. Twenty-five percent of persistent users had at least 1 of the following diagnoses: generalized anxiety disorder, bipolar I disorder, oppositional disorder, drug abuse or dependence, and attention deficit-hyperactivity disorder. Conclusions. In this cohort study, 5 diagnoses were more prevalent among persistent tobacco users than among nonusers, suggesting that several psychiatric disorders contribute to difficulty discontinuing tobacco use during pregnancy. Smoking cessation efforts focusing on pregnant women may need to address co-occurring psychiatric disorders if they are to be successful.

Forrester MB; Merz RD. Risk of selected birth defects with prenatal illicit drug use, Hawaii, 1986-2002. Journal of Toxicology and Environmental Health. Part A, Current Issues 70(1): 7-18, 2007. (50 refs.)

The literature on the association between prenatal illicit drug use and birth defects is inconsistent. The objective of this study was to determine the risk of a variety of birth defects with prenatal illicit drug use. Data were derived from an active, population-based adverse pregnancy outcome registry. Cases were all infants and fetuses with any of 54 selected birth defects delivered during 1986 - 2002. The prenatal methamphetamine, cocaine, or marijuana use rates were calculated for each birth defect and compared to the prenatal use rates among all deliveries. Among all deliveries, the prenatal use rate was 0.52% for methamphetamine, 0.18% for cocaine, and 0.26% for marijuana. Methamphetamine rates were significantly higher than expected for 14 (26%) of the birth defects. Cocaine rates were significantly higher than expected for 13 (24%) of the birth defects. Marijuana rates were significantly higher than expected for 21 (39%) of the birth defects. Increased risk for the three drugs occurred predominantly among birth defects associated with the central nervous system, cardiovascular system, oral clefts, and limbs. There was also increased risk of marijuana use among a variety of birth defects associated with the gastrointestinal system. Prenatal uses of methamphetamine, cocaine, and marijuana are all associated with increased risk of a variety of birth defects. The affected birth defects are primarily associated with particular organ systems.

Gandhi SG; Gilbert WM; McElvy SS; El Kady D; Danielson B; Xing G et al. Maternal and neonatal outcomes after attempted suicide. Obstetrics and Gynecology 107(5): 984-990, 2006. (27 refs.)

OBJECTIVE: The purpose of this study was to describe identifiers and estimate maternal and neonatal outcomes in women who attempt suicide during pregnancy. METHODS: A linked Vital Statistics-Patient Discharge database of the State of California was used to identify cases of intentional injury during pregnancy. A retrospective analysis of maternal and neonatal outcomes in pregnant women who were admitted for attempted suicide is presented. RESULTS: There were 4,833,286 deliveries in California from 1991 to 1999. Of those deliveries, 2,132 were complicated by attempted suicide during pregnancy (0.4 per 1,000 pregnancies). The control population was composed of patients who did not attempt suicide. The group of women that attempted suicide during pregnancy had increases in premature labor, cesarean delivery, and need for blood transfusion. Analysis of neonatal outcomes revealed increases in respiratory distress syndrome and low birth weight infants. A subanalysis, including women who delivered at the hospitalization for attempted suicide, demonstrated increased premature delivery, respiratory distress syndrome, and neonatal and infant death. CONCLUSION: Attempted suicide is associated with significantly higher rates of maternal and perinatal morbidity, and in some cases, perinatal mortality. The best identifier for women at risk for attempting suicide is substance abuse. Care provider identification and prevention are of key importance in preventing these outcomes.

Garcia-Bournissen F; Finkelstein Y; Rezvani M; Koren G. Motherisk Update: Exposure to alcohol-containing medications during pregnancy. Canadian Family Physician 52: 1067-1068, 2006. (14 refs.)

QUESTION: A pregnant patient consulted her physician after discovering that a diphenhydramine preparation (Benadryl elixir) she used for allergy symptoms during the first trimester of her pregnancy contained 15% alcohol. Should she be concerned about fetal alcohol spectrum disorder in her baby? ANSWER: Most ethanol-containing medical preparations are safe during pregnancy. Adult doses of some elixirs with high ethanol concentrations might produce blood levels similar to those achieved by drinking I alcoholic beverage. Caution is advisable when prescribing ethanol-containing elixirs to pregnant women, as is informing them about the alcohol content.

Goebert D; Morland L; Frattarelli L; Onoye J; Matsu C. Mental health during pregnancy: A study comparing Asian, Caucasian and Native Hawaiian women. Maternal and Child Health Journal 11(3): 249-255, 2007. (59 refs.)

Objective: This study examines perinatal mental health issues, ethnic differences, and comorbidity among pregnant women in Hawaii. Methods: Eighty-four participants were recruited from women, ages 18-35, seeking prenatal care on Oahu. They were interviewed at their initial prenatal visit about substance use, depression, and anxiety. Results: Sixty-one percent of women screened positive for at least one mental health issue. Thirteen percent of all pregnant women reported drinking during pregnancy with 5% reporting problem drinking, 15% reported smoking cigarettes on a regular basis, 5% of pregnant women had probable depression, and 13% of pregnant women had probable anxiety. Significant ethnic differences were found in cigarette smoking, with the highest rate among Native Hawaiian women (35%). Native Hawaiian women were also more likely to binge drink. Conclusion: Given the high rates of potential mental health issues in our sample, our findings highlight the importance of screening and treatment for mental health issues early in pregnancy in Hawaii.

Grange G; Vayssiere C; Borgne A; Ouazana A; L'Huillier JP; Valensi P et al. Characteristics of tobacco withdrawal in pregnant women. European Journal of Obstetrics, Gynaecology and Reprooductive Biology 125(1): 38-43, 2006. (30 refs.)

Objective: To describe the management of tobacco withdrawal in pregnant women. Study design: The questionnaire-based, descriptive survey included 979 post-partum women. The variables analysed included the characteristics of the mother and neonate at delivery, her smoking habits, her level of exposure to passive smoking, and the barriers to giving up smoking. The chi square test was used to analyse qualitative variables and the Students t-test for quantitative variables. Results: 76% of women who smoked at the start of pregnancy said that they had been asked about their tobacco consumption. However, only 16% had been asked by a clinician or midwife about their attempts to stop smoking. Seven percent were offered a specialised consultation, but only one-third attended. Seventy-six percent of women who failed to stop smoking during pregnancy had a partner who smoked compared with 63% of women who gave up. Dependency and stress during pregnancy also were lower for women who stopped smoking. Conclusions: Healthcare professionals seems to offer only rudimentary care. Simple strategies to help women give up smoking are required. The partner is an important target, especially if he can be persuaded to give up at the same time.

Hegaard HK; Kjaergaard H; Moller LF; Wachmann H; Ottesen B. Determination of a saliva cotinine cut-off to distinguish pregnant smokers from pregnant non-smokers. Acta Obstetricia et Gynecologica Scandinavica 86(4): 401-406, 2007. (20 refs.)

Background. Objective validation of smoking status is necessary. Earlier studies have used saliva cotinine concentrations between 14.2 and 30 ng/ml as cut-off values to distinguish pregnant smokers from non-smokers. However, these cut-offs derive from studies including men and non-pregnant women. This constitutes a problem, as recent studies have reported an accelerated metabolism in pregnant smokers. The aim of this study was to determine the optimum cut-off cotinine level distinguishing pregnant smokers from pregnant non-smokers. Methods. An observational study of 620 pregnant women, 359 self-reported smokers and 261 self-reported non-smokers, with complete data on smoking status and saliva cotinine. The study was conducted at a large university hospital in Copenhagen, Denmark. Saliva was sampled at the first antenatal visit to the midwife and analyzed for cotinine level by gas chromatography. Participants completed a questionnaire immediately after the first visit. Results. A saliva cotinine cut-off level of 13 ng/ml, corresponding to a sensitivity of 0.99 and specificity 0.98, was found to be the optimum cut-off value separating pregnant smokers from non-smokers. The sum of the sensitivity and specificity was at its maximum, 1.981. A 95% bootstrap confidence interval for the optimum cut-off was (8 - 14 ng/ml). Conclusion. From the present data we recommend that in future studies on smoking cessation and pregnancy a cut-off level of 13 ng/ml should be applied to distinguish between pregnant smokers and non-smokers.

Hey E. Coffee and pregnancy - A moderate reduction in caffeine intake in the second half of pregnancy has no effect on birth weight or length of gestation. (editorial). British Medical Journal 334(7590): 377-377, 2007. (0 refs.)

Higgins ST; Heil SH; Dumeer AM; Thomas CS; Solomon LJ; Bernstein IM. Smoking status in the initial weeks of quitting as a predictor of smoking-cessation outcomes in pregnant women. Drug and Alcohol Dependence 85(2): 138-141, 2006. (7 refs.)

Objective: Any smoking during the initial 2 weeks of attempting to quit predicts poor short- and longer-term outcomes in the general population of cigarette smokers. The present study examined whether that rule applies to pregnant women. Methods: Data were obtained from 129 women participating in clinical trials on smoking-cessation examining the efficacy of voucher-based incentives delivered contingent on biochemically-verified abstinence or a control condition wherein incentives were given independent of smoking status. Smoking status was assessed in weeks I and 2 of the cessation effort and again at an end-of-pregnancy assessment scheduled at weeks 28-32 gestation using self-report and biochemical verification. Results: Smoking in weeks I or 2 predicted smoking at the end-of pregnancy assessment independent of treatment condition. There was a 79% and 92% chance that those who smoked in weeks I or 2 would be classified as smokers at end-of-pregnancy in the contingent-incentive and control conditions, respectively. Conclusions: Clinicians assisting pregnant women trying to quit smoking may want to monitor progress in the initial weeks of the cessation effort and consider enhancing/changing the intervention when smoking is detected.

Hser YI; Niv N. Pregnant women in women-only and mixed-gender substance abuse treatment programs: A comparison of client characteristics and program services. Journal of Behavioral Health Services & Research 33(4): 431-442, 2006. (31 refs.)

This study compared characteristics of pregnant women treated in women-only (WO) and mixed-gender (MG) substance abuse treatment programs and compared services provided by these two types of programs. Participants were 407 pregnant women who were admitted to 7 WO programs and 29 MG programs in 13 counties across California during 2000-2002. Pregnant women treated in WO programs demonstrated greater severity in drug use, legal problems, and psychiatric problems than those treated in the MG programs. They were also less likely to be employed and more likely to be homeless. Women-only programs were more likely to offer child care, children's psychological services, and HIV testing. The greater problem severity of pregnant women treated in WO programs suggests that these specialized services are filling an important gap in addiction services, although further expansion is warranted in psychiatric, legal, and employment services.

Huang CC; Reid RJ. Risk factors associated with alcohol, cigarette, and illicit drug use among pregnant women: Evidence from the Fragile Family and Child Well-being Survey. Journal of Social Service Research 32(4): 1-22, 2006. (44 refs.)

The use of illicit and licit drugs during pregnancy is a major public health concern that has garnered much medical, governmental, and media attention because of the increased health risks it poses for women and their newborns. To date, however, few studies have examined the antecedents contributing to substance use among pregnant women. In this paper, we examine the prevalence of alcohol, cigarette, and illicit drug use among a recent sample of pregnant women and report on the factors that place these women at risk for engaging in the use of these substances. We conclude by making recommendations to improve existing policy and programming efforts that address the specific needs of pregnant substance-using women.

Huijbregts SCJ; Seguin JR; Zelazo PD; Parent S; Japel C; Tremblay RE. Interrelations between maternal smoking during pregnancy, birth weight and sociodemographic factors in the prediction of early cognitive abilities. Infant and Child Development 15(6): 593-607, 2006. (40 refs.)

Maternal prenatal smoking, birth weight and sociodemographic factors were investigated in relation to cognitive abilities of 1544 children (aged 3.5 years) participating in the Quebec Longitudinal Study of Children's Development. The Peabody Picture Vocabulary Test (PPVT) was used to assess verbal ability, the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) block design test to assess visuospatial ability, and the Visually Cued Recall (VCR) task to assess short-term memory. Prenatal smoking was related to performance on the WPPSI-R, the PPVT, and the VCR, although it did not independently predict any cognitive ability after maternal education was taken into account. Birth weight was a more robust predictor of all outcome measures and independently predicted VCR-performance. Birth weight interacted significantly with family income and maternal education in predicting visuospatial ability, indicating a greater influence of birth weight under relatively poor socio-economic conditions. Parenting and family functioning mediated associations between maternal education/family income and cognitive task performance under different birth weight conditions, although there were indications for stronger effects under relatively low birth weight. We conclude that investigations of moderating and mediating effects can provide insights into which children are most at risk of cognitive impairment and might benefit most from interventions.

Infante-Rivard C. Caffeine intake and small-for-gestational-age birth: Modifying effects of xenobiotic-metabolising genes and smoking. Paediatric and Perinatal Epidemiology 21(4): 300-309, 2007. (45 refs.)

The relationship between caffeine consumption and small-for-gestational-age (SGA) birth remains uncertain. However, factors that can influence caffeine metabolism, such as genetic polymorphisms, have not been considered, while other similar factors such as smoking and ethnicity have not always been fully accounted for in the interpretation of results. A case-control study was carried out comprising 493 cases and 472 controls. Cases were newborns whose birthweight was below the 10th percentile according to gestational age and sex, based on national norms, and controls were at or above the 10th percentile. Caffeine consumption from beverages was estimated for each pregnancy trimester. Maternal and newborn variants in the CYP1A2 and CYP2E1 genes involved in the metabolism of caffeine were determined. Contrasting consumption >= 300 mg/day with a lower level, or using caffeiwne as a continuous measure, while adjusting for smoking and nausea, showed no increased risk for SGA. However, when stratifying for cigarette smoking, caffeine odds ratios (for the continuous and dichotomous measures) in the first trimester were statistically heterogeneous, suggesting a greater risk among non-smokers. Using birthweight as the outcome and caffeine as a continuous measure, a small 38 g [95% confidence interval -68, -8] decrement for every 100 mg of daily caffeine was observed in the third trimester. The studied polymorphisms did not modify the effect of caffeine. Caffeine consumption is unlikely to be a major risk factor for SGA or low birthweight in pregnant women.

Infante-Rivard C; El-Zein M. Parental alcohol consumption and childhood cancers: A review. (review). Journal of Toxicology and Environmental Health. Part B, Critical Reviews 10(1-2): 101-129, 2007. (79 refs.)

The etiology of childhood cancers remains generally unknown. Given that the metabolites of alcohol are likely carcinogens and that leukemia, the most frequent childhood cancer, can arise in utero, the study of alcohol consumption as a potential risk factor for the development of childhood cancer is justified. This article summarizes the epidemiological evidence on the association between parental exposure to alcohol and the risk of childhood cancers. To do this, a thorough search of the literature from 1960 to 2003 using the PubMed database was carried out. It yielded 33 case-control studies published between 1982 and 2003, including 13 studies that considered paternal exposure in the preconceptional period. In 10 of the 33 studies at least 1 statistically significant risk increase was reported in relation with parental alcohol consumption; in 7 of these studies the increase was related to maternal consumption, whereas in 3 studies, it was related to paternal consumption. The cancers most often found associated with parental drinking were leukemia, brain tumors, and neuroblastoma. A few studies also reported a protective effect with maternal exposure at modest levels. Inconsistencies in the results and the low risks reported do not suggest an association between childhood cancer and parental consumption of alcohol. However, before reaching any definitive conclusions, methodological issues need to be addressed in future studies, as well as the role of genetic susceptibility. Moreover, subtypes of specific cancers need to be studied separately.

Jones HE; Jasinski D; Johnson RE. Response to "transferring methadone-stabilized pregnant patients to buprenorphine" (letter). American Journal on Addictions 15(5): 401-402, 2006. (4 refs.)

This article presents a response to Dr Newman's commentary on "Transferring Methadone--Stabilized Pregnant Patients to Buprenorphine Using and Immediate Release Morphine Transition: An Open-Label Exploratory Study."

Kahila H; Saisto T; Kivitie-Kallio S; Haukkamaa M; Halmesmaki E. A prospective study on buprenorphine use during pregnancy: Effects on maternal and neonatal outcome. Acta Obstetricia et Gynecologica Scandinavica 86(2): 185-190, 2007. (24 refs.)

Background. Exposure to illicit drugs in utero is associated with low birth weight and premature birth. Therefore, maintenance therapy for opioid dependence during pregnancy has been recommended to help withdrawal from street drugs, in order to improve maternal health and decrease risks to the fetus. Methods. In 2002-2005, 67 pregnancies of 66 buprenorphine users were followed prospectively in an outpatient multidisciplinary antenatal setting by an obstetrician, a midwife, a psychiatric nurse and a social worker. Decreasing doses or even abstinence from buprenorphine was encouraged. Outcome measures were daily buprenorphine dose, fetal growth, gestational age at birth, mode of delivery, birth weight, Apgar scores, umbilical pH values, and occurrence of neonatal abstinence syndrome [NAS]. National statistics were used as reference values. Results. The daily dose of buprenorphine decreased by 2.3 mg (median, range increase of 8 mg to decrease of 24 mg). There were no more incidences of premature birth, cesarean section, low Apgar scores (<= 6) or umbilical artery pH <7.05 at birth than in the national register, despite the lower birth weight. A total of 91% of the infants needed treatment in a neonatal care unit, 76% had NAS, and 57% needed morphine replacement therapy. Seven infants were taken into care directly from the maternity hospital. Two sudden infant deaths occurred later. Conclusions. The pregnancies and deliveries of buprenorphine-using women were uneventful, but severe NAS and need for morphine replacement therapy was seen in 57% of the buprenorphine-exposed newborns. A high number of sudden infant deaths occurred.

Kunins HV; Bellin E; Chazotte C; Du E; Arnsten JH. The effect of race on provider decisions to test for illicit drug use in the peripartum setting. Journal of Women's Health 16(2): 245-255, 2007. (33 refs.)

Background: Testing for illicit drugs may expose women who test positive to severe legal and social consequences. It is unknown whether racial disparities in drug testing practices underlie observed disparities in legal and social consequences of positive tests. Methods: Using administrative hospital and birth certificate data, we analyzed factors associated with both receipt and results of illicit drug testing among women with live births during 2002 - 2003. We assessed the independent association of race and other sociodemographic factors with both receipt of a drug test by the mother or her newborn infant and positive maternal or neonatal toxicology results, after controlling for obstetrical conditions and birth outcomes associated with maternal substance abuse. Results: Of the 8487 women with live births, 244 mother-newborn pairs (3%) were tested for illicit drug use. Black women and their newborns were 1.5 times more likely to be tested for illicit drugs as nonblack women in multivariable analysis. However, race was not independently associated with a positive result. Conclusions: We identified racial differences in rates of testing for illicit drug use between black and nonblack women. We found equivalent positivity rates among tested black and nonblack women. The prevalence of drug use among untested women is unknown, however, so although tested women had equivalent rates of substance use detected, whether black and nonblack substance users are equally likely to be identified in the course of peripartum care remains uncertain.

Lawrence WT; Haslam C. Smoking during pregnancy: Where next for stage-based interventions? Journal of Health Psychology 12(1): 159-169, 2007. (55 refs.)

Pregnancy is a 'window of opportunity' for encouraging positive behaviour change, such as quitting smoking. Associations have been shown between smoking stage of change and other health behaviour during pregnancy. For example, women in the precontemplative stage have poorer assessment of risks associated with smoking, feel less personally responsible for their unborn child's health and in turn are less likely to adopt health-promoting behaviour. Stage of change models are a popular tool within the health services, but the results of stage-based smoking cessation interventions are mixed. Identifying the crucial components of effective interventions is an important imperative for research in this area. This article reviews the literature to ascertain these components and makes recommendations for designing effective interventions.

Lawson CC; LeMasters GK. Regarding "Caffeine metabolism, genetics, and perinatal outcomes: A review of exposure assessment considerations during pregnancy" (letter). Annals of Epidemiology 16(9): 733-733, 2006. (3 refs.)

Lee M; Hajek P; McRobbie H; Owen L. Best practice in smoking cessation services for pregnant women: Results of a survey of three services reporting the highest national returns, and three beacon services. Journal of the Royal Society for the Promotion of Health 126(5): 233-238, 2006. (13 refs.)

Aims: The NHS allocated dedicated funds to establish specialist smoking cessation services for pregnant smokers in England in 2000. An early survey revealed some uncertainty as to how the new services should work and monitor their outcome. The current survey focused on identifying examples of good practice in this difficult new field. Method: Three services with the highest number of successful four-week quitters reported for the 2003/4 monitoring year were identified from Department of Health (DH) monitoring records, and three services were nominated from those known in the field as examples of best practice. There was no overlap between the two groups. All six services provided in-depth interviews. Results: All three highest ranking services that reported close to 100 per cent success rates included unaided quitters identified from hospital wards, rather then smokers actually treated. They had only minimal or average genuine treatment provision for pregnant smokers in place. The three beacon services far exceeded the national throughput and outcome average identified in the previous survey, and provided a wealth of useful information. Although they differed in staffing levels and other aspects of their activities, they all shared several key elements, including a systematic training of midwives in how to refer pregnant smokers, offering nicotine replacement treatment to almost all clients and having an efficient system of providing the prescriptions, offering flexible home visits, and providing intensive multi-session treatment delivered by a small number of dedicated staff. Conclusion: Smoking cessation services for pregnant women may need clearer guidance on what they are expected to provide, and how they should monitor their outcome. The key features of the beacon services can serve as a practical model of current best practice applicable across most PCTs.

Leeners B; Neumaier-Wagner P; Kuse S; Rath W. Smoking and the risk of developing hypertensive diseases in pregnancy: What is the effect on HELLP syndrome? Acta Obstetricia et Gynecologica Scandinavica 85(10): 1217-1224, 2006. (31 refs.)

Background. The aim of our study was to investigate the role of smoking in the development of HELLP syndrome, preeclampsia and gestational hypertension. Methods. A self-administered questionnaire was sent to 2,600 women who had contacted the German Pre-eclampsia Self-help Group previously for information on hypertensive disorders in pregnancy and to 1,233 controls. Diagnoses were verified by reviewing medical records and classified according to ISSHP criteria. Student's t-test, Wilcoxon test, Chi-square test, and multiple logistic regressions were used for statistical analysis. Results. After matching age, parity, nationality, and education a total of 905 women with a hypertensive disease in pregnancy and 945 controls were evaluated for the present study. In comparison to the patients, controls smoked significantly more often during their pregnancies (8.5%/18%, p <0.0001). Smoking during pregnancy was associated with a decreased risk of developing hypertensive disorders in pregnancy by 56%. The most prominent effect of smoking was on the risk of developing HELLP syndrome (OR 0.19, 95% CI 0.08-0.43) followed by HELLP syndrome + pre-eclampsia (OR 0.33, 95% CI 0.17-0.63), pre-eclampsia only (OR 0.46, 95% CI 0.26-0.8), and gestational hypertension (OR 0.66, 95% CI 0.41-1.08). Conclusions. Smoking is associated with an 80% reduction of the risk developing HELLP syndrome. However, pregnant women should be advised to quit smoking. Understanding the different effects of smoking in the etiology of each subtype of hypertensive diseases in pregnancy will improve the knowledge of underlying pathophysiological mechanisms and may help in designing more effective prevention and treatment strategies.

Levine MD; Marcus MD; Kalarchian MA; Weissfeld L; Qin L. Weight concerns affect motivation to remain abstinent from smoking postpartum. Annals of Behavioral Medicine 32(2): 147-153, 2006. (43 refs.)

Background: Although many women quit smoking during pregnancy, most resume smoking postpartum. One factor that may be important in postpartum relapse is a pregnant woman's motivation to remain abstinent after delivery. Purpose: We assessed motivation for postparturn abstinence among pregnant women who had quit smoking and examined the relationship of weight concerns and mood to abstinence motivation. Methods: Pregnant former smokers, recruited between February 2000 and November 2004, completed assessments of smoking, weight concerns, depressive symptoms, and perceived stress. Results: Sixty-five percent were highly motivated to remain abstinent postpartum. Women who were and were not motivated were similar in age, race, and nicotine dependence. However motivated women reported more stress, greater self-efficacy for weight management, less hunger, and less smoking for weight control than did less motivated women. After controlling for intention to breast-feed, nicotine dependence, years of smoking, partner smoking, and I-ace, self-efficacy for weight control was related to motivation to maintain postpartum abstinence. Conclusions: These data suggest that weight concerns are associated with motivation for postpartum smoking abstinence, and interventions designed to prevent postpartum smoking relapse may need to target eating, weight, and shape concerns.

Lewis MW. Relationship of prior custody loss to maternal-fetal bonding in a subsequent pregnancy. Children and Youth Services Review 28(10): 1169-1180, 2006. (48 refs.)

Maternal-fetal bonding is the emotional investment a woman has for her fetus and is the foundation for nurturance and protection. Effects of prior custody loss on bonding during a subsequent pregnancy have received scant attention but may resemble other reproductive losses. This study compares the strength of the maternal-fetal bond among women grouped according to lifetime history of custody loss. Sixty-seven pregnant women with a history of giving birth were assigned to either a Loss (13.4%) or Non-Loss (86.6%) group. They were administered a demographic questionnaire and standardized measures of maternal-fetal bonding, substance use, perceived social support, depressive symptoms, and economic status. The Loss group endorsed more pregnancies, more abortions, living with fewer children, less social support, and illicit drug use during the third trimester. The Loss group endorsed a stronger maternal-fetal bond compared to women in Non-Loss group. Multivariate analyses were exploratory due to the small sample size but suggest that pregnant women who have experienced one custody loss may differ from those who have experienced multiple custody losses. Future research with a larger sample is needed to examine the direction of the relationship between prior custody loss and maternal bonding to a subsequent fetus.

Littner Y; Bearer CF. Detection of alcohol consumption during pregnancy: Current and future biomarkers. (review). Neuroscience and Biobehavioral Reviews 31(2): 261-269, 2007. (85 refs.)

Alcohol, one of the most frequently reported addictions, is a significant public health problem in the. Early identification is important and would aid in intervention for the pregnant woman who continues to drink and for the affected infant. To date, there isn't a definitive test which identifies either alcohol abuse during pregnancy or newborns exposed to alcohol prenatally. The existing biomarkers can detect varying degrees of alcohol exposure but further research is needed to improve sensitivity/specificity and to validate these markers.

Lyttle T. Stop the injustice: A protest against the unconstitutional punishment of pregnant drug-addicted women. New York University Journal of Legislation and Public Policy 9: 781-815, 2005. (237 legal refs.)

SUMMARY: Beginning in the late 1970s, an innovative prosecutorial strategy arose: states began prosecuting pregnant women because of their criminal behavior and its effects on their unborn and newborn children. ... In Robinson v. California, the Supreme Court established the principle that it is cruel and unusual punishment to punish an individual solely for his or her status as a drug offender. ... The punishment of drug-addicted women for their behavior during pregnancy is closer to the context of Robinson v. California than Powell v. Texas. Unlike the defendant in Powell, who committed the illegal act of being drunk in public, drug addiction during pregnancy is not an affirmative "act" but rather an involuntary addictive behavior. ... While the actions of these women could potentially endanger their fetuses, the women who are not drug addicts but use drugs during pregnancy are nevertheless still protected by the Constitution's Cruel and Unusual Punishment Clause, as the State is unlawfully punishing them for their status as drug users, which Robinson prohibits. ... The reasons behind a pregnant woman's drug use are numerous and should not be reduced to the assumption that the woman simply does not care about her fetus. ... In addition to the principles laid out in Robinson, punishing women for their behavior during pregnancy is precluded by the Cruel and Unusual Punishment Clause's principle of equality. Part I provides an overview of states' strategies for prosecuting pregnant drug-addicted women. States have primarily used child abuse, neglect, endangerment, controlled substance, homicide, and manslaughter statutes to punish pregnant drug-addicted women for allegedly exposing their fetuses to potential harm. Part II explores the constitutional and policy arguments most frequently made against criminalizing maternal substance abuse. Part III analyzes the Eighth Amendment argument against punishing pregnant drug-addicted women, including a brief overview of the origins of the Eighth Amendment, the purpose of the Amendment, and the Supreme Court's interpretation of the Cruel and Unusual Punishment Clause. Part III then builds on this information, applying it to the prosecution of pregnant drug-addicted women.

Magnusson A; Goransson M; Heilig M. Hazardous alcohol users during pregnancy: Psychiatric health and personality traits. Drug and Alcohol Dependence 89(2-3): 275-281, 2007. (32 refs.)

Background: We examined alcohol use disorders, psychiatric symptoms and personality traits in women reporting alcohol use during pregnancy. Methods: In a pilot cohort (n = 139), subjects were screened for alcohol use disorders, and assessed for psychopathology, personality traits, and alcohol use during the first trimester. Those reporting consumption exceeding a conservative threshold for harmful use were offered a diagnostic psychiatric interview. The main findings of the pilot study were replicated using a large sample of women in the third trimester (n = 715), who were screened for alcohol use disorders, had their consumption during pregnancy assessed, and were assessed for personality traits. Results: In the pilot cohort, only a minority of women who consumed significant amounts of alcohol during pregnancy fulfilled alcohol dependence criteria, or had scores on the Alcohol Use Disorder Identification Test typically associated with such a diagnosis. Psychiatric morbidity was also unremarkable as assessed by self-reported symptom intensity. The distinguishing feature was high novelty seeking. The results were robustly confirmed in the replication study. Conclusions: Most women with significant alcohol consumption during pregnancy do not seem to be alcohol dependent. Instead, use during pregnancy may reflect impulsive personality traits, and be correlated with additional risk behaviors.

Malet L; de Chazeron I; Llorca PM; Lemery D. Alcohol consumption during pregnancy: A urge to increase prevention and screening. (editorial). European Journal of Epidemiology 21(10): 787-788, 2006. (10 refs.)

Alcohol consumption was evaluated in 1,027 pregnant women in the Auvergne region of central France. Only 53% declared total abstinence during pregnancy. 33% had 1-4 units on monthly occasion, while 13% drunk more frequently. One percent had 5 or more units per occasion. Despite the consensus recommending total abstinence during pregnancy, prenatal alcohol exposure remains a major public health issue.

Malow RM; Devieux JG; Rosenberg R; Dyer JG; St Lawrence JS. Integrated HIV care: HIV risk outcomes of pregnant substance abusers. Substance Use & Misuse 41(13): 1745-1767, 2006. (98 refs.)

Identifying contextual factors that may influence the effects of HIV risk-reduction strategies aimed at inner-city, minority female populations may be critical to interrupting the alarming trends in seroprevalence in the United States, especially among pregnant women with substance use-related problems. The objective of this Phase I, NIDA- funded project was to determine which contextual and cognitive factors were most predictive of HIV outcomes in this population. Eighty-one HIV-negative women were enrolled in a maternal addiction program with a cognitive-behavioral HIV risk-reduction component. Measures were administered between 1996 and 1998, one week post-admission, and follow-up assessments were conducted on 69 participants at 6 months post-discharge Paired t-tests were conducted to assess changes in sex risk behaviors, HIV/AIDS-related knowledge, and HIV risk-related attitudes/behaviors. Hierarchical regression analyses were conducted to investigate the relationship between attitudes/knowledge with contextual variables. At six months follow-up, there were significant increases in favorable condom attitudes (t = 3.36, p = .01) and in factual knowledge regarding HIV (t = 3.20, p = .01), with a significant decrease in the number of sexual partners (t = 2.21, p = .05). Hierarchical regression analysis revealed that the strongest predictors of the number of partners-a key outcome variable-were alcohol use, intentions to engage in safer sex behaviors, psychiatric symptoms, and a history of physical abuse (F[11, 57] = 6.58, p < .001). This study also reinforces the strategic importance of utilizing substance user treatment programs as crucial vehicles for integrating HIV risk-reduction strategies. Additionally, it will further guide the design of effective procedures to test the feasibility of an integrated HIV risk-reduction intervention for a larger randomized controlled study. The study's limitations are noted.

Mancinelli R; Ceccanti M; Laviola G. Fetal alcohol spectrum disorders (FASD): From experimental biology to the search for treatment. (editorial). Neuroscience and Biobehavioral Reviews 31(2): 165-167, 2007. (11 refs.)

Meng C; Rayburn BB; Ramirez-Cacho WA; Rayburn WF. Effect of a specialized prenatal clinic on medical student attitudes toward women with drinking problems. Journal of Maternal-Fetal and Neonatal Medicine 20(3): 217-220, 2007. (10 refs.)

Objective. To determine if student attendance at a specialized prenatal clinic would yield any change in their comfort level and in their attitudes toward pregnant women with drinking problems. Methods. A total of 117 third-year students rotating consecutively on our core obstetrics - gynecology clerkship consented to enrolling in this prospective cohort study between February 2004 and June 2005. Each was assigned either to attend a half-day prenatal clinic designed specifically for women with alcohol and substance use disorders (study group) or not to attend the clinic (control group). The students answered anonymously a 15-question survey (using a 5-point Likert scale from 'strongly disagree' to 'strongly agree') at the beginning and at the midway point of the eight-week clerkship. Scores averaged for each question at the two points were compared within and between the two groups using paired-samples and independent-samples t-tests. Results. No differences in responses to the survey were found between the study and control groups at the beginning of the clerkship. Students who attended the clinic became more comfortable in inquiring about patient alcohol consumption (p < 0.001) and about social problems such as domestic violence (p < 0.001). After attending the clinic, students reported that alcoholism was associated less with a weak will (p < 0.01) and that group therapy has more importance (p < 0.05). In contrast, the control group disagreed less that alcohol use was more of a moral and legal problem than a medical problem (p < 0.05). Conclusions. An experience at this special prenatal clinic improved medical student awareness of complexities faced by problem drinkers, enhanced their comfort in talking to pregnant alcohol drinkers, and favored more sympathy toward alcoholism in general but not necessarily during pregnancy.

Mengel MB; Searight HR; Cook K. Preventing alcohol-exposed pregnancies. (review). Journal of the American Board of Family Medicine 19(5): 494-505, 2006. (103 refs.)

Fetal alcohol exposure affects approximately 1% to 3% of live births in the United States. Family physicians are in a unique position to reduce the incidence of alcohol-exposed pregnancy. Fetal alcohol exposure can be minimized through 2 general approaches: reducing alcohol consumption or increasing effective contraception among childbearing-aged women who engage in "at-risk" drinking and encouraging pregnant women to abstain from alcohol. Although no safe level of alcohol consumption during pregnancy is established, women who binge drink are more likely to deliver infants with physical and cognitive-developmental anomalies. Screening tools, such as quantity/frequency questions, the TWEAK and the T-ACE, developed specifically for prenatal care, are more useful with women than the CAGE and Michigan Alcohol Screening Test (MAST). Screening alone seems to reduce alcohol use among pregnant women. Brief interventions, including education about alcohol's effects on the developing fetus, are effective among women not responding to screening. Unfortunately, many barriers exist to effective implementation of alcohol-exposed pregnancy (AEP) prevention in the clinical setting. Designing effective office base systems so the entire burden of implementing AEP prevention activities doesn't fall solely on the family physician is critical.

Mirzaie F; Mohammad-Alizadeh S. Contributing factors of preterm delivery in parturient in a University Hospital in Iran. Saudi Medical Journal 28(3): 400-404, 2007. (19 refs.)

Objective: Preterm labor is one of the common causes of prenatal morbidity and mortality. With considering the importance of preterm labor and lack of sufficient studies about the relationship between preterm labor and some factors such as cigarette smoking and opiate-using, the present study was designed. Method: We performed this descriptive-analytic study on 988 pregnant women referring to the Delivery Ward of Afzalipour Hospital, Kerman, Iran from February 2005 to September 2006. We analyzed the data using t-test and Chi-square test. Results: From 988 subjects, 39.4% had preterm labor and 60.6% had term delivery. There was no significant difference between preterm and term groups in regard to their mean age (26.7 +/- 5.6 and 26.5 +/- 5.7 years), job, gravidity, educational level, abortion history, and periodontal or urinary infection (p>0.05). In preterm, group, the rate of previous history of preterm labor (56%) and family history of preterm labor (88%) were significantly more in comparison to term delivery (p<0.1 and p<0.001). In women with a cigarette smoker husband, the rates of preterm labor was 44,6% and term labor was 55.4%, while in the case of both couples being cigarette smoker the rate of preterm labor was 69.2% and term labor was 31.9% (p<0.0001). In couples that were cigarette smoker and substance consumer, the rate of preterm was 77.4% and term labor was 22.6% (p<0.0001). Conclusion: The results of this study showed that women with personal and family history of preterm labor and women cigarette smokers and opiate-using should be considered as a major risk for preterm labor.

Newman RG. Response to "transferring methadone-stabilized pregnant patients to buprenorphine". (letter). American Journal on Addictions 15(5): 400-400, 2006. (2 refs.)

This article concerns transferring methadone stabilized pregnant patients to buprenorphines. During pregnancy, the risk of inducing withdrawal when dosages are changed in the course of opiate addiction treatment should be avoided. All patients returned to methadone from buprenorphines. The transitional use of immediate release morphine (IRM) appears safe for both mother and fetus. Withdrawal symptoms appeared during buprenorphine induction and the severity of these symptoms may be lessened by the dose and frequency of buprenorphine administration.

Nielsen A; Hannibal CG; Lindekilde BE; Tolstrup J; Frederiksen K; Munk C et al. Maternal smoking predicts the risk of spontaneous abortion. Acta Obstetricia et Gynecologica Scandinavica 85(9): 1057-1065, 2006. (22 refs.)

Background. Few studies have examined smoking prior to pregnancy and the occurrence of spontaneous abortion, as most studies have addressed the risk of spontaneous abortion in relation to smoking during pregnancy. However, results are not entirely consistent. The aim of the present study was to assess the risk of spontaneous abortion considering smoking prior to pregnancy. Methods. We performed a nested case-control study using prospective data from a population-based cohort comprising 11,088 women aged 20-29 years. From this cohort, women who experienced either a spontaneous abortion (n =/ 343) or who gave birth (n =/ 1,578) during follow-up were selected. Associations between self-reported smoking at enrolment and subsequent spontaneous abortion were analyzed by means of multiple logistic regression. Results. The risk of spontaneous abortion in relation to pre-pregnancy smoking showed a clear dose-response effect. The adjusted odds ratio (95% confidence interval) for spontaneous abortion among current smokers prior to conception was 1.20 (1.04-1.39) per every extra five cigarettes smoked per day. The increased risk was only present for current smokers. The duration of smoking prior to pregnancy was not a significant predictor for subsequent spontaneous abortion. Conclusions. The amount of daily smoking prior to pregnancy seems to be associated with an increased risk of spontaneous abortion, whereas the duration of smoking does not seem to be related to an increased risk of spontaneous abortion.

Office of the Surgeon General; Carmona R. Advisory on Alcohol Use in Pregnancy. Washington DC: Department of Health and Human Services, 2005. (0 refs.)

In the United States, FAS is the leading preventable birth defect with associated mental and behavioral impairment. There are many individuals exposed to prenatal alcohol who, while not exhibiting all of the characteristic features of FAS, do manifest lifelong neurocognitive and behavioral problems arising from this early alcohol exposure. In the United States, the prevalence of FAS is between 0.5 to 2 cases per 1,000 births. It is estimated that for every child born with FAS, three additional children are born who may not have the physical characteristics of FAS but still experience neurobehavioral deficits resulting from prenatal alcohol exposure that affect learning and behavior. On February 12, 2005, the U. S. Surgeon General released an Advisory on the importance of not drinking alcohol if a woman is pregnant or considering becoming pregnant. It notes that the best science available we now know the following: Alcohol consumed during pregnancy increases the risk of alcohol related birth defects, including growth deficiencies, facial abnormalities, central nervous system impairment, behavioral disorders, and impaired intellectual development. No amount of alcohol consumption can be considered safe during pregnancy. Alcohol can damage a fetus at any stage of pregnancy. Damage can occur in the earliest weeks of pregnancy, even before a woman knows that she is pregnant. The cognitive deficits and behavioral problems resulting from prenatal alcohol exposure are lifelong. And, that alcohol-related birth defects are completely preventable. Therefore it is advised that a pregnant woman should not drink alcohol during pregnancy; a pregnant woman who has already consumed alcohol during her pregnancy should stop in order to minimize further risk; andy woman who is considering becoming pregnant should abstain from alcohol; recognizing that nearly half of all births in the United States are unplanned, women of child-bearing age should consult their physician and take steps to reduce the possibility of prenatal alcohol exposure; and health professionals should inquire routinely about alcohol consumption by women of childbearing age, inform them of the risks of alcohol consumption during pregnancy, and advise them not to drink alcoholic beverages during pregnancy.

Public Domain

Orr ST; Newton ER; Weismiller DG. Prenatal smoking cessation among Black and White women in eastern North Carolina. American Journal of Health Promotion 21(3): 192-195, 2007. (10 refs.)

Purpose. Limited information is available about Black-White disparities in prenatal smoking cessation, and the results of prior research are inconsistent. We analyzed smoking cessation and factors associated with cessation (attitudes, environment, and nicotine addiction) in a sample (of pregnant Black and While women. Methods. Women were interviewed at the first prenatal visit at two hospital-based clinics. Results. Among former and current smokers, there were no significant differences in the percentage of former smokers between Black (46.8 %) and White (43.3 %) pregnant women, or in the percentage of "spontaneous quitters" (i.e., those who quit after learning that they were pregnant) for Blacks (36 %) and Whites (28 %). Both Black and White spontaneous quitters had evidence of occasional relapses to smoking. For Black and White women, smoking more than a pack a day prior to pregnancy was associated with smoking during pregnancy. Discussion. Among current and former smokers, spontaneous cessation was about the same for Black and While women, and about two thirds of women who were smokers when they learned of the pregnancy continued to smoke during pregnancy. Nicotine addiction contributed to continued smoking.

Ortendahl M. Predicting lapse when stopping smoking among pregnant and non-pregnant women. Journal of Obstetrics and Gynaecology 27(2): 138-143, 2007. (37 refs.)

This study aimed to investigate factors predicting lapse among pregnant and non-pregnant women when trying to stop smoking. A total of 40 women, pregnant and non-pregnant, were investigated over a 2-week period when trying to stop smoking. One-quarter of the women lapsed every day. Not being pregnant was a significant predictor for the occurrence of any lapse during the time period, whereas age, number of years of smoking, number of earlier attempts to stop smoking, and number of cigarettes smoked per day did not predict lapse. There was a four times higher risk for lapse in non-pregnant compared with pregnant women. Being pregnant gives an opportunity to help stop smoking with a considerably lower risk of lapse compared with non-pregnant women.

Ortendahl M. Smoking as a decision among pregnant and non-pregnant women. Addictive Behaviors 31(10): 1806-1819, 2006. (31 refs.)

Objectives: The purpose was to examine values and beliefs related to smoking, and to test the validity of a decision model based on the product of the value of smoking-related events and states, and the belief that these will occur, (in decision research labeled Expected Utility, or EU). Methods: Over a two-week period eighty women, divided into subgroups consisting of pregnant vs. non-pregnant women, and those intending vs. those not intending to quit smoking, performed evaluations of values and beliefs for the two conditions of quitting and not quitting smoking. Results: For both pregnant and non-pregnant women expected utility of smoking was negative. Of all the four groups pregnant women not intending to quit smoking estimated the expected utility of smoking as least negative. Conclusions: A decision analytic approach is applicable to describe the addictive behavior of smoking. Values as well as beliefs about smoking should be stressed in smoking cessation programs, especially among pregnant women.

Oyelese Y; Ananth CV. Placental abruption. Obstetrics and Gynecology 108(4): 1005-1016, 2006. (48 refs.)

Placental abruption complicates about 1% of pregnancies and is a leading cause of vaginal bleeding in the latter half of pregnancy. It is also an important cause of perinatal mortality and morbidity. The maternal effect of abruption depends primarily on its severity, whereas its effect on the fetus is determined both by its severity and the gestational age at which it occurs. Risk factors for abruption include prior abruption, smoking, trauma, cocaine use, multifetal gestation, hypertension, preeclampsia, thrombophilias, advanced maternal age, preterm premature rupture of the membranes, intrauterine infections, and hydramnios. Abruption involving more than 50% of the placenta is frequently associated with fetal death. The diagnosis of abruption is a clinical one, and ultrasonography and the Kleihauer-Betke test are of limited value. The management of abruption should be individualized on a case-by-case basis depending on the severity of the abruption and the gestational age at which it occurs. In cases where fetal demise has occurred, vaginal delivery is preferable. Disseminated intravascular coagulopathy should be managed aggressively. When abruption occurs at or near term and maternal and fetal status are reassuring, conservative management with the goal of vaginal delivery may be reasonable. However, in the presence of fetal or maternal compromise, prompt delivery by cesarean is often indicated. Similarly, abruption at extremely preterm gestations may be managed conservatively in selected stable cases, with close monitoring and rapid delivery should deterioration occur. Most cases of placental abruption cannot be predicted or prevented. However, in some cases, maternal and infant outcomes can be optimized through attention to the risks and benefits of conservative management, ongoing evaluation of fetal and maternal well-being, and through expeditious delivery where appropriate.

Parackal S; Ferguson E; Harraway J. Alcohol and tobacco consumption among 6-24-months post-partum New Zealand women. Maternal and Child Nutrition 3(1): 40-51, 2007. (61 refs.)

Maternal alcohol or tobacco consumption may negatively impact the fetus and breastfeeding infants. Maternal tobacco consumption is also known to negatively affect exposed young children. The current study therefore aimed to assess the prevalence of these lifestyle behaviours in a sample of 6-24-months post-partum women and to elucidate socio-demographic and maternal factors associated with these behaviours. A community-based cross-sectional survey was conducted on 6-24-months post-partum women (n = 318) in three cities in the South Island of New Zealand. Self-reported data on current alcohol and tobacco consumption were collected from these women using a self-administered questionnaire. The results showed that nearly 72% and 23% of these women consumed alcohol and tobacco, respectively. Being Caucasian, having a higher level of education and higher household income were significant factors for alcohol consumption, while being of younger age and of lower educational status were significant factors for tobacco consumption. Pregnancy was associated with lower odds for alcohol consumption (0.07; P < 0.001), but not with lower odds for tobacco consumption. In contrast, breastfeeding was not associated with lower odds of alcohol consumption (0.08; P = 0.075). In conclusion, younger women with lower levels of education and household income must be targeted for public health education on the negative effects of tobacco consumption on their own health and on the health of their children.

Pollak KI; Oncken CA; Lipkus IM; Peterson BL; Swamy GK; Pletsch PK et al. Challenges and solutions for recruiting pregnant smokers into a nicotine replacement therapy trial. Nicotine & Tobacco Research 8(4): 547-554, 2006. (39 refs.)

Improvements in smoking cessation interventions for pregnant smokers are needed. One major step is to examine the potential effectiveness of nicotine replacement therapy (NRT). The potential benefits of providing pregnant women with NRT to help them quit smoking are still unknown; early interventions to test the effectiveness and efficacy are vital to advancing the field. This paper describes recruitment efforts for a multiclinic trial to test the effectiveness of NRT use in addition to behavioral therapy in promoting cessation during pregnancy. The biggest challenge is recruiting sufficient numbers of pregnant women. This paper discusses specific obstacles for recruitment and solutions. Knowing the potential pitfalls to recruiting pregnant women into these trials can lead to better studies and thus improved outcomes.

Pollard I. Neuropharmacology of drugs and alcohol in mother and fetus. Seminars in Fetal & Neonatal Medicine 12(2): 106-113, 2007. (35 refs.)

Epidemiological evidence suggests that an adverse prenatal environment can have profound long-term health consequences throughout postnatal Life. This chapter discusses the underlying mechanisms implicated in the consumption of mood-altering recreational drugs and teratogenicity in the fetus. The way metabolic parameters in pregnancy influence the pharmacokinetic characteristics of drugs and alcohol and the developmental stage of neurotoxicity are reviewed. The general underlying mechanisms that link multifaceted interactions between drug characteristics, gene polymorphisms, dietary deficiencies, changed endocrine indices and fetal programming are outlined, with specific examples throughout the text. As developmental injury is of significant social concern, the final section questions whether society provides adequate support for making appropriate and informed lifestyle choices to alleviate preventable transgenerational harm.

Rayburn WF; Meng C; Rayburn BB; Proctor B; Handmaker NS. Beer consumption among hazardous drinkers during pregnancy. Obstetrics and Gynecology 107(2, Part 1): 355-360, 2006. (28 refs.)

OBJECTIVE: The objective of this study was to examine the prevalence of beer consumption among hazardous drinkers in our pregnant patient population. METHODS: This prospective clinic-based cohort study involved women who were surveyed during their first prenatal visit. Hazardous drinking was identified on alcohol surveys as frequent or binge drinking habits with related consequences. Participants completed initial and postpartum interviews about the quantity, frequency, and type (beer, wine, liquor, and/or combinations) of alcoholic beverages consumed before and after pregnancy recognition. RESULTS: Of the total 4,494 patients who completed the survey, 203 (4.52%) met criteria for hazardous drinking, met study eligibility criteria, and completed the interviews. Beer was consumed most often (n = 151, 74.4%) and in greater quantities than wine (P <.05) or liquor (P <.01). Beer continued to be consumed by 52.3% women after pregnancy recognition. Although abstinence for prolonged periods was common during pregnancy, beer was consumed more than wine and liquor per drinking episode (2.7 versus 0.9 drinking units per drinking day; P =.002) indicating a hinging pattern. Very few switched to drinking either a light beer (n = 6) or a nonalcoholic beer (n = 1). CONCLUSION: Beer is the most consumed among women with hazardous drinking habits before and after pregnancy awareness. Focusing on binge beer drinking is worthwhile during routine prenatal questioning.

Robbins JM; Bird TM; Tilford JM; Reading JA; Cleves MA; Aitken ME et al. Reduction in newborns with discharge coding of in utero alcohol effects in the United States, 1993 to 2002. Archives of Pediatrics & Adolescent Medicine 160(12): 1224-1231, 2006. (48 refs.)

Objective: To determine whether use of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for fetal alcohol effects has declined during the past 10 years among hospitalized newborns in the United States. Design: Trends in use of the ICD-9-CM code 760.71, "alcohol affecting the fetus," among newborns from 1993 through 2002 were compared with trends in self-reported drinking during pregnancy and maternal diagnoses of alcohol abuse during childbirth. Setting: Sampled short-term, nonfederal general and specialty hospitals. Participants: Infants born from 1993 to 2002 in the United States who were included in the Healthcare Cost and Utilization Project databases. Main Outcome Measures: Documentation of ICD-9-CM code 760.71 among newborns, self-reported drinking during pregnancy, and diagnoses of maternal alcohol abuse during childbirth from 1993 through 2002. Results: The prevalence of the ICD-9-CM code 760.71 for alcohol affecting the fetus, as documented in the discharge record of newborns, declined from 0.73 (95% confidence interval, 0.56-0.92) per 1000 live births in 1993 to 0.17 (95% confidence interval, 0.13-0.20) per 1000 live births in 2002. Rates declined concurrently with those of self-reported alcohol consumption during pregnancy and diagnoses of maternal alcohol abuse during childbirth. Conclusions: Use of the ICD-9-CM code for alcohol affecting the fetus among newborns declined 75% throughout 10 years. Results may be due to decreases in drinking during pregnancy, decreases in disclosure of alcohol use by the mother, or more selective use of the discharge code. National hospital discharge databases may allow cost-effective monitoring of public health interventions that address rare conditions of the fetus and newborn.

Ryan DM; Bonnett DM; Gass CB. Sobering thoughts: Town hall meetings on fetal alcohol spectrum disorders. (editorial). AIDS Education and Prevention 96(12): 2098-2101, 2006. (7 refs.)

Prenatal exposure to alcohol is one of the leading causes of preventable birth defects and developmental disabilities. During the past 30 years, fetal alcohol spectrum disorders (FASD), including fetal alcohol syndrome, have gradually begun to attract attention. However, awareness and understanding of the disorders remain low, and people who are affected are seriously underserved. The FASD Center for Excellence held a series of town hall meetings in 2002 and 2003 to gauge the issues surrounding FASD nationwide. On the basis of its findings, the center proposed a series of recommendations to begin to remedy some of the deficiencies that were identified.

Sansoy P; Ambroselli C; Padieu R; Ives R; Masar O; Anokhina IP, eds. Ethical Eye: Drug Addiction. Strasbourg France: Council of Europe Publishing, 2005

This edited volume with twelve chapters and sixteen contributors deals with ethical issues related to substance abuse, drawing upon the experiences in a variety of European countries and the Russian Federation. Following an introduction and opening chapter which outline ethical issues in respect to durg and use and the societal concerns drug use presents, the following chapters focus upon specific issues. Chapters consider information processing and data confidentiality; drug prevention and education; intensive treatment in countries with weak economics; compulsory treatment from three perspectives, the approach in the Russian Federation, the Swedish approach, and the treatment as an alternative to imprisonment. Other areas addressed are drug testing in the workplace, care for pregnant women or mothers, and treatment access for young people. The concluding chapter deals with the role of the Council of Europe in addressing drug addiction.

Schuetze P; Eiden RD; Dombkowski L. The association between cigarette smoking during pregnancy and maternal behavior during the neonatal period. Infancy 10(3): 267-288, 2006. (89 refs.)

This study examined the association between maternal smoking during pregnancy and maternal behavior during mother-infant interactions during the neonatal period. Participants included 84 mother-infant dyads (43 cigarette-exposed and 41 nonexposed) who were recruited after birth and assessed at 2 to 4 weeks of infant age. Results indicated that mothers who smoked during pregnancy had higher levels of maternal insensitivity (MI) and lower levels of maternal warmth (MW) during interactions with their infant even after controlling for demographics and pregnancy alcohol use. Maternal anxiety and hostility mediated the association between smoking and MI and maternal anger mediated the association between smoking and reduced MW. In addition, there was an interaction between infant gender and maternal smoking for MW with smokers displaying less warmth to boys during interactions.

Shankaran S; Das A; Bauer CR; Bada H; Lester B; Wright L et al. Fetal origin of childhood disease: Intrauterine growth restriction in term infants and risk for hypertension at 6 years of age. Archives of Pediatrics & Adolescent Medicine 160(9): 977-981, 2006. (36 refs.)

Objective: To examine the association between intrauterine growth restriction (IUGR) status at birth among full-term infants, exposure to substance use during pregnancy, and risk of hypertension at 6 years of age. Design: Prospective evaluation of high-risk children. Setting: Four centers of the National Institute of Child Health and Human Development Neonatal Research Network. Participants: One thousand three hundred eighty-eight infants (600 cocaine exposed, 781 nonexposed, and 7 indeterminate, matched by gestational age, race, and sex), were enrolled at these sites. Nine hundred fifty children (415 exposed, 535 nonexposed) were followed up for 6 years. Intervention: Right arm blood pressure was measured using the Dinamap portable adult/pediatric monitor with appropriate cuff size. Main Outcome Measure: Blood pressure levels. Hypertension was defined as either systolic or diastolic blood pressure higher than the 95th percentile for sex, age, and height. Results: Eight hundred ninety-one children had blood pressure data at 6 years of age: 516 were born at full term; 144 (28%) of the 516 children had a diagnosis of IUGR at birth. At 6 years of age, 93 (19%) of 516 children had hypertension. Of 144 children with IUGR, 35 (24%) had hypertension as compared with 58 (16%) of 372 children without IUGR (P <.05). Twenty percent of cocaine-exposed children had hypertension as compared with 16% of nonexposed children (P=.20). Intrauterine growth restriction status at birth was significantly associated with hypertension (relative risk, 1.8 [95% confidence interval, 1.2-2.7]) when multivariable Poisson regression analysis was performed adjusting for site; maternal race, education, and tobacco, marijuana, alcohol, and cocaine use during pregnancy; and child's current body mass index (calculated as weight in kilograms divided by height in meters squared). Conclusion: In term infants, IUGR is linked to risk of hypertension in early childhood, which may be a marker for adult cardiovascular disease.

Shankaran S; Lester BM; Das A; Bauer CR; Bada HS; Lagasse L et al. Impact of maternal substance use during pregnancy on childhood outcome. Seminars in Fetal & Neonatal Medicine 12(2): 143-150, 2007. (42 refs.)

The impact of maternal substance abuse is reflected in the 2002-2003 National Survey on Drug Use and Health. Among pregnant women in the 15-44 age group, 4.3%, 18% and 9.8% used illicit drugs, tobacco and alcohol, respectively. Maternal pregnancy complications following substance use include increases in sexually transmitted disorders, placental abruption and HIV-positive status. Effects on the neonate include a decrease in growth parameters and increases in central nervous system and autonomic nervous system signs and in referrals to child protective agencies. In childhood, behavioral and cognitive effects are seen after prenatal cocaine exposure; tobacco and alcohol have separate and specific effects. The ongoing use of alcohol and tobacco by the caretaker affects childhood behavior. Therefore, efforts should be made to prevent and treat behavioral problems as well as to limit the onset of drug use by adolescent children born to women who use drugs during pregnancy.

Singh SP; Razani-Boroujerdi S; Pena-Philippides JC; Langley RJ; Mishra NC; Sopori ML. Early postnatal exposure to cigarette smoke impairs the antigen-specific T-cell responses in the spleen. Toxicology Letters 167(3): 231-237, 2006. (40 refs.)

Annually, approximately two million babies are exposed to cigarette smoke in utero and postnatally through cigarette smoking of their mothers. Exposure to mainstream cigarette smoke is known to impair both innate and adaptive immunities, and it has been hypothesized that the effects of in utero exposure to cigarette smoke on children's health might primarily stem from the adverse effects of cigarette smoke on the immune system. To simulate the environment that babies from smoking mothers encounter, we examined the effects of prenatal mainstream and postnatal sidestream cigarette smoke on spleen cell responses. Results show that postnatal exposure of newborn Balb/c mouse pups to sidestream cigarette smoke through the first 6 weeks of life strongly suppresses the antibody response of spleen cells to the T-cell-dependent antigen, sheep red blood cells. The reduction in the antibody response seen within 6 weeks of postnatal smoke exposure is much quicker than the published data on the time 25 weeks) required to establish reproducible immunosuppression in adult rats and mice. Moreover, the immumosuppression is not associated with significant changes in T-cell numbers or subset distribution. While the postnatal exposure to cigarette smoke did not affect the mitogenic response of T and B cells, the exposure inhibited the T cell receptor-mediated rise in the intracellular calcium concentration. These results suggest that the early postnatal period is highly sensitive to the immunosuppressive effects of environmental tobacco smoke, and the effects are causally associated with impaired antigen-mediated signaling in T cells.

Sinha C; Guthrie KA; Lindow SW. A survey of postnatal contraception in opiate-using women. Journal of Family Planning and Reproductive Health 33(1): 31-34, 2007. (18 refs.)

Objective: To document the contraceptive choices and continuation rates for different contraceptives in a group of pregnant women who use opiates. Methods: A prospective study set in a large city in the north of England that looked at 40 pregnant women who used opiates in the index pregnancy. The study involved reviewing the records from the patients' general practitioners with information on the continuation rates of the chosen method of contraception and any related problems. Results: The women given Depo-Provera (R) (n = 14) did not continue the method after the first injection. Those given implants (n = 20) had a 95% continuation rate at a mean follow-up of over 11 months. Conclusions: Implants had a good continuation rate when used for postnatal contraception in women who used opiates in pregnancy. Depo-Provera may not be a suitable choice since all the women who chose this contraceptive method failed to continue with it.