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CORK Bibliography: Pregnancy

81 citations. January 2008 to present

Prepared: September 2008

Abrevaya J. Trends and determinants of second-pregnancy smoking among young-adult mothers who smoked during their first pregnancy. Nicotine & Tobacco Research 10(6): 951-957, 2008. (22 refs.)

We examined the trends and determinants of second-pregnancy smoking behavior among Michigan young-adult mothers who smoked during their first pregnancy (N=14,731). Maternally linked Michigan birth certificate data (1989-2004) were used to identify first and second pregnancies for young-adult mothers. ZIP code data were merged with census data to proxy for median household income and population size at the ZIP code level. For first-pregnancy smokers, linear and logistic regressions were used to analyze (a) the determinants of second-pregnancy smoking and (b) the association of birth outcomes with second-pregnancy smoking. Among young adults who smoked during their first pregnancy, second-pregnancy smoking was (a) inversely related to income and population, (b) less prevalent after 1997, (c) more likely after a low-birthweight first birth, and (d) less likely after a premature first birth. Despite recent declines in second-pregnancy smoking rates among young adults who smoked during their first pregnancy, these rates remain disturbingly high (more than 70%). Future smoking cessation efforts should target mothers who have lower incomes, live in less-populated areas, and have previously had low-birthweight babies. The results suggest that higher cigarettes taxes would also further reduce recurrent smoking.

Aliyu MH; Salihu HM; Wilson RE; Alio AP; Kirby RS. The risk of intrapartum stillbirth among smokers of advanced maternal age. Archives of Gynecology & Obstetrics 278(1): 39-45, 2008. (45 refs.)

Background/aim The effects of advanced maternal age and smoking in pregnancy on fetal survival have previously been reported. However, whether advanced maternal age modifies the relationship between smoking in pregnancy and intrapartum stillbirth remains unknown. We therefore set out to determine the impact of advanced maternal age (>= 35 years) on the association between smoking during pregnancy and intrapartum stillbirth by employing retrospective analysis of birth registry data. Methods We used a cohort of singleton births in Missouri from 1978 through 1997 (N = 1,436,628) to compute the risk of total, antepartum, and intrapartum stillbirth in smoking mothers. We categorized mothers into two age groups: "younger" (< 35 years), and "older" (>= 35 years). Non-smoking mothers age < 35 years were the referent category. Cox regression models were used to generate independent measures of association between intrauterine tobacco exposure and the risk of total, antepartum, and intrapartum stillbirth in each age group. Results A total of 5,772 counts of stillbirth were identified, yielding a stillbirth rate of 4.0 per 1,000. Approximately 33% (N = 1,900) occurred among older smokers resulting in a stillbirth rate of 9.1 per 1,000. The probability of intrapartum stillbirth was greatest among older smokers, followed by younger smokers and lowest among younger non-smokers (P < 0.01). As compared to non-smoking younger gravidas, younger smoking mothers had a 30% greater likelihood for both antepartum and intrapartum stillbirth (adjusted hazard ratio [95% confidence interval]: 1.3 [1.2-1.4] and 1.3 [1.2-1.5], respectively). Among older smokers the risk for intrapartum stillbirth was three times that of the referent group (adjusted hazard ratio: 3.2, 95% confidence interval: 2.2-4.5). Conclusions The risk of intrapartum stillbirth associated with smoking in pregnancy is potentiated by the age of the mother. This information will help policy makers develop targeted smoking cessation campaigns and positively impact quit rates in older mothers.

Aliyu MH; Wilson RE; Zoorob R; Chakrabartya S; Alio AP; Kirby RS et al. Alcohol consumption during pregnancy and the risk of early stillbirth among singletons. Alcohol 42(5): 369-374, 2008. (44 refs.)

The purpose of this study is to investigate the association between maternal alcohol intake in pregnancy and the occurrence of early stillbirth using a retrospective cohort analysis of singleton births in Missouri that occurred in the period 1989 through 1997 (N = 655,979). We used Cox proportional hazards regression to generate adjusted risk estimates for total, early, and late stillbirth associated with maternal alcohol intake and used the Robust Sandwich Estimator to adjust for intracluster correlations among sibships. Overall, a total of 3,508 counts of stillbirth were identified, yielding a stillbirth rate of 5.3 per 1,000. Among mothers who consumed alcohol during pregnancy, the stillbirth rate was 8.3 per 1,000. Mothers who consumed alcohol while pregnant were 40% more likely to experience stillbirth as compared with nondrinking mothers (adjusted hazards ratio = 1.4, 95% confidence interval: 1.2-1.7). A dose-response relationship was evident; mothers who consumed five or more drinks per week during pregnancy experienced a 70% elevated risk of stillbirth compared with nondrinking mothers (adjusted hazards ratio = 1.7; 95% confidence interval: 1.0-3.0). The risk of early stillbirth was 80% higher among drinking mothers compared with abstainers (adjusted hazards ratio = 1.8; 95% confidence interval: 1.3-2.3). The elevated risks for both early and late stillbirth did not reach statistical significance when broken down by level of alcohol intake. In conclusion, maternal drinking during pregnancy is associated with an increased risk of early stillbirth. These findings underscore the need to reinforce current counseling strategies toward pregnant women and women who intend to conceive on the detrimental effects of alcohol use in pregnancy.

Alvanzo AAH; Svikis DS. History of physical abuse and periconceptional drinking in pregnant women. Substance Use & Misuse 43(8/9): 1098-1109, 2008. (20 refs.)

This study examines the relationship between physical abuse and periconceptional drinking in women presenting to a mid-Atlantic, urban hospital-based OB/GYN clinic serving a largely indigent population between April 2003 and May 2004. During their first prenatal visit, 308 women completed a screening battery that included the Abuse Assessment Screen (AAS) and measures of alcohol use, including the CAGE, T-ACE, TWEAK, and the PRIME-MD Patient Health Questionnaire (PHQ). Bivariate analyses, including odds ratios (ORs) and 95% confidence intervals (CIs), revealed that women with a history of physical abuse were more likely to report drinking alcohol within the 3 months prior to their prenatal care visit and were significantly more likely to meet criteria for risk drinking on multiple measures. A history of physical abuse appears to be associated with higher self-reported rates of periconceptional drinking in pregnant women. Study findings support the need for assessment of abuse history as a potential risk factor for alcohol use in pregnant women.

Araojo R; McCune S; Feibus K. Substance abuse in pregnant women: Making improved detection a good clinical outcome. (editorial). Clinical Pharmacology and Therapeutics 83(4): 520-522, 2008. (8 refs.)

In this issue, Gideon Koren and colleagues review the maternal and child health implications of drug-residue testing in maternal and neonatal hair and testing for drugs in meconium. Since the 1990s, these methods have been used to varying degrees in clinical practice, but recent technological advances have increased their accuracy and usability in the clinical setting. Compared with self-reported maternal use, drug-residue testing in hair and testing for drugs in meconium are more reliable methods for detecting drug and alcohol exposure during pregnancy. These methods can also provide insights into patterns of use and abuse of these substances.

Ashford J; van Lier PAC; Timmermans M; Cuijpers P; Koot HM. Prenatal smoking and internalizing and externalizing problems in children studied from childhood to late adolescence. Journal of the American Academy of Child and Adolescent Psychiatry 47(7): 779-787, 2008. (42 refs.)

Objective: To study whether prenatal smoking only relates to externalizing problems or whether it is associated with both internalizing and externalizing problems from childhood into late adolescence. Method: Child Behavior Checklist-derived, parent-reported internalizing and externalizing problems of 396 children were longitudinally assessed at ages 5, 10 to 11, and 18 years. The influence of self-reported prenatal smoking on the course of internalizing and externalizing problems over these ages was assessed, controlling for the co-occurrence of internalizing and externalizing problems and co-occurring pre- and perinatal risk factors, demographic characteristics, maternal mental health, and child social and attention problems. Results: Children whose mothers had smoked during pregnancy had increased levels of both internalizing and externalizing problems over the period of ages 5 to 18 years when compared with children whose mothers did not smoke during pregnancy. These associations remained significant after controlling internalizing for externalizing and vice versa and possible confounding variables. Conclusions: Maternal smoking during pregnancy is a predictor of internalizing as well as externalizing psychopathology in offspring. The association between prenatal smoking and internalizing and externalizing problems persists throughout childhood and late adolescence.

Bachir R; Chaaya M. Maternal smoking: Determinants and associated morbidity in two areas in Lebanon. Maternal and Child Health Journal 12(3): 298-307, 2008. (35 refs.)

Objectives: This study assessed the factors related to smoking during pregnancy in two areas in Lebanon, and the association of smoking to selected maternal and newborn health related factors. Methods: This was a secondary analysis of data on 538 women who delivered in nine hospitals in two areas in Lebanon. Women were interviewed about their smoking practices, and on demographic and psychosocial variables. 396 women were followed up and re-interviewed about their smoking status, and the mother's and baby's health after delivery. Smoking during pregnancy included both cigarettes and narghile smoking. Results: About 25.7% of women were smoking some kind of tobacco during pregnancy. Older women, Muslim women, women with poor education, those who had financial difficulty, nervousness, lower support, and delay in seeking prenatal care were more likely to smoke during pregnancy. Women who smoked during pregnancy were more likely to have a low birth weight baby and to stop breastfeeding. Conclusions: It is important to address smoking among women in general, and not only during pregnancy. We discuss the role of public and private sectors in smoking cessation and interventions.

Bell J; Harvey-Dodds L. Pregnancy plus - Pregnancy and injecting drug use. British Medical Journal 336(7656): 1303-1305, 2008. (24 refs.)

Beratis NG; Asimacopoulou A; Varvarigou A. Association of secondary sex ratio with smoking and parity. Fertility and Sterility 89(3): 662-667, 2008. (51 refs.)

Objective: To assess the sex ratio in offspring of smoking and nonsmoking mothers in relationship to parity. Design: Prospective study. Setting: University hospital. Patient(s): The authors studied 2,108 term singleton neonates born between 1993 and 2002, 665 from smoking mothers and 1,443 from nonsmoking mothers. Intervention(s): A prospective recording of maternal age, parity and smoking status, and gender of neonates delivered over a 10-year period. Main Outcome Measure(s): Secondary sex ratio in regard to maternal smoking and parity. Result(s): The offspring sex ratio in the total sample studied was 1.09; in the offspring of smoking and nonsmoking mothers, it was 1.26 and 1.03, respectively, a statistically significant difference. In the offspring of smoking women who had parity 1, 2, and >= 3, it was 1.47, 1.35, and 0.92, whereas in those of nonsmoking women, it was 1.04, 1.00, and 1.03, respectively (the differences of the parity 1 and 2 groups between the offspring of smoking and nonsmoking mothers were statistically significant). Logistic regression analysis showed that the possibility of a boy being delivered by a mother who smoked was significantly greater in primiparous women than in women who had parity 3, independent of the maternal age. Conversely, parity did not affect significantly the sex ratio in the offspring of nonsmoking women. Conclusion(s): The findings suggest that among women who smoked, significantly more male than female offspring are born from primiparous women, whereas women who had parity 3 gave birth to more female offspring; F biparous women give birth to significantly more male offspring, but the offspring sex ratio declined with the number of cigarettes when the mothers smoked >= 10 cigarettes per day.

Binder T; Vavrinkova B. Prospective randomised comparative study of the effect of buprenorphine, methadone and heroin on the course of pregnancy, birthweight of newborns, early postpartum adaptation and course of the neonatal abstinence syndrome (NAS) in women followed up in the outpatient department. Neuroendocrinology Letters 29(1): 80-86, 2008. (13 refs.)

OBJECTIVE: The aim of the study was to evaluate the effect of substitution therapy in heroin addicted pregnant women on the course of pregnancy, perinatal outcomes and course of the neonatal abstinence syndrome. DESIGN OF THE STUDY. A five-year randomised prospective comparative study METHODS: The study was carried out in the period of 2002-2007. The group of patients included 147 i.v. heroin-addicted pregnant women. All of them were outpatients of our Perinatal Care Unit. Their daily dose of heroin was approximately lg. Later, 30 women were disqualified from the study for breaking the randomised criteria engagement. The substitution therapy in women who agreed to undergo it, started during the 1. trimester of pregnancy. Finally, 47 heroin, 32 methadone and 38 buprenorphine addicted women were enrolled in the study. Birthweight of newborns was compared with the national birthweight tables. Severity and duration of neonatal abstinence syndrome (NAS) were evaluated by Finnegan's score scale. RESULTS: None of the women delivered before the end of 34(th) gestational week. We did not encounter any perinatal death or developmental defect. The lowest birthweight, the highest number of newborns with IUGR and the most numerous placental changes were found in the group of heroin-addicted women. The differences compared to the two groups receiving substitution therapy were statistically significant (p < 0.05). The severity and course of NAS were the most severe (p < 0.001) in newborns of women from the methadone group.

Braaten K; Briegleb C; Hauke S; Niamkey N; Chang G. Screening pregnant young adults for alcohol and drug use: A pilot study. Journal of Addiction Medicine 2(2): 74-78, 2008. (45 refs.)

This study. ascertained the feasibility of offering a self-report alcohol and drug screen embedded in a general health habits survey to patients attending the Young Adult Reproductive Medicine Clinic and compared those who screened positive for a substance use problem with those who did not. An anonymous convenience sample of 100 young adults completed the Health Habits Survey, which included the CRAFFT screening test, designed specifically to identify substance-related problems in adolescent populations and recently recommended as a potential tool to reduce adverse outcomes from prenatal alcohol exposure. Eighty of the 100 respondents were pregnant and younger than aged 25 years, and they are the focus of the study. With a mean age of 18.2 years and 23.5 weeks gestation, most were single (75%) and had a high school education or less (75%). The majority (81%) was CRAFFT screen negative, but 15 answered yes to at least 1 CRAFFT question. There were no systematic differences between those with positive or negative CRAFFT screens. The CRAFFT, when embedded in a general health habits survey, seems to be a feasible option for pregnant young adults, but further studies to assess reliability, sensitivity, and specificity are recommended.

Branson BM; Handsfield HH; Lampe MA; Janssen RS; Taylor AW; Lyss SB et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. (review). Journal of the National Medical Association 100(1): 131-147, 2008. (116 refs.)

These recommendations for human immunodeficiency virus (HIV) testing are intended for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care, clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings. The recommendations address HIV testing in health-care settings only. They do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans). The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States. These revised recommendations update previous recommendations for HIV testing in health-care settings and for screening of pregnant women (CDC Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR 1993;42[No. RR-2]:1-10; CDC. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50[No. RR-19]:1-62; and CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50[No. RR-19]:63-85). Major revisions from previously published guidelines are as follows: For patients in all health-care settings HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Persons at high risk for HIV infection should be screened for HIV at least annually. Separate written consent for HIV testing should not be required; general consent for medical care should be considered. sufficient to encompass consent for HIV testing. Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in healthcare settings. For pregnant women HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women. HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required, general consent for medical care should be considered sufficient to encompass consent for HIV testing. Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.

Burns L; Mattick RP; Wallace C. Smoking patterns and outcomes in a population of pregnant women with other substance use disorders. Nicotine & Tobacco Research 10(6): 969-974, 2008. (38 refs.)

Using a retrospective cross-sectional study design, we examined smoking patterns and associated neonatal outcomes in infants born to women with a diagnosis of a substance use disorder in pregnancy. Antenatal and birth admissions were linked to midwives data on pregnancy care, services, and outcomes over a 5-year period (1998-2002). Birth admissions were flagged as positive for drug use where a birth admission or any pregnancy admission for that birth involved a cannabis-, opioid-, stimulant-, or alcohol-related ICD-10AM code. There were 4,346 live births to women with a substance-related diagnosis in pregnancy. Women with a substance-related diagnosis (the drug group) had an adjusted odds ratio for smoking during pregnancy of 10.8 (95% CI=9.9-11.7) relative to women without a substance-related diagnosis (the non-drug group). Women in the drug group also were heavier smokers; 26% smoked 1-10 cigarettes/day and 56% smoked more than 10 cigarettes/day compared with 8% in both groups in the non-drug group. Relative to the drug group, the adjusted odds ratio for quitting smoking during pregnancy in the non-drug group was 3.1 (95% CI=2.3-4.3). Among women in the drug group, any smoking significantly increased the risk of poor fetal growth, prematurity, and admission to the special care nursery. In conclusion, innovative and effective strategies for tobacco cessation should target pregnant women as a high priority. Further research should identify the models of tobacco cessation most suited to women who also use other substances during pregnancy.

Carter S; Paterson J; Gao WZ; Lusitini L. Maternal smoking during pregnancy and behaviour problems in a birth cohort of 2-year-old Pacific children in New Zealand. Early Human Development 84(1): 59-66, 2008. (47 refs.)

Aim: The present study investigated associations between maternal smoking during pregnancy and child behaviour problems in a cohort of Pacific Islands two-year-old children in New Zealand. Study design: Data were gathered as part of the Pacific Islands Families (PIF) Study. Mothers of a cohort of 1398 Pacific infants born in South Auckland, New Zealand were interviewed when their children were six-weeks, 12 and 24 months of age. Within the context of a wider interview, data regarding cigarette smoking during pregnancy was obtained from 1038 biological mothers at the six-week interview and reports of child behaviour using the Child Behaviour Checklist were gathered when the children were 24 months old. Results: The prevalence rates of clinically relevant cases were higher in children of smokers compared to non-smokers for internalising (22.6% versus 15.2%), externalising (9.6% versus 5.7%) and total problem scores (20% versus 12.4%). Following adjustment for potential confounding factors, smoking was associated with a moderately increased prevalence of total behaviour problems (OR=1.75, 95% CI=(1.12, 2.74); p=0.015). For internalising scores, the effects of smoking appeared to be raised for children of non-partnered mothers (OR=3.35, 95% CI=(1.29, 8.67); p=0.013). For externalising scores, smoking appeared to have a greater detrimental effect on girls (OR=237, 95% CI=(1.12, 5.04); p=0.024). Conclusions: Findings indicate there are significant effects of prenatal tobacco exposure on problem behaviour among young children. Smoking is a modifiable factor worthy of increased early preventive efforts.

Christensen C. Management of chemical dependence in pregnancy. Clinical Obstetrics and Gynecology 51(2): 445-455, 2008. (41 refs.)

Although the percentage of pregnant patients who use illicit drugs is relatively low, the effects can be devastating on both mother and fetus-loss of custody, growth restriction, placental abruption, and death. The practicing obstetrician may be unfamiliar with the various presentations of chemical dependency in pregnancy, including intoxication and withdrawal, and difficulty in making the diagnosis. The obstetrician is in the unique situation of being responsible for the safety of both mother and fetus, which may involve engaging the unwilling patient in treatment.

Cohn SE; Umbleja T; Mrus J; Bardeguez AD; Andersen JW; Chesney MA. Prior illicit drug use and missed prenatal vitamins predict nonadherence to antiretroviral therapy in pregnancy: Adherence analysis A5084. AIDS Patient Care and STDS 22(1): 29-40, 2008. (40 refs.)

Adherence to antiretroviral therapy (ART) in pregnancy is crucial to optimize its efficacy and minimize mother-to-child transmission. Our objective was to examine adherence patterns to ART and health behaviors during and after pregnancy among HIV-positive women enrolled in A5084, a prospective, observational, multisite study. Between 2002-2005, HIV-infected women between 20 and 34 weeks' gestation completed at least 1 self-reported adherence questionnaire antepartum (AP), and were followed through 12 weeks' postpartum (PP). Questionnaires also addressed tobacco, alcohol, and illicit drugs use. Adherence was defined as reporting not having missed any doses for more than 3 months. Exact McNemar's tests were used for paired binary data and exact logistic regression was used for predictors of nonadherence. We report on 149 women (55% black, 26% Hispanic, 32% less than 25 years, 9% with AIDS, 100% on ART). PP, 31 (21%) women stopped ART and 18 (12%) withdrew from the study. AP, 57% reported adherence to ART and PP, 45% (p = 0.03, n = 87). AP, 11% reported ongoing alcohol use and 23% tobacco use compared to 37% and 30% PP (p < 0.0001, n = 103; p = 0.07, n = 99, respectively). Although 39% ever used marijuana (n = 116) and 25% used illicit drugs (n = 107), few participants reported use during the study. In multivariate analyses, those who had ever used illicit drugs had 5.95 times higher odds (p = 0.002) and those who missed prenatal vitamins had 4.84 times higher odds (p = 0.001) of ART nonadherence. Women reporting a history of illicit drug use and/or having missed prenatal vitamins should be targeted for programs to enhance adherence to ART during pregnancy.

Cooper AR; Moley KH. Maternal tobacco use and its preimplantation effects on fertility: More reasons to stop smoking. Seminars in Reproductive Medicine 26(2): 204-212, 2008. (76 refs.)

There are numerous health concerns regarding tobacco smoke. Yet, only recently have researchers extensively explored the association between tobacco smoke and a woman's inability to conceive. Whether exposure occurs in utero, during pregnancy, or throughout the reproductive years, it can affect all facets of fertility and lead to diminished ovarian function and earlier menopause. This review analyzes the literature concerning the delay or absence of conception in some women exposed to cigarette smoke and provides a detailed examination of the potential reproductive targets of the mutagenic and toxic components of tobacco. A negative influence on ovarian steroidogenesis and gametogenesis, oocyte maturity, ovulation, oocyte cumulus complex pick-up, gamete and embryo transport by the oviduct, fertilization, and implantation could all play a role. Assisted reproductive technology, or more specifically, in vitro fertilization, has allowed us to more thoroughly analyze successful pregnancy cycles and the negative consequences of smoking. Objective measurements of tobacco compounds and their metabolites in follicular fluid correlate with subjective measures of ovarian, gamete, and embryo quality in smokers and in those exposed to passive smoke. Regardless, there is an abundance of literature accumulating and more than enough reasons to tell patients to stop smoking.

Cox S; Posner SF; Kourtis AP; Jamieson DJ. Hospitalizations with amphetamine abuse among pregnant women. Obstetrics and Gynecology 111(2 (Part 1)): 341-347, 2008. (30 refs.)

OBJECTIVE: To examine trends in pregnancy hospitalizations with a diagnosis of amphetamine or cocaine abuse and the prevalence of associated medical complications. METHODS: Data were obtained from the Nationwide Inpatient Sample. Hospitalization ratios per 100 deliveries for amphetamine or cocaine abuse from 1998 to 2004 were tested for linear trends. Amphetamine-abuse hospitalizations were compared with cocaine-abuse hospitalizations and non-substance-abuse hospitalizations. A chi(2) analysis was used to compare hospitalization characteristics. Conditional probabilities estimated by logistic regression were used to calculate adjusted prevalence ratios for each medical diagnosis of interest. RESULTS: From 1998 to 2004, the hospitalization ratio for cocaine abuse decreased 44%, whereas the hospitalization ratio for amphetamine abuse doubled. Pregnancy hospitalizations with a diagnosis of amphetamine abuse were geographically concentrated in the West (82%), and were more likely to be among women younger than 24 years than the cocaine-abuse or non-substance-abuse hospitalizations. Most medical conditions were more prevalent in the amphetamine-abuse group than the non-substance-abuse group. When the substance abuse groups were compared with each other, obstetric diagnoses associated with infant morbidity such as premature delivery and poor fetal growth were more common in the cocaine-abuse group, whereas vasoconstrictive effects such as cardiovascular disorders and hypertension complicating pregnancy were more common in the amphetamine-abuse group. CONCLUSION: As pregnancy hospitalizations with a diagnosis of amphetamine abuse continue to increase, clinicians should familiarize themselves with the adverse consequences of amphetamine abuse during pregnancy and evidence-based guidelines to deal with this high-risk population.

Crawford JT; Tolosa JE; Goldenberg RL. Smoking cessation in pregnancy: Why, how, and what next... Clinical Obstetrics and Gynecology 51(2): 419-435, 2008. (63 refs.)

Smoking cessation in pregnancy has been shown to reduce low birth weight, preterm birth, and infant morbidities. The effectiveness and safety profile of current cessation approaches in pregnancy are presented. The highest cessation rates are associated with counseling and behavioral interventions. Further studies are needed to evaluate the safety and efficacy of pharmacotherapy in pregnancy including nicotine replacement therapy, bupropion and the recently approved drug Varenicline. The risks and benefits of nicotine replacement therapy in heavy smokers and bupropion are discussed. Data on fetal risk are not yet available for Varenicline.

da Veiga PV; Wilder RP. Maternal smoking during pregnancy and birthweight: A propensity score matching approach. Maternal and Child Health Journal 12(2): 194-203, 2008. (30 refs.)

There is accumulated evidence of the existence of a deleterious effect of smoking on birth outcomes. Understanding the effect of smoking on pregnancy is a critical issue because of the public policy implications for dissuading maternal smoking. We explore this issue by using the propensity score method and compare that with parametric estimators. First we estimate the treatment effect of smoking during pregnancy on different birth outcomes, by race. Then, we extend the method to the case of the multi-treatment "intensity of smoking." The deleterious effect of smoking is found robust to the different estimation methods used.

Donnelly JC; Cooley SM; Walsh TA; Sarkar R; Durnea U; Geary MP. Illegal drug use, smoking and alcohol consumption in a low-risk Irish primigravid population. Journal of Perinatal Medicine 36(1): 70-72, 2008. (10 refs.)

To evaluate the prevalence of illegal drug use, smoking and alcohol consumption in Irish primigravidas, we interviewed 1011 women at their booking visit. A total of 23.5% (235) of women had used illegal drugs prior to their first pregnancy, 28.9% were ex-smokers and 27.9% were still smoking during pregnancy. A total of 53.9% admitted to drinking alcohol during pregnancy. Smokers are 2.8 times more likely to have used drugs in the past than non-smokers. Level of alcohol consumption appears to be a significant predictor of drug use.

Dorfman SF. Tobacco and fertility: our responsibilities. Fertility and Sterility 89(3): 502-504, 2008. (12 refs.)

The publication of the new US Public Health Service-sponsored Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008, coupled with the persistent prevalence of tobacco use in the reproductive-age population and the negative effect of tobacco on fertility, prompts an updated review of this topic, geared to those who treat infertility. The article covers prevalence in the reproductive-age population; pertinence for fertility specialists; a synopsis of ASRM's educational bulletin; effective intervention; pharmacologic intervention for this special population; universal screening; personalized advice and assistance, and available resources.

Flynn HA; Chermack ST. Prenatal alcohol use: The role of lifetime problems with alcohol, drugs, depression, and violence. Journal of Studies on Alcohol and Drugs 69(4): 500-509, 2008. (62 refs.)

Objective: The purpose of this study was to examine a broader array of lifetime factors that theoretically may be associated with prenatal alcohol use than have previously been studied together, including family history of alcohol-use problems, history of physical or sexual abuse, lifetime major depressive disorder, alcohol-use disorder, illicit-drug-use problems, and partner violence. Method: A total of 186 pregnant women, all of whom used alcohol in the year before pregnancy, were initially recruited in prenatal care settings. Women who reported no prenatal alcohol use (n = 96) were compared with women who drank 1-10 standard drinks during pregnancy (n = 75) and with women who drank more than 10 standard drinks during pregnancy (n = 13), considered to be a higher risk group, on the lifetime risk variables. Because of the public health implications, secondary analyses compared women who abstained during pregnancy with those who used any alcohol. Results: Significant intercorrelations were found among most of the lifetime risk factors studied. Multivariate analyses showed that drug-use problems and partner violence were most strongly associated with prenatal alcohol use than any other variable studied. Conclusions: Consistent with a life span risk framework for alcohol-use problems, results of this study show that childhood abuse, familial alcoholism, lifetime major depressive disorder, and alcohol- and drug-use problems are interrelated. However, when considered together, only lifetime partner violence and drug use are significantly related to various levels of prenatal alcohol use. Identification, assessment, and intervention efforts should integrate these important factors.

Freour T; Masson D; Mirallie S; Jean M; Bach K; Dejoie T et al. Active smoking compromises IVF outcome and affects ovarian reserve. Reproductive Biomedicine Online 16(1): 96-102, 2008. (41 refs.)

Although the association between smoking and female infertility is now largely demonstrated, the proportion of smokers in women of reproductive age remains important. Tobacco contains numerous toxicants that could affect ovarian reserve and lead to poor prognosis in assisted reproductive techniques. To investigate the effect of female active smoking on ovarian reserve and IVF outcome, smoking status, hormonal status, i.e. serum FSH, oestradiol and anti-Mullerian hormone (AMH), ovarian response to hyperstimulation, i.e. mature oocytes retrieved, and IVF outcome, i.e. clinical pregnancy, were retrospectively analysed in 111 women undergoing IVF-embryo transfer cycles. Compared with non-smokers (n = 71), active smoking women (n = 40) had decreased ovarian response (12.12 +/- 5 versus 8.62 +/- 4 mature oocytes retrieved) to hyperstimulation and lower clinical pregnancy rate (29.6 versus 10.0%). Serum AMH concentrations were lower in the smoker group (3.86 +/- 1.92 versus 3.06 +/- 1.68 mu g/l) and had no predictive value for ovarian response, inversely to non-smokers. In conclusion, active smoking is associated with poor prognosis in assisted reproduction cycles, i.e. ovarian response and pregnancy, and leads to altered ovarian reserve, as reflected by decreased serum AMH concentrations.

Gaither K. Cocaine abuse in pregnancy: An evolution from panacea to pandemonium. (editorial). Southern Medical Journal 101(8): 783-784, 2008. (5 refs.)

Gilman SE; Breslau J; Subramanian SV; Hitsman B; Koenen KC. Social factors psychopathology, and maternal smoking during pregnancy. American Journal of Public Health 983(3): 448-453, 2008. (64 refs.)

We investigated the relative importance of sociodemographic factors and psychiatric disorders for smoking among 453 pregnant women in the National Epidemiological Survey on Alcohol and Related Conditions. Women with less than a high school education and those with current-year nicotine dependence had the highest risk of smoking (90.5%), compared with women with a college degree and without nicotine dependence (3.9%). More effective and accessible interventions for nicotine dependence among pregnant smokers are needed.

Goy J; Dodds L; Rosenberg MW; King WD. Health-risk behaviours: Examining social disparities in the occurrence of stillbirth. Paediatric and Perinatal Epidemiology 22(4): 314-320, 2008. (25 refs.)

While an association between low socio-economic status (SES) and increased risk of stillbirth has been observed consistently over several decades, the pathways through which SES exerts these effects have not been established. Given that some key health-risk behaviours for stillbirth, including smoking and pre-pregnancy obesity, have strong relationships with SES, health-risk behaviours may serve as a channel through which low SES contributes to stillbirth outcomes. The objective of this study was to estimate the proportion of the relationship between low SES and the occurrence of stillbirth that is explained by health-risk behaviours in populations of Eastern Ontario and Nova Scotia (112 stillbirth cases and 398 controls). Both area and individual level influences of SES were assessed. The study population consisted of 112 cases (women delivering stillborn infants) and 398 controls. Odds ratios and 95% confidence intervals estimated by multivariable logistic regression were used to approximate relative risks. The contribution of health-risk behaviours to relationships between SES and stillbirth was assessed by a change in the relative risk estimate following omission of each health-risk behaviour from the model. Of the three measures of individual level SES examined (household income, education, Blishen occupational index), only household income was a statistically significant predictor of stillbirth. After controlling for individual level SES, no community level SES effects were observed for stillbirth. Adjustments for key health-risk behaviours (smoking) resulted in an 18.5% reduction in the odds ratio estimate for low SES, from 3.31 to 2.79. This large unexplained SES effect that remained highlights the need for research into other potential pathways that may account for increased risk of stillbirth among those of lower SES.

Hannover W; Thyrian JR; Ebner A; Roske K; Grempler J; Kuhl R et al. Smoking during pregnancy and postpartum: Smoking rates and intention to quit smoking or resume after pregnancy. Journal of Women's Health 17(4): 631-640, 2008. (51 refs.)

Background: A substantial number of women smoke while pregnant. The majority of those who quit return to smoking within 12 months. The aim of this study is to estimate smoking rates and to measure the urge to smoke and the motivation to change smoking behavior among women who recently delivered. Methods: Data presented stem from two studies. Study 1 is an epidemiological survey investigating the health of neonates. Study 2 presents screening data of an efficacy trial for a smoking cessation and relapse prevention intervention. Participants were recruited on maternity wards within 7 days after delivery. Results: Five hundred fifty-three (29.1%) women were never smokers, 145 (7.6%) were former smokers, 492 (25.9%) abstained during pregnancy, and 712 (37.4%) smoked throughout pregnancy. Of the smokers, 69% did not intend to quit smoking within the next 6 months. Of the women who quit during pregnancy, 80% did not want to resume smoking within the next 6 months or after weaning. Conclusions: Smoking and relapse rates indicate a need for increased efforts to reduce smoking during pregnancy and postpartum. Reported intention to quit or resume does not reflect the high number of relapses. Indicators for relapse need to be found.

Haskins A; Mukhopadhyay S; Pekow P; Markenson G; Bertone-Johnson E; Carbone E et al. Smoking and risk of preterm birth among predominantly Puerto Rican women. Annals of Epidemiology 18(6): 440-446, 2008. (29 refs.)

PURPOSE: Studies of smoking during pregnancy and preterm birth among Hispanic women are sparse. Our goal was to evaluate the effect of cigarette smoking during pre-pregnancy, early pregnancy, and mid pregnancy on preterm birth among Hispanic women, the fastest growing ethnic group in the United States. METHODS: We evaluated data from a prospective cohort study of 1,041 Hispanic (predominantly Puerto Rican) women recruited between 2000 and 2004 in Springfield, Massachusetts. At recruitment (mean = 15 weeks), women reported their smoking since pregnancy awareness (early pregnancy) and in the year prior to pregnancy (pre-pregnancy). Mid pregnancy smoking was collected at a second interview (mean = 28 weeks). RESULTS: Smoking in pre-pregnancy was not associated with preterm birth. After adjustment for age, parity, education, and illicit drug use, women who smoked in early pregnancy had 1.6 times the risk of preterm birth (95% confidence interval [CI], 1.0-2.7) compared with nonsmokers. Women who smoked in mid pregnancy had 2.1 times the risk of preterm birth (95% CI, 1.0-4.2) compared with nonsmokers with a trend of increased risk of preterm birth with increasing levels of smoking (p trend, 0.03). CONCLUSIONS: Smoking in early or mid pregnancy increased the risk of spontaneous preterm birth in a Hispanic population.

Heil SH; Higgins ST; Bernstein IM; Solomon LJ; Rogers RE; Thomas CS et al. Effects of voucher-based incentives on abstinence from cigarette smoking and fetal growth among pregnant women. Addiction 103(6): 1009-1018, 2008. (35 refs.)

Aims: This study examined whether voucher-based reinforcement therapy (VBRT) contingent upon smoking abstinence during pregnancy is an effective method for decreasing maternal smoking during pregnancy and improving fetal growth. Design, setting and participants: A two-condition, parallel-groups, randomized controlled trial was conducted in a university-based research clinic. A total of 82 smokers entering prenatal care participated in the trial. Intervention Participants were assigned randomly to either contingent or non-contingent voucher conditions. Vouchers exchangeable for retail items were available during pregnancy and for 12 weeks postpartum. In the contingent condition, vouchers were earned for biochemically verified smoking abstinence; in the non-contingent condition, vouchers were earned independent of smoking status. Measurements Smoking outcomes were evaluated using urine-toxicology testing and self-report. Fetal growth outcomes were evaluated using serial ultrasound examinations performed during the third trimester. Findings Contingent vouchers significantly increased point-prevalence abstinence at the end-of-pregnancy (41% versus 10%) and at the 12-week postpartum assessment (24% versus 3%). Serial ultrasound examinations indicated significantly greater growth in terms of estimated fetal weight, femur length and abdominal circumference in the contingent compared to the non-contingent conditions. Conclusions: These results provide further evidence that voucher-based reinforcement therapy has a substantive contribution to make to efforts to decrease maternal smoking during pregnancy and provide new evidence of positive effects on fetal health.

Heil SH; Sigmon SC; Jones HE; Wagner M. Comparison of characteristics of opioid-using pregnant women in rural and urban settings. American Journal of Drug and Alcohol Abuse 34(4): 463-471, 2008. (25 refs.)

Historically, research on opioid use during pregnancy has occurred in urban settings and it is unclear how urban and rural populations compare. We examined sociodemographic and other variables in opioid-using pregnant women seeking treatment and screened for participation in a multi-site randomized controlled trial. Women screened in rural Burlington, Vermont (n = 54), were compared to those screened in urban Baltimore, Maryland (n = 305). Rural opioid-using pregnant women appear to have some characteristics associated with better treatment outcomes (e. g., less severe drug use, greater employment). However, they may face additional barriers in accessing treatment (e. g., greater distance from treatment clinic).

Helmbrecht GD; Thiagarajah S. Management of addiction disorders in pregnancy. Journal of Addiction Medicine 2(1): 1-16, 2008. (155 refs.)

In this article, we will review the prevalence of addiction disorders in pregnancy and the impact that it has on perinatal morbidity and mortality. We will then review effective screening techniques and propose a management scheme for achieving short-term abstinence leading to the ultimate goal of long-term recovery. The various medical and obstetric complications unique to this patient population will be discussed as well as the specific adverse effects of substance abuse on placentation and the developing fetus. Finally, medications proven efficacious in the treatment of addiction disorders will be reviewed in the context of their use in the pregnant population.

Huuskonen P; Storvik M; Reinisalo M; Honkakoski P; Rysa J; Hakkola J; Pasanen M. Microarray analysis of the global alterations in the gene expression in the placentas from cigarette-smoking mothers. Clinical Pharmacology and Therapeutics 83(4): 542-550, 2008. (47 refs.)

The effects of maternal cigarette smoking on the transcriptome of human full-term placentas were investigated by a microarray analysis. QPCR was performed for a selected set of metabolizing genes. Differentially expressed genes were selected by fold change (+/- 1.5-fold) and analysis of variance (P<0.05) between the control and smoker groups. The expression of 174 probe sets was affected significantly. Chronic cigarette smoking induced the expression of CYP1A1. A trend toward a decrease in the expression of several steroid hormone-metabolizing enzymes, including CYP19A1, was detected. The expression of phase II enzymes was not altered, and no enriched categories were observed among the regulated genes, except for aryl hydrocarbon receptor (AhR)-CYP1A1. The unaltered expression of phase II enzymes may result in an increase in the levels of active metabolites and elevated oxidative chemical stress in the placenta and the fetus. On the basis of our results, it seems that cigarette smoke acts as a hormone disrupter in the placenta.

Ip P; Chan WT; Lee YT; Chow CB. Early intervention program for pregnant heroin users and their young children: Hong Kong's experience. Hong Kong Journal of Pediatrics 13(2): 99-109, 2008. (14 refs.)

Objectives: To achieve early identification of pregnant heroin users and their young children and to provide adequate support, modify important risk factors and monitor the welfare of their children. Methodology: Pregnant heroin users were identified during early pregnancy by social workers in a major methadone centre in Kowloon West and referred to a district hospital for early assessment, counselling, management of drug addiction and formulation of child care plan. Their infants and young children were followed up and closely monitored by a paediatrician and staff in a local maternity and child health centre. Results: Fifty-eight heroin users and their families (69 children) were recruited in the Kowloon West District from May 2006 to April 2007, among which 9 (15.5%) underwent successful detoxification and 38 (65.5%) became stable methadone users, which were significantly higher than the 7% successful detoxification rate and 14% stable methadone user rate found in the baseline study before the program. Vaccination compliance of their young children was 94%, which was higher than the 77% compliance rate found in the surveillance study before the program. Conclusions: Modification of risk factors of pregnant heroin abusers and their young children could be achieved by an early intervention program through enhanced work of health care and social service workers.

Jaddoe VWV; Troe EJWM; Hofman A; Mackenbach JP; Moll HA; Steegers EAP et al. Active and passive maternal smoking during pregnancy and the risks of low birthweight and preterm birth: the Generation R Study. Paediatric and Perinatal Epidemiology 22(2): 162-171, 2008. (21 refs.)

The objective of this study was to examine the associations between active and passive smoking in different periods of pregnancy and changing smoking habits during pregnancy, with low birthweight and preterm birth. The study was embedded in the Generation R Study, a population-based prospective cohort study from early fetal life onwards in Rotterdam, The Netherlands. Active and passive smoking were assessed by questionnaires in early, mid- and late pregnancy. Analyses were based on 7098 pregnant women and their children. Active smoking until pregnancy was ascertained and was not associated with low birthweight and preterm birth. Continued active smoking after pregnancy was also recorded and was associated with low birthweight (adjusted odds ratio 1.75 [95% CI 1.20, 2.56]) and preterm birth (adjusted odds ratio 1.36 [95% CI 1.04, 1.78]). The strongest associations were found for active maternal smoking in late pregnancy. Passive maternal smoking in late pregnancy was associated with continuously measured birthweight (P for trend < 0.001). For all active smoking categories in early pregnancy, quitting smoking was associated with a higher birthweight than continuing to smoke. Tendencies towards smaller non-significant beneficial effects on mean birthweight were found for reducing the number of cigarettes without quitting completely. This study shows that active and passive smoking in late pregnancy are associated with adverse effects on weight and gestational age at birth. Smoking in early pregnancy only, seems not to affect fetal growth adversely. Health care strategies for pregnant women should be aimed at quitting smoking completely rather than reducing the number of cigarettes.

Jones HE; Johnson RE; O'Grady KE; Jasinski DR; Tuten M; Milio L. Dosing adjustments in postpartum patients maintained on buprenorphine or methadone. Journal of Addiction Medicine 2(2): 103-107, 2008. (14 refs.)

Scant scientific attention has been given to examining the need for agonist medication dose changes in the postpartum period. Study objectives were: 1) to determine the need for medication dose adjustments in participants stabilized on buprenorphine or methadone 3 weeks before and 4 weeks after delivery, and 2) to evaluate the need for methadone dose adjustments during the first 7 days in participants transferred from buprenorphine to methadone at 5 weeks postpartum. Participants were opioid-dependent pregnant women who had completed a randomized, double-blind, double-dummy, flexible dosing comparison of buprenorphine to methadone. Participants received a stable dose of methadone (N = 10) or buprenorpbine (N = 8) before and 4 weeks after delivery. Buprenorphine-maintained participants were transferred to methadone at 5 weeks postpartum. There were no significant differences predelivery and/or postdelivery between the buprenorphine and methadone conditions in the mean ratings of dose adequacy, "liking," "hooked," and "craving" of heroin or cocaine. Patient response to the conversion from buprenorphine to methadone seems variable. Buprenorphine-maintained participants required dose changes postpartum only after they transferred to methadone. Regardless of type of medication, postpartum patients should be monitored for signs of overmedication.

Kakko J; Heilig M; Sarman I. Buprenorphine and methadone treatment of opiate dependence during pregnancy: Comparison of fetal growth and neonatal outcomes in two consecutive case series. Drug and Alcohol Dependence 96(1-2): 69-78, 2008. (31 refs.)

Aim: To compare the effects of fetal buprenorphine and methadone exposure during maintenance treatment of pregnant heroin dependent subjects. Design and setting: A population based comparison of consecutive, prospectively followed buprenorphine-exposed pregnancies in Stockholm County, Sweden, to retrospectively analyzed consecutive methadone-exposed pregnancies. Participants: All 47 pregnancies in 39 women with opiate dependence and buprenorphine maintenance treatment 2001-2006, and all 35 methadone-exposed pregnancies (26 women) 1982-2006 in Stockholm County. Measurements: Intrauterine growth, birth outcome, malformations, neonatal adaptation, withdrawal syndrome and infant mortality. Findings: Buprenorphine-exposed pregnancies resulted in 47 uneventful live births (2 twin pairs), 1 stillbirth (for which no explanation was found) and 1 miscarriage. The birth weight of the infants was normal. Neonatal abstinence syndrome (NAS) occurred in 19 cases (40.4%), the majority mild in nature and only 7 (14.9%) needing withdrawal treatment. Compared to 35 infants born after intrauterine methadone exposure at the same hospital since 1982 (77.8% of them exhibiting NAS and 52.8% needing withdrawal treatment), there were significant advantages with buprenorphine treatment: birth weight was higher, due to longer gestation. Incidence of NAS of any intensity, as well as incidence of NAS that required pharmacological treatment was lower, while length of hospital stay was shorter. When buprenorphine treatment started pre-conception, NAS at any level was significantly less frequent than in subjects with post-conception initiated treatment (7/27, 26%; 12/20, 60%, respectively). Conclusions: Data from this non-randomized comparison suggest that buprenorphine may offer advantages for treatment of opiate dependence during pregnancy.

Khawaja M; Al-Nsour M; Saad G. Khat (Catha edulis) chewing during pregnancy in Yemen: Findings from a national population survey. Maternal and Child Health Journal 12(3): 308-312, 2008. (37 refs.)

Aims: This study examines the prevalence of khat chewing among women during pregnancy and some of the risk factors for this habit in Yemen. Methods: Survey data on 7,343 ever-married women from the Yemen Demographic and Maternal and Health Survey (YDMHS), conducted in 1997 are used. Women who had a live birth during the 5 years preceding the survey were asked if they chewed khat during each of their pregnancies (=1) or not (=0). Associations between chewing khat and socio-demographic risk factors were assessed using odds ratios from binary logistic regression models. Results: About 40.7% of women surveyed reported chewing khat while pregnant during the 5 years before the survey. Old age, no education, rural residence, living in mountainous regions, and low wealth were significant risk factors for chewing khat. Conclusions: Khat chewing during pregnancy is highly prevalent in Yemen. Socio-economically disadvantaged women were more likely to chew khat than other women.

Koren G; Blanchette P; Lubetzky A; Kramer M. Hair nicotine: Cotinine metabolic ratio in pregnant women: A new method to study metabolism in late pregnancy. Therapeutic Drug Monitoring 30(2): 246-248, 2008. (14 refs.)

A large number of smoking women cannot quit their habit when they become pregnant. Preliminary evidence suggests an enhanced nicotine clearance rate in late pregnancy. To evaluate the change in nicotine metabolism in late pregnancy, we undertook a prospective cohort study of a large, diverse group of pregnant women recruited from four Montreal maternal hospitals. Smoking histories were obtained by structured questionnaires administered at 24 to 26 weeks of gestation and postpartum. Hair concentrations of nicotine and cotinine were measured by immunoassays for each trimester based on sectioning the hair and assuming average hair growth of I cm per month. A strong correlation was observed between average number of cigarettes smoked per day and hair nicotine and cotinine in all three trimesters. A significant decrease in hair nicotine was observed among steady smokers from the first to third trimester paralleled by a significant increase in hair cotinine. The ratio of hair nicotine: cotinine decreased significantly from the first to the third trimester. Increased nicotine metabolism in late pregnancy results in lower systemic exposure to nicotine. This phenomenon may explain why many pregnant women feel the urge to continue smoking and why standard-dose nicotine replacement therapy has not been effective in reducing smoking during pregnancy in several clinical trials.

Koren G; Hutson J; Gareri J. Novel methods for the detection of drug and alcohol exposure during pregnancy: Implications for maternal and child health. Clinical Pharmacology and Therapeutics 83(4): 631-634, 2008. (31 refs.)

Despite extensive evidence of fetal and neonatal risk, a large number of pregnant women are involved in excessive alcohol and drug abuse, such as with cocaine, methamphetamine, opioids, and cannabinoids.

Lakey B; Ondersma SJ. A new approach for detecting client-treatment matching in psychological therapy. Journal of Social and Clinical Psychology 27(1): 56-69, 2008. (30 refs.)

Identifying the treatments that are most effective for specific clients (i.e., client-treatment matching) is a major goal of research in psychological therapy. Unfortunately, there is little evidence that clients differ in the treatments to which they respond. This could result from the use of between-subjects designs that might be insensitive to client-treatment matching. In other areas of psychology, Generalizability (G) and Social Relations Model (SRM) designs routinely obtain large, conceptually identical matching effects. The current study investigated client-treatment matching using a G/SRM design. Postpartum women with a history of drug use completed three computer-delivered treatment segments of a brief motivational intervention, and rated themselves on state motivation for change following each segment. Strong client-treatment matching effects were found when using G/SRM analyses, but not when using between-subjects analyses. G/SRM methods might be more sensitive to client-treatment matching effects than are commonly used between-subjects designs.

Livy DJ; Elberger AJ. Alcohol exposure during the first two trimesters-equivalent alters the development of corpus callosum projection neurons in the rat. Alcohol 42(4): 285-293, 2008. (49 refs.)

Children exposed prenatally to alcohol can display a variety of neural deficits, including an altered development of the corpus callosum (CC), the largest interhemispheric axon pathway in the brain. Furthermore, these children show functional abnormalities that are related to brain regions with significant numbers of CC connections. Little is known about how alcohol imparts influence on CC development, but one possible mechanism is by affecting the corpus callosum projection neurons (CCpn) directly. The purpose of this study was to quantify the effects of prenatal alcohol exposure on the number, size, and distribution of CCpn within the visual cortex. The visual cortex was selected specifically due to the many vision-related deficits noted in fetal alcohol exposed children and because the critical role of the CC in visual cortex development is well documented. Sprague-Dawley rat pups received one of four alcohol dosages during gestational days (G) 1-20, or reared as nutritional or untreated control animals. Each litter was categorized according to the peak blood alcohol concentration experienced. Pups were removed from each litter on days equivalent to G29, G36, G43, and G50, for histology and measurement. Callosal axons were labeled retrogradely to their CCpn using 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) and the CCpn were then examined using confocal laser scanning microscopy. Differences between alcohol-exposed and control animals were observed in CCpn cell body size, number, and location with the cortex. This was particularly true of animals exposed to high doses of alcohol. In addition, some trends of CCpn development were found to be unchanged as a result of prenatal alcohol exposure. The results demonstrate clear differences in the development of CCpn in the visual cortex between alcohol-exposed and control animals and suggest that this development is particularly affected in those animals exposed to high doses of alcohol.

Lopez EN; Simmons VN; Quinn GP; Meade CD; Chirikos TN; Brandon TH. Clinical trials and tribulations: Lessons learned from recruiting pregnant ex-smokers for relapse prevention. Nicotine & Tobacco Research 10(1): 87-96, 2008. (45 refs.)

The development of smoking cessation and relapse prevention interventions for pregnant and postpartum women is a public health priority. However, researchers have consistently reported substantial difficulty in recruiting this population into clinical trials. The problem is particularly acute for relapse prevention studies, which must recruit women who have already quit smoking because of their pregnancy. Although these individuals are an important target for tobacco control efforts, they represent an extremely small subgroup of the general population. This paper describes multiple recruitment strategies used for a clinical trial of a self-help relapse prevention program for pregnant women. The effectiveness of the strategies and the direct expense per participant recruited are provided. A proactive recruitment strategy (telephoning women whose phone numbers were purchased from a marketing firm) was ultimately much more successful than a variety of reactive strategies (advertisements, press releases, direct mail, Web placement, health care provider outreach). We found few differences between proactively and reactively recruited participants on baseline variables. The primary difference was that the former had smoked fewer cigarettes per day and reported lower nicotine dependence prior to quitting. Strengths and limitations of the recruitment strategies are discussed.

Lui S; Terplan M; Smith EJ. Psychosocial interventions for women enrolled in alcohol treatment during pregnancy. (review). Cochrane Database of Systematic Reviews 3(article CD006753), 2008. (53 refs.)

Background: Excessive alcohol use during pregnancy has been associated with adverse maternal and neonatal effects. It is therefore important to develop and evaluate effective interventions during this important time in a woman's life. To our knowledge there have been no systematic reviews of randomised control trials (RCT) in this population. Objectives: To evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in alcohol treatment programs for improving birth and neonatal outcomes, maternal abstinence and treatment retention. Search strategy We searched the Cochrane Drugs and Alcohol Group's Trial register (December 2007); MEDLINE (1950 to 2007); PsycINFO (1806 to 2007); EMBASE (1974 to 2007); CINAHL (1982 to 2007) Selection criteria: We sought to include randomised or quasi-randomised studies comparing any psychosocial intervention versus pharmacological interventions or placebo or non-intervention or another psychosocial intervention for treating alcohol dependence in pregnancy. Data collection and analysis Three review authors independently assessed trials for inclusion in review. Studies were to be assessed using standardized data extraction and quality assessment forms. No suitable trials were identified. Main results: The search strategy identified 958 citations. 17 citations were deemed relevant for full text review, an additional 9 articles were retrieved through hand searching references, for a total of 26 articles. Following full text review no articles met the inclusion criteria. Data extraction and assessment of methodological quality were therefore not possible. Authors' conclusions: The review question remains unanswered as there were no randomised control trials found relevant to the topic. There is a need for high quality randomised controlled trials to determine the effectiveness of psychosocial interventions in pregnant women enrolled in alcohol treatment programs.

Meschke LL; Hellerstedt W; Holl JA; Messelt S. Correlates of prenatal alcohol use. Maternal and Child Health Journal 12(4): 442-451, 2008. (30 refs.)

Objectives: To identify correlates of prenatal alcohol use in a statewide population-based sample. Methods: A self-reported survey was conducted in 67 prenatal clinics in Minnesota with 4,272 women at their first prenatal visit. Chi-squared and multivariate logistic regression analyses were conducted to identify risk markers associated with any prenatal alcohol use. Results: Nearly 27% of the respondents were calculated as having used alcohol during pregnancy. In multivariable analyses, the following were risk markers for prenatal alcohol use: older age, being unmarried, lower gravidity, greater depressed mood, currently smoking, exposure to intrapersonal violence, a history of not remembering things because of alcohol use, and feelings that the respondent should reduce her drinking. Subsequent analyses revealed that the association of intrapersonal violence with prenatal drinking was mediated by whether the woman reported that she did not remember things while drinking or that the woman felt she should reduce her drinking. Conclusions: The demographic and behavioral correlates reported here are consistent with previous research. The significance of two alcohol behavioral factors (i.e., not remembering things and feeling that she should reduce her drinking) suggest that the women who drank during pregnancy would likely have substance abuse issues.

Minnes S; Singer LT; Kirchner HL; Satayathum S; Short EJ; Min M et al. The association of prenatal cocaine use and childhood trauma with psychological symptoms over 6 years. Archives of Women's Mental Health 11(3): 181-192, 2008. (55 refs.)

The use of cocaine and other drugs during pregnancy may have serious public health consequences. The objective of this study was to determine if the use of cocaine prenatally identifies women for ongoing risk of psychological symptoms. Four hundred and two women (207 cocaine using [C], 195 non-cocaine using [NC]) were assessed for rates of clinically elevated psychological symptoms shortly after childbirth, 6.5 months and 1, 2, 4 and 6 years after using the Brief Symptom Inventory (BSI). Generalized estimating equation modeling (GEE) was used to compare psychological symptom severity, controlling for confounding factors including early childhood trauma. Results indicated that women identified as having used cocaine during pregnancy had clinically elevated psychological distress (OR = 1.76, 95%CI = 1.15-2.71, p = 0.01), psychoticism (OR = 1.97, 95%CI = 1.41-2.76, p = 0.001), interpersonal sensitivity (OR = 2.34; 95%CI = 1.65-3.34; p < 0.0001) and phobic anxiety (OR = 1.86; 95%CI = 1.24-2.79) across all assessments compared to NC women. Childhood emotional abuse was also independently associated with psychological distress. Women who use cocaine during pregnancy should be recognized as at very high risk of ongoing clinically elevated psychological symptoms and should receive early and regular assessments and intervention for mental health and substance use problems.

Mitchell MM; Severtson SG; Latimer WW. Pregnancy and race/ethnicity as predictors of motivation for drug treatment. American Journal of Drug and Alcohol Abuse 34(4): 397-404, 2008. (27 refs.)

While drug use during pregnancy represents substantial obstetrical risks to mother and baby, little research has examined motivation for drug treatment among pregnant women. We analyzed data collected between 2000 and 2007 from 149 drug-using women located in Baltimore, Maryland. We hypothesized that pregnant drug-using women would be more likely than non-pregnant drug-using women to express greater motivation for treatment. Also, we explored race/ethnicity differences in motivation for treatment. Propensity score analysis was used to match a sample of 49 pregnant drug-using women with 100 non-pregnant drug-using women. The first logistic regression model indicated that pregnant women were more than four times as likely as non-pregnant women to express greater motivation for treatment. The second logistic regression analysis indicated a significant interaction between pregnancy status and race/ethnicity, such that white pregnant women were nearly eight times as likely as African-American pregnant women to score higher on the motivation for treatment measure. These results suggest that African-American pregnant drug-using women should be targeted for interventions that increase their motivation for treatment.

Mota N; Cox BJ; Enns MW; Calhoun L; Sareen J. The relationship between mental disorders, quality of life, and pregnancy: Findings from a nationally representative sample. Journal of Affective Disorders 109(3): 300-304, 2008. (26 refs.)

Background: The present study examined health-related quality of life (HRQOL) and the prevalence of mental disorders in pregnant and past-year pregnant women compared to non-pregnant women. Method: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions. Three groups of women (ages 18-44) were compared: currently pregnant (n = 451), past-year pregnant (n = 1061), and not pregnant (n = 10,544). Past-year mood, anxiety and substance use disorders were assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. HRQOL was measured by the Medical Outcomes Study Short Form (SF-12). All analyses included sociodemographics as covariates. Results: Multiple logistic regression analyses showed that pregnant women were less likely than non-pregnant women to have depression and alcohol abuse or dependence; and less likely than past-year pregnant women to have depression and mania. Past-year pregnant women were less likely than non-pregnant women to have social phobia and alcohol dependence or abuse. Multiple linear regression analyses demonstrated that pregnant and non-pregnant women had higher mental component scores than past-year pregnant women. Physical component scores were lower in pregnant women than in non-pregnant and past-year pregnant groups. Limitations: This was a cross-sectional survey and the causality of relationships cannot be inferred. Conclusions: Results suggest that pregnant women have a lower likelihood of mental disorder than both non-pregnant and past-year pregnant women.

Naughton F; Prevost AT; Sutton S. Self-help smoking cessation interventions in pregnancy: A systematic review and meta-analysis. Addiction 103(4): 566-579, 2008. (52 refs.)

Aims: Self-help smoking cessation interventions for pregnant smokers are of importance due to their potential to be wide-reaching, low-cost and their appeal to pregnant smokers who are interested in quitting smoking. To date, however, there has been no systematic assessment of their efficacy. This systematic review aimed to assess the efficacy of self-help interventions for pregnant smokers and to investigate whether self-help material intensity, type or delivery are associated with cessation. Methods The literature was searched for randomized and quasi-randomized controlled trials of self-help smoking cessation interventions for pregnant smokers without significant cessation counselling. Fifteen trials met the inclusion criteria and relevant data were extracted independently. Results: The primary meta-analysis pooled 12 trials comparing usual care (median quit rate 4.9%) with self-help (median quit rate 13.2%) and yielded a pooled odds ratio (OR) of 1.83 [95% confidence interval (CI) 1.23-2.73], indicating that self-help interventions on average nearly double the odds of quitting compared with standard care. However, a further meta-analysis failed to find evidence that intervention materials of greater intensity increase quitting significantly over materials of lesser intensity (pooled OR = 1.25, 95% CI 0.81-1.94). There was insufficient evidence to determine whether the tailoring of materials or levels of one-to-one contact were related to intervention efficacy. Conclusions: Self-help interventions appear to be more effective than standard care although, due mainly to a lack of trials, it is unclear whether more sophisticated and intensive approaches increase intervention effectiveness.

O'Gorman C. We need better data on smoking in pregnancy. (letter). British Medical Journal 336(7639): 330-330, 2008. (0 refs.)

Orr ST; James SA; Reiter JP. Unintended pregnancy and prenatal behaviors among urban, black women in Baltimore, Maryland: the Baltimore preterm birth study. Annals of Epidemiology 18(7): 545-551, 2008. (32 refs.)

PURPOSE: We explored associations between intendedness of pregnancy with maternal prenatal behaviors, including smoking, use of alcohol, use of illicit drugs, and late initiation of prenatal care. METHODS: Pregnant black women ages 18 years or older (N = 913) were enrolled in the study at their first visit to prenatal clinics in Baltimore, Maryland, at which time data were obtained from the women about intendedness of pregnancy. Data on behavioral risks were abstracted from clinical records, Logistic regression was used to adjust analyses for maternal demographic characteristics. RESULTS: Women with unwanted pregnancies were significantly more likely than women with wanted or mistimed pregnancies, or who were unsure about intendedness, to smoke (odds ratio [OR], 2.0; 95% CI, 1.2-3.3), use alcohol (OR, 2.1; 95% CI, 1.1-3.9), and use illicit drugs (OR, 1.8; 95% CI, 1.0-2.9) during pregnancy, and to initiate prenatal care in the third trimester (OR, 5.7; 95% CI, 3.5-9.4). CONCLUSIONS: Unwanted pregnancy is associated with prenatal behaviors that increase the risk of poor pregnancy outcomes. The facilitation of wanted pregnancies and reduction of harmful maternal behaviors may result in improved pregnancy outcomes in the United States.

Palmer JM; Indermaur MD; Tebes CC; Spellacy WN. Placenta increta and cocaine abuse in a grand multipara leading to a second trimester rupture of an unscarred uterus: A case report. Southern Medical Journal 101(8): 834-835, 2008. (5 refs.)

A case of a uterine rupture in a grand multiparous patient with an unscarred uterus at 19 weeks' gestation secondary to placenta increta and cocaine abuse is presented. This was a diagnostically difficult case where abnormal implantation of the placenta, grand multiparity, and cocaine abuse were all contributors to the uterine rupture.

Patni S; Gandhi A; Llewellyn R. How good are the maternity services for 'drug misusers' in England and Wales? A national survey. Journal of Obstetrics and Gynaecology 28(1): 44-47, 2008. (11 refs.)

To assess the state of maternity services for pregnant drug misusers, a postal questionnaire-based survey was carried out in England and Wales in 2005. A total of 222 questionnaires were sent with a response rate of 80.63%, reporting a total of 5,324 births to drug-misusers. Data were collated and analysed using Microsoft Excel 2003. Despite improvement in the services provided to the pregnant drug-misusers, there is wide regional variation. Hepatitis-C screening is particularly under-offered. Pre-birth meetings appear to be the way forward to optimise overall outcome. Maternity-unit staff need appropriate training for providing sufficient knowledge of drug use and its consequences for the pregnancy.

Pipkin FB. Smoking in moderate/severe preeclampsia worsens pregnancy outcome, but smoking cessation limits the damage. Hypertension 51(4): 1042-1046, 2008. (33 refs.)

We studied phenotypic and clinical outcome data in an observational, multicenter cohort study of 1001 Western European white women and their singleton babies, with stringently defined moderate-to-severe preeclampsia. Ninety women admitted to being current smokers; 71 had stopped smoking before entry to the study. Across the categories of never-smoker, stopped, and current smoker there were significant increases in the proportion of women delivering before 34 weeks' gestation (P = 0.011), delivering a baby below the third birth weight centile (P < 0.001), or delivering a baby with any adverse outcome (P = 0.011). By comparison with never-smokers, smoking during pregnancy was associated with a doubling of risk of being delivered before 34 weeks' (odds ratio: 1.98; 95% CI: 1.24 to 3.16; P = 0.004), of delivering babies below the third centile of corrected birth weight (odds ratio: 2.20; 95% CI 1.41 to 3.44; P < 0.0001), or for their babies to have any adverse outcome (odds ratio: 1.87; 95% CI: 1.19 to 2.95; P < 0.006). Worryingly, the risk of developing eclampsia was increased 5-fold (odds ratio: 4.88; 95% CI: 1.44 to 16.61; P = 0.005). The proportion of smokers in these preeclamptic women was lower than in our pregnant population generally. However, preeclampsia still carries significant perinatal morbidity, and cigarette smoking in preeclamptic pregnancies exacerbates this. Stopping smoking decreases the risks. Smoking in young women should be a particular target for advice by general practitioners before pregnancy, with active encouragement after conception to enroll in such trials as the current Smoking, Nicotine and Pregnancy Trial to support cessation.

Pletsch PK; Pollak KI; Peterson BL; Park J; Oncken CA; Swamy GK et al. Olfactory and gustatory sensory changes to tobacco smoke in pregnant smokers. Research in Nursing & Health 31(1): 31-41, 2008. (50 refs.)

Models of smoking behavior change include addiction, social, and behavioral concepts. The purpose of this study was to explore the prevalence of two biologic factors, olfactory and gustatory responses to tobacco smoke, as potentially powerful contributors to smoking behavior change among pregnant women. Data were obtained from 209 pregnant smokers. The majority of women reported olfactory (62%) and gustatory (53%) aversions to tobacco. Aversions first appeared during the first trimester of pregnancy. Women who experienced olfactory aversions were more likely also to experience gustatory aversions. Olfactory aversions were associated with women smoking less. Aversions to tobacco smoke are common among pregnant smokers, are associated with women smoking less, and could help explain pregnant women's smoking patterns.

Post A; Gilljam H; Bremberg S; Galanti MR. Maternal smoking during pregnancy: a comparison between concurrent and retrospective self-reports. Paediatric and Perinatal Epidemiology 22(2): 155-161, 2008. (24 refs.)

Retrospective reports of smoking in pregnancy are of importance for clinical or scientific purposes. Careful analyses of stability and accuracy of recalled behaviour are, therefore, needed. In 1998, the mothers of 2369 pre-teens born in Sweden retrospectively reported their smoking behaviour during the first trimester of the index pregnancy. We matched these reports with those recorded by midwives at the beginning of the index pregnancy, using information from the Swedish Medical Birth Registry. Using this registry as gold standard, the sensitivity and specificity of the retrospective reports containing any smoking were 83.9% and 92.8% respectively, but the sensitivity was low for daily smoking, 56.0%. Of the 222 discordant reports, 19.0% were due to mothers recalling daily smoking which was not reported at the time of pregnancy, and 42% were due to failure to recall smoking reported at the time of pregnancy, while the remaining 39% retrospectively reported occasional smoking, whereas they were registered as non-daily smokers when pregnant. Retrospective recall of pregnancy smoking is fairly stable over time.

Pragst F; Yegles M. Determination of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) in hair: A promising way for retrospective detection of alcohol abuse during pregnancy? Therapeutic Drug Monitoring 30(2): 255-263, 2008. (51 refs.)

The retrospective detection of alcohol consumption during pregnancy is an important part of the diagnosis of the fetal alcohol syndrome. A promising way to solve this problem can be the determination of fatty acid ethyl esters (FAEE) or/and ethyl glucuronide (EtG) in hair of the mothers. In this article, the present state in analytical determination and interpretation of FAEE and EtG concentrations in hair are reviewed. Both FAEE and EtG are minor metabolites of ethanol and as direct alcohol markers very specific for alcohol. They are durably deposited in hair, which enables taking advantage of the long diagnostic time window of this sample material. In the last years, specific and sensitive methods for determination of both alcohol markers in hair were developed. Headspace solid phase microextraction in combination with gas chromatography-mass spectroscopy after hair extraction with an n-heptane/dimethylsulfoxide mixture proved to be a favorable technique for determination of four characteristic FAEE (ethyl myristate, ethyl palmitate, ethyl oleate, and ethyl stearate). EtG is extracted from hair by water and analyzed either by gas chromatography-mass spectroscopy with negative chemical ionization after cleanup with solid phase extraction and derivatization with pentafluoropropionic anhydride or by liquid chromatography-mass spectroscopy-mass spectroscopy. The detection limits of the single FAEE as well as of EtG are in the range of 1 to 10 pg/mg. FAEE as well as EtG were determined in a larger number of hair samples of teetotalers, social drinkers, patients in alcohol withdrawal treatment, and death cases with previous known heavy drinking. From the results, the following criteria were derived: strict abstinence is excluded or improbable at C-FAEE > 0.2 ng/mg or C-EtG > 7 pg/mg. Moderate social drinkers should have CFAEE < 0.5 ng/mg and CEtG < 25 pg/mg; above these values, alcohol abuse is probable. Until now, there has been no evaluation in context of FAS diagnosis; however, a successful application for this purpose can be expected from the good experience in driving ability examination.

Quinton A; Cook CM; Peek MJ. The relationship between cigarette smoking, endothelial function and intrauterine growth restriction in human pregnancy. BJOG: An International Journal of Obstetrics and Gynaecology 115(6): 780-784, 2008. (12 refs.)

This study examined the relationship of cigarette smoking and endothelial function in pregnant women by comparing smokers with nonsmokers. Endothelial function was assessed at 28-32 weeks of gestation by flow-mediated dilatation (FMD) using ultrasound of the brachial artery. The initial FMD was significantly different between the smoking group (n = 21) at 4.0 +/- 2.3, indicating endothelial dysfunction, and the nonsmoking group (n = 20) at 9.7 +/- 4.0 (P < 0.001). After smoking, this difference in the groups persisted. Babies who were growth restricted (< 10th percentile) had mothers with a significantly lower FMD, that is endothelial dysfunction. This work demonstrates persistent endothelial dysfunction in smoking pregnant women.

Richthoff J; Elzanaty S; Rylander L; Hagmar L; Giwercman A. Association between tobacco exposure and reproductive parameters in adolescent males. International Journal of Andrology 31(1): 31-39, 2008. (45 refs.)

Cigarette smoking is quite prevalent in the general population but our knowledge of its effect on male reproductive function is still very limited. Therefore, we investigated the impact of tobacco exposure on reproductive characteristics in young males. Military conscripts, 217 non-smokers and 85 smokers, with a median age of 18 years were enrolled. Physical examination and semen analysis, including measurement of accessory sex gland markers and reproductive hormone levels, were performed. Lifestyle-associated factors, including maternal smoking during pregnancy and snuffing, were recorded. Non-smokers had 49% higher total sperm number than smokers (95% CI 4.5-112%, p = 0.01). In addition, sperm concentration was 37% higher among non-smokers (95% CI -4% to 95%, p = 0.08). Serum levels of follicle-stimulating hormone (FSH) were 17% higher among non-smokers (95% CI 3-33%, p = 0.02), whereas no significant differences between smokers and non-smokers were found for inhibin B, testosterone, sex hormone binding globulin, luteinizing hormone and oestradiol. Those who smoked > 10 cigarettes per day exhibited 37% lower (95% CI 10-69%, p = 0.005) FSH levels than those who smoked less. Maternal smoking during pregnancy had a negative impact on epididymal and seminal vesicle marker secretion. Smoking seems to impair sperm production and epididymal as well as accessory sex gland function and could be one of the factors contributing to regional differences in sperm parameters.

Riddell S; Shanahan M; Degenhardt L; Roxburgh A. A review of the use of US-derived aetiological fractions in an Australian setting for antenatal problems related to cocaine use. (review). Australian and New Zealand Journal of Public Health 32(4): 393-394, 2008. (17 refs.)

Aetiological fractions are often used as an indirect measure of morbidity and mortality related to a specific risk factor. Aetiological fractions previously used in Australia for cocaine-related antenatal haemorrhage and low birth weight newborns have relied on risk ratios calculated from US-based studies. As outlined in this paper, there are several differences in the use and prevalence of cocaine and its associated harms between the two nations. As such, it is recommended that any use of these aetiological fractions with Australian data should occur with caution.

Rigotti NA; Park ER; Chang YC; Regan S. Smoking cessation medication use among pregnant and postpartum smokers. Obstetrics and Gynecology 111(2 (Part 1)): 348-355, 2008. (36 refs.)

OBJECTIVE: To assess how often pregnant and postpartum smokers use medications and how often obstetric providers recommend them. METHODS: We analyzed end-of-pregnancy and 3-month postpartum surveys of 296 pregnant smokers enrolled in a randomized controlled trial of telephone counseling for smoking cessation that did not include medication. Patients were asked whether any obstetric provider discussed cessation medication and whether they had used medication. RESULTS: At end of pregnancy, 29.3% of respondents reported discussing a cessation medication with their obstetric providers, more often nicotine replacement (26.5%) than bupropion (12.2%) (P=.001). Ten percent of trial respondents used a medication while pregnant (7.4% nicotine replacement, 3.4% bupropion, P=.023). Obstetricians discussed medication with 29.4% of smokers at the postpartum visit; 14.3% of postpartum smokers used medication. Contrary to guidelines, women who smoked more cigarettes per day or had already tried quitting during pregnancy were not more likely to use medication or to discuss medication with their provider. Medication use was associated with older age, more education, living with a partner, a previous birth, having an obstetric provider who discussed medication, and having private health insurance in a state whose Medicaid program did not cover cessation medications (all P<.05). CONCLUSION: Pregnant women are more reluctant to use cessation medications than clinical guidelines recommend. More pregnant smokers might use cessation medications if their obstetricians discussed them routinely and if health insurance covered their cost.

Ruger JP; Emmons KM. Economic evaluations of smoking cessation and relapse prevention programs for pregnant women: A systematic review. (review). Value In Health 11(2): 180-190, 2008. (27 refs.)

Objective: Smoking cessation and relapse prevention during and after pregnancy reduces the risk of adverse maternal and infant health outcomes, but the economic evaluations of such programs have not been systematically reviewed. This study aims to critically assess economic evaluations of smoking cessation and relapse prevention programs for pregnant women. Methods: All relevant English-language articles were identified using PubMed (January 1966-2003), the British National Health Service Economic Evaluation Database, and reference lists of key articles. Economic evaluations of smoking cessation and relapse prevention among pregnant women were reviewed. Fifty-one articles were retrieved, and eight articles were included and evaluated. A single reviewer extracted methodological details, study designs, and outcomes into summary tables. All studies were reviewed, and study quality was judged using the criteria recommended by the Panel on Cost-Effectiveness in Health and Medicine and the British Medical Journal (BMJ) checklist for economic evaluations. Results: The search retrieved 51 studies. No incremental cost-effectiveness studies or cost-utility studies were found. A narrative synthesis was conducted on the eight studies thatmet the inclusion criteria. Roughly one-third employed cost-benefit analyses (CBA). Those conducting CBA have found favorable benefit-cost ratios of up to 3:1; for every dollar invested $3 are saved in downstream health-related costs. Conclusions: CBA suggests favorable cost-benefit ratios for smoking cessation among pregnant women, although currently available economic evaluations of smoking cessation and relapse prevention programs for pregnant women provide limited evidence on cost-effectiveness to determine optimal resource allocation strategies. Although none of these studies had been performed in accordance with Panel recommendations or BMJ guidelines, they are, however, embryonic elements of a more systematic framework. Existing analyses suggest that the return on investment will far outweigh the costs for this critical population. There is significant potential to improve the quality of economic evaluations of such programs; therefore, additional analyses are needed. The article concludes with ideas on how to design and conduct an economic evaluation of such programs in accordance with accepted quality standards.

Ruger JP; Weinstein MC; Hammond SK; Kearney MH; Emmons KM. Cost-effectiveness of motivational interviewing for smoking cessation and relapse prevention among low-income pregnant women: A randomized controlled trial. Value In Health 11(2): 191-198, 2008. (33 refs.)

Objective: Low-income women have high rates of smoking during pregnancy, but little is known about the costs, benefits, and cost-effectiveness of motivational interviewing (MI), focused on the medical and psychosocial needs of this population, as an intervention for smoking cessation and relapse prevention. Methods: A sample of 302 low-income pregnant women was recruited from multiple obstetrical sites in the Boston metropolitan area into a randomized controlled trial of a motivational intervention for smoking cessation and relapse prevention versus usual care (UC). The findings of this clinical trial were used to estimate the costs, benefits, and cost-effectiveness of the intervention from a societal perspective, incorporating published quality-adjusted life-year (QALY) and life-year (LY) estimates. Outcomes included smoking cessation and relapse, maternal and infant outcomes, economic costs, LYs and QALYs saved, and incremental cost-effectiveness ratios. Results: The cost-effectiveness of MI for relapse prevention compared to UC was estimated to be $851/LY saved and $628/QALY saved. Including savings in maternal medical costs in sensitivity analyses resulted in cost savings for MI for relapse prevention compared to UC. For smoking cessation, MI cost more but did not provide additional benefit compared to UC. In one-way sensitivity analyses, the incremental cost-effectiveness of MI versus UC would have been $117,100/LY saved and $86,300/QALY saved if 8% of smokers had quit. In two-way sensitivity analyses, MI was still relatively cost-effective for relapse prevention ($17,300/QALY saved) even if it cost as much as $2000/participant and was less effective. For smoking cessation, however, a higher level of effectiveness (9/110) and higher cost ($400/participant) resulted in higher incremental cost-effectiveness ratios ($112,000/QALY). Conclusions: Among low-income pregnant women, MI helps prevent relapse at relatively low cost, and may be cost-saving when net medical cost savings are considered. For smoking cessation, MI cost more but provided no additional benefit compared to UC, but might offer benefits at costs comparable to other clinical preventive interventions if 8-10% of smokers are induced to quit.

Salihu HM; Sharma PP; Getahun D; Hedayatzadeh M; Peters S; Kirby RS et al. Prenatal tobacco use and risk of stillbirth: A case-control and bidirectional case-crossover study. Nicotine & Tobacco Research 10(1): 159-166, 2008. (39 refs.)

We sought to estimate the association between prenatal smoking and stillbirth in a longitudinal cohort using two study designs: a case-control study and a bidirectional case-crossover study. The analysis was conducted using the Missouri maternally linked cohort dataset from 1978 through 1997. In the case-control study, each mother contributed only one birth to the analysis. For the bidirectional crossover design, analysis was restricted to women who gave birth to at least one stillbirth, and the controls comprised all live births before and after the stillbirth. The independent association between prenatal smoking and stillbirth was computed using nonconditional (case-control design) and conditional (bidirectional case-crossover design) logistic regression. Prenatal smoking decreased from 29.7% in 1978 to 21.2% by 1997 (p <.001). The absolute risk of stillbirth was greater among smokers (7.7/1000) than nonsmokers (5.3/1000), p <.001. In the case-control design, the risk of stillbirth was 34% greater among smokers than nonsmokers (OR=1.34, 95% CI 1.26-1.43). For each 10-unit increase in the number of cigarettes consumed per day prenatally, the likelihood of stillbirth rose by about 14% (p.001). In the bidirectional case-crossover design, the association between stillbirth and smoking during pregnancy was confirmed, although the magnitude of the relationship was smaller (OR=1.20, 95% CI 1.03-1.39). In conclusion, we found prenatal smoking to be a risk factor for stillbirth even after minimizing the influence of known and unknown sources of confounding as well as changes in temporal trend in prenatal smoking.

Savitz DA; Chan RL; Herring AH; Howards PP; Hartmann KE. Caffeine and miscarriage risk. Epidemiology 19(1): 55-62, 2008. (24 refs.)

Background: Coffee and caffeine have been inconsistently found to be associated with increased risk of clinical miscarriage-a potentially important association given the high prevalence of exposure. Methods: Women were recruited before or early in pregnancy and interviewed regarding sources of caffeine, including assessment of changes over the perinatal period. We identified 2407 clinically-recognized pregnancies resulting in 258 pregnancy losses. We examined the relationship of coffee and caffeine intake with clinically-recognized pregnancy loss prior to 20 weeks' completed gestation, using a discrete-time continuation ratio logistic survival model. Results: Coffee and caffeine consumption at all 3 time points were unrelated to total miscarriage risk and the risk of loss after the interview. Reported exposure at the time of the interview was associated with increased risk among those with losses before the interview. Conclusions: There is little indication of possible harmful effects of caffeine on miscarriage risk within the range of coffee and caffeine consumption reported, with a suggested reporting bias among women with losses before the interview. The results may reflect exposure misclassification and unmeasured heterogeneity of pregnancy losses.

Sellstrom E; Arnoldsson G; Bremberg S; Hjern A. The neighbourhood they live in - Does it matter to women's smoking habits during pregnancy? Health & Place 14(2): 155-166, 2008. (35 refs.)

Socioeconomic factors in the neighbourhood are associated with smoking habits in various populations. We studied a 10-year cohort to determine whether women's smoking behaviour during pregnancy can similarly be determined by neighbourhood economic and ethnic factors. The cohort included 127,074 primiparous pregnant women in 592 Swedish neighbourhoods during the years 1992-2001. Multilevel technique was used to regress pregnancy smoking on socioeconomic individual-level variables and neighbourhood characteristics. Seven percent of the variation in pregnancy smoking was at the neighbourhood level and the odds of smoking during pregnancy were doubled in poorer areas. Health education and smoking cessation interventions should be directed at maternity care units in deprived neighbourhoods.

Shannon L; Walker R. Increasing the recognition of barriers for pregnant substance users seeking treatment. (editorial). Substance Use & Misuse 43(8-9): 1266-1267, 2008. (8 refs.)

Shea AK; Steiner M. Cigarette smoking during pregnancy. (review). Nicotine & Tobacco Research 10(2): 267-278, 2008. (118 refs.)

Maternal smoking during pregnancy is associated with several adverse developmental outcomes in the offspring. These include preterm delivery, spontaneous abortion, growth restriction, increased risk of sudden infant death syndrome (SIDS), as well as long-term behavioral and psychiatric disorders. However, the underlying physiological mechanisms for these ill-effects are not fully understood. The aim of this paper is to review the animal and human data to date, linking in utero smoke exposure to negative neurodevelopmental outcomes. It is known that nicotine from cigarette smoke exerts its effects by affecting placental vasculature, and also by nicotinic acetylcholine receptor binding in fetal membranes. Thus, subsequent consequences involve a cascade of events causing not only dysregulation of the nicotinic and muscarinic, but also catecholaminergic and serotonergic neurotransmitter systems. These observations provide some insight into how smoking can impair neurodevelopment, but the long-term neurotransmitter involvement in dysregulation of emotion and attention awaits further elucidation. It is important that pregnant women are warned of the detrimental effects of smoking, and encouraged to abstain for healthy fetal development.

Shih SF; Chen LK; Wen CP; Yang WC; Shih YT. An investigation of the smoking behaviours of parents before, during and after the birth of their children in Taiwan. BMC Public Health 8(e-article 67), 2008. (27 refs.)

Background: Although many studies have investigated the negative effects of parental smoking on children and Taiwan has started campaigns to promote smoke-free homes, little is known about the smoking behaviours of Taiwanese parents during the childbearing period. To help fill the gap, this study investigated Taiwanese parents' smoking behaviours before, during and after the birth of their children, particularly focusing on smoking cessation during pregnancy and relapse after childbirth. Methods: We used data from the Survey of Health Status of Women and Children, conducted by Taiwan's National Health Research Institutes in 2000. After excluding survey respondents with missing information about their smoking behaviours, our sample consisted of 3,109 women who were married at the time of interview and had at least one childbearing experience between March 1, 1995 and February 28, 1999. Data on parental smoking behaviour in the six months before pregnancy, during pregnancy, and in the first year after childbirth were extracted from the survey and analysed by descriptive statistics as well as logistic regression. Results: Four percent of the mothers and sixty percent of the fathers smoked before the conception of their first child. The educational attainment and occupation of the parents were associated with their smoking status before the first pregnancy in the family. Over 80% of smoking mothers did not quit during pregnancy, and almost all of the smoking fathers continued tobacco use while their partners were pregnant. Over two thirds of the women who stopped smoking during their pregnancies relapsed soon after childbirth. Very few smoking men stopped tobacco use while their partners were pregnant, and over a half of those who quit started to smoke again soon after their children were born. Conclusion: Among Taiwanese women who had childbearing experiences in the late 1990s, few smoked. Of those who smoked, few quit during pregnancy. Most of those who quit relapsed in the first year after childbirth. The smoking prevalence was high among the husbands of these Taiwanese women, and almost all of these smoking fathers continued tobacco use while their partners were pregnant. It is important to advocate the benefits of a smoke-free home to Taiwanese parents-to-be and parents with young children, especially the fathers. The government should take advantage of its free prenatal care and well-child care services to do this. In addition to educational campaigns through the media, the government can request physicians to promote smoke-free homes when they deliver prenatal care and well-child care. This could help reduce young children's health risks from their mothers' smoking during pregnancy and second-hand smoke at home.

Simpson M; McNulty J. Different needs: Women's drug use and treatment in the UK. International Journal of Drug Policy 19(2): 169-175, 2008. (83 refs.)

The experiences of female drug users are often very different from that of their male counterparts. Female, and especially pregnant, drug users suffer greater social stigma than men, and often suffer a greater severity of addiction with physical and psychological reactions. This paper explores how women's experience of drug use differs from men, and the implication that this has for delivering drug treatment and drug services in the UK, including in the prison setting. It is argued that drug services in the UK need to be better tailored to meet the specific needs of women.

Street K; Whitlingum G; Gibson P; Cairns P; Ellis M. Is adequate parenting compatible with maternal drug use? A 5-year follow-up. Child Care Health and Development 34(2): 204-206, 2008. (2 refs.)

Introduction: This prospective, cohort study compares child protection outcomes over the first 5 years of life in a group of children born to self-declared drug-using mothers recruited during pregnancy (cases) and a group of children matched for gestational age, chronological age, maternal neighbourhood and place of delivery whose mothers made no such declaration of problematic drug use (controls). Methodology We monitored local child protection registers to identify cohort members who came to the attention of the local authority. Results Of the 71 original cases and 142 original controls, 55 (77%) and 96 (68%) remained in the area enrolled in local schools at 5 years of age. In total, 26 (47.3%) of the case children were subject to child protection procedures compared with 18 (18.8%) of the control children. This risk difference of 28.5% (95% CI 13.2% to 43.9%) has increased marginally since our previous report in this journal of child protection outcomes at 18 months of age (32% vs. 7%). However, the level of intervention deemed necessary to protect the child has increased significantly with six cases (compared with one control child) taken into the care of the local authority. Conclusions: Despite early maternal intentions and multiple supportive interventions, 27% of children born to women with significant substance abuse problems in our area required child protection during the pre-school years. Child protection risk assessment procedures need to weigh problematic maternal drug use heavily. Intervention studies with child welfare outcomes are needed to identify the most effective harm reduction strategies and inform public debate on how we can minimize child abuse related to substance misuse.

Subramoney S; Gupta PC. Anemia in pregnant women who use smokeless tobacco. Nicotine & Tobacco Research 10(5): 917-920, 2008. (29 refs.)

A significantly higher mean hemoglobin level in women smokers in comparison to nonsmokers with a generalized rightward shift of the hemoglobin distribution curve has been reported at the population level. Studies on pregnant women, however, have often associated smoking with decreased hemoglobin levels, although not consistently. We examined whether smokeless tobacco use during pregnancy influenced hemoglobin levels in a population-based cohort of 918 pregnant women in Mumbai, India. Mean hemoglobin levels (Hb) were significantly lower in users (10.00g/dl) compared with nonusers (10.46g/dl),p<.000. Anemia (Hb<10g/dl) was significantly associated with smokeless tobacco in the univariate analysis (OR=1.7, 95% CI 1.2-2.5). There was no change after adjusting odds ratios for potential confounders in multivariate analysis (OR=1.7, 95% CI 1.2-2.5). The odds ratios for anemia were adjusted for age of mother, education, socioeconomic status, type of residence, lower body mass index, parity, vegetarian or nonvegetarian food habit, and hemodilution during pregnancy. The results suggest that smokeless tobacco use during pregnancy is associated with lower hemoglobin levels, as has often been observed with cigarette smoking. Smokeless tobacco use is widely prevalent among women in Southeast Asia and is gaining popularity across the world as a safe alternative to smoking. Further exploration and clarification of this association is therefore of considerable importance to public health.

Toner P; Hardy E; Mistral W. A specialized maternity drug service: Examples of good practice. Drugs: Education, Prevention and Policy 15(1): 93-105, 2008. (20 refs.)

This mixed-method study explores the views of professionals and service users with regard to Maternity Drugs Service provision in Bristol, UK. Findings indicate that this specialist multidisciplinary service, in many ways, can be seen as a model of good practice. Effective multi-agency and multidisciplinary working; early engagement; a service-user-centred approach; positive and non-judgemental staff attitudes contribute to good maternal and child outcomes. However, this service also experiences challenges arising from unclear management structures, differing work practices, and staffing levels. Consistency and clarity within and across complex services, and continuous service development are identified as necessary to effectively meet the needs of an extremely vulnerable population.

Triche EW; Hossain N; Paidas MJ. Genetic influences on smoking cessation and relapse in pregnant women. (review). Journal of Obstetrics and Gynaecology 28(2): 155-160, 2008. (79 refs.)

Cigarette smoking during pregnancy continues to be a significant public health concern. Maternal smoking during pregnancy has been associated with low birth weight(< 2500 g), fetal growth restriction, placental problems, pre-term delivery and spontaneous abortion. Mothers who smoke during pregnancy are twice as likely to give birth to low birth weight infants, and smoking during pregnancy is estimated to be responsible for 20-30% of all low birth weight infants. Smoking during pregnancy not only affects placental function, thus causing obstetrical complications, but nicotine also crosses the placenta and acts as a neuroteratogen. This in turn, elevates the risk of cognitive and auditory processing deficits, and has also been found to be negatively associated with long-term consequences on offspring behaviour. In addition, smoking has negative long-term health consequences for both mother and child, including respiratory conditions, cancer and cardiovascular problems. This review provides insight into the genetic influences on smoking behaviour in pregnant women. In particular, the roles of genes in the neuro transmitter pathways are highlighted. It also emphasises the need for further research in this area, and provides rationale for the importance of focusing on pregnant women who are highly motivated to quit when researching smoking behaviours in women.

Vahidnia F; Eskenazi B; Jewell N. Maternal smoking, alcohol drinking, and febrile convulsion. Seizure 17(4): 320-326, 2008. (21 refs.)

Background: Previous studies have suggested that maternal cigarette smoking and alcohol drinking during pregnancy may increase risk for febrile convulsion during childhood. We evaluated the relationship of maternal smoking, alcohol drinking, and their interaction on febrile convulsion. Method: Pregnant women (n = 10, 108) enrolled in the Child Health and Development Studies in California between 1959 and 1966 were interviewed about their habits during pregnancy and febrile convulsions of the child were ascertained soon after an event. Results: Febrile convulsions were reported in 2.9% of children of mothers who both smoked and drank alcohol, 2.0% for children of mothers who smoked but did not drink, 1.5% for children of mothers who drank but did not smoke and 2.1% of children of mothers who neither smoked nor drank. After adjusting for covariates, children of smokers who did not drink and children of drinkers who did not smoke did not have a significant hazard for febrile convulsion, compared to children of non-smokers nondrinkers. However, children of smokers who drank had a 30% increased hazard of febrile convulsion (95% Cl = 1.0, 1.9). The interaction term for smoking and alcohol drinking was significant in the multivariable model (p = 0.02). Conclusion: These results suggest that children of mothers who both smoke and drink alcohol during pregnancy may have a higher risk for febrile convulsions.

Weaver K; Campbell R; Mermelstein R; Wakschlag L. Pregnancy smoking in context: The influence of multiple levels of stress. Nicotine & Tobacco Research 10(6): 1065-1073, 2008. (32 refs.)

Pregnancy smoking remains a major public health concern in the United States. Approximately 10.2% of women smoke during pregnancy, placing their offspring at increased risk for adverse perinatal and childhood outcomes. However, little is known about contextual influences on pregnancy smoking. This study examines the intimate social context, broader social context, and socioeconomic context as predictors of smoking in a sample of 113 pregnant women (M-age=29.7 years; 90.3% White, non-Hispanic). We developed latent variables at each contextual level comprising indicators of stress and resources measured during the first and second trimesters, to serve as predictors of both persistent pregnancy smoking and smoking intensity during the third trimester in a single comprehensive structural equation model. Results indicate that stressful socioeconomic context was positively associated with the probability of being a persistent pregnancy smoker (probit regression coefficient=.70, p<.05). Broader social context was the only significant predictor of smoking rate, with greater stress and fewer resources associated with a greater number of cigarettes smoked during the third trimester (standardized regression coefficient=.81, p<.05). Results suggest that pregnancy smoking is a complex phenomenon that may be influenced by psychosocial context at multiple levels. Elucidating mechanisms by which contextual influences affect pregnant women's smoking patterns may inform smoking cessation and reduction interventions with this population.

Winklbaur B; Kopf N; Ebner N; Jung E; Thau K; Fischer G. Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: A knowledge synthesis for better treatment for women and neonates. (review). Addiction 103(9): 1429-1440, 2008. (134 refs.)

Aims: Through a novel synthesis of the literature and our own clinical experience, we have derived a set of evidence-based recommendations for consideration as guidance in the management of opioid-dependent pregnant women and infants. Methods PubMed literature searches were carried out to identify recent key publications in the areas of pregnancy and opioid dependence, neonatal abstinence syndrome (NAS) prevention and treatment, multiple substance abuse and psychiatric comorbidity. Results Pregnant women dependent on opioids require careful treatment to minimize harm to the fetus and neonate and improve maternal health. Applying multi-disciplinary treatment as early as possible, allowing medication maintenance and regular monitoring, benefits mother and child both in the short and the long term. However, there is a need for randomized clinical trials with sufficient sample sizes. Recommendations: Opioid maintenance therapy is the recommended treatment approach during pregnancy. Treatment decisions must encompass the full clinical picture, with respect to frequent complications arising from psychiatric comorbidities and the concomitant consumption of other drugs. In addition to standardized approaches to pregnancy, equivalent attention must be given to the treatment of NAS, which occurs frequently after opioid medication. Conclusion: Methodological flaws and inconsistencies confound interpretation of today's literature. Based on this synthesis of available evidence and our clinical experience, we propose recommendations for further discussion.

Winklbaur B; Kopf N; Ebner N; Jung E; Thau K; Fischer G. Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: A knowledge synthesis for better treatment for women and neonates. (review). Addiction 103(9): 1429-1440, 2008. (134 refs.)

Aims: Through a novel synthesis of the literature and our own clinical experience, we have derived a set of evidence-based recommendations for consideration as guidance in the management of opioid-dependent pregnant women and infants. Methods: PubMed literature searches were carried out to identify recent key publications in the areas of pregnancy and opioid dependence, neonatal abstinence syndrome (NAS) prevention and treatment, multiple substance abuse and psychiatric comorbidity. Results Pregnant women dependent on opioids require careful treatment to minimize harm to the fetus and neonate and improve maternal health. Applying multi-disciplinary treatment as early as possible, allowing medication maintenance and regular monitoring, benefits mother and child both in the short and the long term. However, there is a need for randomized clinical trials with sufficient sample sizes. Recommendations: Opioid maintenance therapy is the recommended treatment approach during pregnancy. Treatment decisions must encompass the full clinical picture, with respect to frequent complications arising from psychiatric comorbidities and the concomitant consumption of other drugs. In addition to standardized approaches to pregnancy, equivalent attention must be given to the treatment of NAS, which occurs frequently after opioid medication. Conclusion: Methodological flaws and inconsistencies confound interpretation of today's literature. Based on this synthesis of available evidence and our clinical experience, we propose recommendations for further discussion.

Wood L; France K; Hunt K; Eades S; Slack-Smith L. Indigenous women and smoking during pregnancy: Knowledge, cultural contexts and barriers to cessation. Social Science & Medicine 66(11): 2378-2389, 2008. (44 refs.)

Despite active tobacco control efforts in Australia, smoking prevalence remains disproportionately high in pregnant Indigenous women. This study investigated the place of smoking in pregnancy and attitudes towards smoking within the broader context of Indigenous lives. Focus groups and in-depth interviews were used to collect data from 40 women, and ten Aboriginal Health Workers (AHWs) in Perth, Western Australia. The research process and interpretation was assisted by working with an Indigenous community reference group. Results demonstrated the impact of contextual factors in smoking maintenance, and showed that smoking cessation even in pregnancy was not a priority for most women, given the considerable social and economic pressures that they face in their lives. Overwhelmingly, smoking was believed to reduce stress and to provide opportunities for relaxation. Pregnancy did not necessarily influence attitudes to cessation, though women's understanding of the consequences of smoking during pregnancy was low. Reduction of cigarette intake during pregnancy was seen as an acceptable and positive behaviour change. The AHWs saw their role to be primarily one of support and were conscious of the importance of maintaining positive relationships. As a result, they were often uncomfortable with raising the issue of smoking cessation with pregnant women. The stories of Indigenous women and AHWs provided important insight into smoking during pregnancy and the context in which it occurs.

Xue F; Willett WC; Rosner BA; Forman MR; Michels KB. Parental characteristics as predictors of birthweight. Human Reproduction 23(1): 168-177, 2008. (78 refs.)

BACKGROUND: Previous studies provided conflicting results on the relevance of parental characteristics for offspring's size at birth. The objective of this study was to investigate parental predictors of birthweight. METHODS: In this cross-sectional study, 34 063 women in the Nurses' Mother's Cohort were queried about parental characteristics during the pregnancy with and birthweight of their nurse daughter. RESULTS: The predictive linear regression model of birthweight included 13 factors and the majority of the predictive power came from parental anthropometric factors. In the adjusted analysis, daily consumption of each additional glass of milk was associated with an increase of similar to 6 g in birthweight (P for trend = 0.01) and daily consumption of each additional cup of coffee was associated with a decrease of similar to 10 g in birthweight (P for trend < 0.0001). Drinking 1-2, 3-4 and 5+ cups of coffee daily was associated with a 28% [95% confidence interval (CI) 0.12, 0.47], 30% (95% CI 0.10, 0.55) and 63 % (95 % CI 0.25, 1.12) increase, respectively, in the odds of intrauterine growth restriction when compared with non-drinkers. CONCLUSIONS: The present study confirmed several previously reported determinants of birthweight. Maternal dietary intake of milk and coffee during pregnancy may influence fetal growth.

Yamaguchi ET; Cardoso MMSC; Torres MLA; de Andrade AG. Drug abuse during pregnancy. (review) [Portuguese]. Revista de Investigacion Clinica 35(Supplement 1): 44-47, 2008. (41 refs.)

Background: Despite the fact that it has being a growing problem worldwide, very few works and papers have been published on drug use during pregnancy. Objectives: To objectively address the most commonly abused drugs (alcohol, cocaine, marijuana, and tobacco) by women of a reproductive age. Methods: A literature review (MEDLINE, LILACS) of the most recent papers on drug abuse by women of reproductive age was carried out. Results: The primary consequences of drug abuse both for the mother and the infant are described. Conclusions: This is a little discussed major public health issue which requires the involvement of a multidisciplinary team. The publication of a greater number of papers on the problem is necessary in order to establish the best strategy for addressing intervention in this population.