Municipal smoke-free laws and preterm birth.

BACKGROUND: Smoking during pregnancy and prenatal secondhand smoke exposure increase the risk of preterm birth. As Kentucky has the second highest rate of smoking in the United States and no statewide smoke-free law, an examination of the effect of municipal smoke-free legislation on preterm birth is warranted. OBJECTIVE: This study used state-level live birth data and county-level municipal smoke-free legislation status to assess the association between the presence and strength of smoke-free laws and the likelihood of preterm birth. Moreover, this study hypothesized that pregnant persons living in counties with comprehensive municipal smoke-free laws prohibiting smoking inside all workplaces and enclosed public places would exhibit a lower likelihood of preterm birth than those living in counties with weak or moderate laws (ie, smoke-free laws with exemptions that do not cover all workplaces and enclosed public places) or no smoke-free law. STUDY DESIGN: Using live birth data from the Kentucky Office of Vital Statistics with birth years ranging from 2004 to 2020, a total of 894,372 live births were recorded that indicated that a childbearing person was between the ages of 18 and 49 years and a resident of Kentucky; these live births formed the sample for the study. Municipal ordinances implemented during a given calendar year were coded in the model as present starting with the following calendar year, as the birth records were time deidentified except for the year of birth. This lagged law convention maximized the likelihood that pregnant persons included in the study were exposed to the smoke-free policy for at least a portion of their pregnancy. Multilevel logistic regression was used to assess the effect of smoke-free ordinances on the likelihood of preterm birth, with personal- and county-level variables included as potential covariates and pregnant persons nested within the county of residence. Data analysis was conducted using SAS (version 9.4; SAS Institute, Cary, NC), with an alpha level of .05. RESULTS: Nearly all personal-level variables were associated with preterm birth status. Personal factors associated with an increased likelihood of preterm birth included being older (relative to 18-24 years old; odds ratios [95% confidence intervals]: 1.02 [1.01-1.04] and 1.27 [1.24-1.31] for ages 25-34 and 35-49 years, respectively); having a history of preterm birth (odds ratio, 4.65; 95% confidence interval, 4.53-4.78); and smoking before pregnancy (odds ratio, 1.14; 95% confidence interval, 1.12-1.16). Pregnant persons living in counties with comprehensive laws were 9% less likely to have a preterm birth than those living in counties without a smoke-free ordinance (odds ratio, 0.91; 95% confidence interval, 0.89-0.94; P<.001). There was no difference in the likelihood of preterm birth between those living in counties with moderate or weak laws and those unprotected by any smoke-free ordinance in their county of residence. CONCLUSION: This study demonstrated that comprehensive municipal smoke-free laws are associated with reduced risk of preterm birth and that moderate or weak smoke-free laws are not. The findings have major implications for public health policy and underscore the potential influence of healthcare providers' advocacy for strong smoke-free policies, prohibiting smoking in all workplaces (including restaurants, bars, and casinos), to support healthy pregnancies.

Linking Postpartum and Parenting Women With a National Diabetes Prevention Program: Recruitment Efforts, Challenges, and Recommendations.

IN BRIEF Women with a history of gestational diabetes mellitus (GDM) are at higher risk for type 2 diabetes. This project piloted the National Diabetes Prevention Program lifestyle change program in cohorts of women with a history of GDM. The article describes recruitment efforts, challenges, and study participation and provides recommendations for future program implementation.

Previous cesarean delivery associated with subsequent preterm birth in the United States.

OBJECTIVE: To examine the relationship between previous cesarean delivery and subsequent preterm birth in the second pregnancy among women in the United States with registered birth records. STUDY DESIGN: We conducted a retrospective cohort study utilizing United States birth certificate data to generate the study population, which consisted of women delivering a singleton infant in their second live birth (n = 1,076,517) in the year 2016. Preterm birth and previous cesarean delivery measures were derived from United States birth certificates. Covariates included maternal age, race/ethnicity, education, marital status, payer source for delivery, pre-pregnancy body mass index, previous preterm birth, interpregnancy interval, and factors in the second pregnancy such as hypertensive disorders, diabetes, and cigarette use, trimester prenatal care began, weight gain during pregnancy, and presence of congenital anomalies. Women who experienced a cesarean delivery in the first pregnancy were compared to those who did not. RESULTS: When controlling for all covariates, women who had a cesarean delivery in their first pregnancy were 14% more likely to have a preterm birth in their second pregnancy (OR = 1.137, 95% CI = 1.117-1.158) compared to women who had not previously experienced a cesarean delivery. When risk was analyzed by sub categories of preterm birth based on gestational age, a differential association was noted, with a 10% increased risk of delivering before 34 weeks, a 1% increased risk for delivery between 34-36 weeks and no increased risk for delivery after 36 weeks compared to delivery at 39-40 weeks. CONCLUSION: This small, but statistically significant association between previous cesarean section and subsequent preterm birth suggests that efforts to reduce the number of index cesarean sections may contribute to reducing the overall preterm birth rate in the United States.

Electronic cigarette liquid and device parameters and aerosol characteristics: A survey of regular users.

INTRODUCTION: Electronic cigarettes are widely variable devices, typically with user definable liquid and device parameters. Yet, little is known about how regular users manipulate these parameters. There is also limited understanding of what factors drive electronic cigarette use and liquid purchasing, and whether two common ingredients, propylene glycol and vegetable glycerin, alter the subjective effects of these devices. METHODS: During the spring of 2016 522 adults, who reported daily use of electronic cigarettes containing nicotine, completed a survey on electronic cigarettes. Survey questions included an electronic cigarette dependence questionnaire, questions on tobacco and electronic cigarette use, and device and liquid preferences. RESULTS: Fifty-nine percent of respondents reported using another tobacco product, which was positively associated with level of nicotine dependence. On average, devices were set to 28.3 (SD = 24.2) watts. Ability to change device voltage, and level of resistance typically used, was significantly associated with level of nicotine dependence. Amount of liquid consumed, nicotine concentration, and milligrams of nicotine used per week, were positively associated with nicotine dependence. Participants rated 'good taste' as the most important consideration when using and purchasing liquids, and propylene glycol is associated with undesirable effects and vegetable glycerin with desirable effects. CONCLUSIONS: These data indicate that electronic cigarette users utilize a wide range device parameter settings and liquid variables, and that individuals with greater nicotine dependence favor voltage control devices, and lower resistance heating elements. Taste is a key factor for electronic cigarette selection, and concentrations of propylene glycol and vegetable glycerin may have a significant impact on the reinforcing effects of liquids.

Patterns of Systemic and Cervicovaginal Fluid Inflammatory Cytokines throughout Pregnancy.

OBJECTIVE: This study describes the normal variations in serum and cervicovaginal fluid (CVF) cytokine levels throughout pregnancy. STUDY DESIGN: This multicenter, prospective study examined trimester-specific maternal serum and CVF cytokines (interleukin [IL]-1α, IL-1ß, IL-6, IL-8, IL-10, tumor necrosis factor-α, and C-reactive protein [CRP]). A two-factor linear mixed modeling approach compared cytokine distribution, while pairwise comparisons evaluated differences over time. RESULTS: Trimester-specific serum cytokine data were available for 288, 243, and 221 patients, whereas CVF cytokine data were available for 273, 229, and 198 patients. CVF had significantly higher concentrations of IL-1α, IL-1ß, IL-6, IL-8, and matrix metalloproteinase-8 (p < 0.001), irrespective of the trimester. At all time points, IL-10 and CRP concentrations were higher in serum than CVF (p < 0.001). Serum IL-10 increased significantly throughout pregnancy (p < 0.001). CONCLUSION: Differences in cytokine distribution across different biological fluids are evident throughout pregnancy. These findings provide a framework for examining patterns of changes in cytokines throughout pregnancy.

Buprenorphine for Medication-Assisted Treatment of Opioid Use Disorder in Pregnancy: Relationship to Neonatal Opioid Withdrawal Syndrome.

Objective To examine the relationship between antepartum buprenorphine dose for medication-assisted treatment (MAT) of opioid use disorder (OUD) and incident neonatal opioid withdrawal syndrome (NOWS). Study Design We performed a prospective cohort study of pregnant women with a singleton gestation diagnosed with OUD and receiving buprenorphine for MAT at a tertiary care academic institution from July 2015 to January 2017. We divided the study cohort into two groups-pregnancies with versus without NOWS. Substance abuse patterns in pregnancy, maternal, and neonatal clinical outcomes were compared. Results The incidence of NOWS was 31.11% ( n = 28/90) in our study cohort. Pregnancies with NOWS had a significantly higher rate of benzodiazepine positive urine tests and number of positive urine drug screen (UDS) results for illicit opioids. The group without NOWS had significantly higher number of patients with an appropriate UDS result at delivery through postpartum. Rates of neonatal intensive care unit (NICU) admission, length of NICU stay, and maximum Finnegan score were significantly higher in the group with NOWS. Neither the initial (10.6 ± 5.2 versus 10.3 ± 4.8 mg, p = 0.80) nor the final buprenorphine doses (13.3 ± 5.1 versus 13.0 ± 4.6 mg, p = 0.81) were significantly different between study groups. Conclusion The occurrence of NOWS was not related to buprenorphine dose used for MAT.

Ethnicity, smoking status, and preterm birth as predictors of maternal locus of control.

A woman's psychological health can affect prenatal behaviors. The purpose of this study was to examine the relationship between maternal beliefs, prenatal behaviors, and preterm birth (PTB) in a multiethnic population. This was a planned secondary analysis of a cross-sectional trial of postpartum women with singleton gestation. In all, 210 participants were given the Fetal Health Locus of Control (FHLC) scale to measure three primary maternal beliefs that influenced their prenatal behaviors (Internal Control, Chance, Powerful Others). Women who experienced preterm delivery and those who smoked during pregnancy scored the Chance category significantly higher than those who delivered term infants (p = .05; p = .004, respectively). This suggests those who smoked during pregnancy had a greater degree of belief that Chance influenced their infant's health status. Cultural differences also emerged specific to the impact of health care providers on PTB; with Hispanic women scoring Powerful Others the highest among the groups (p = .02). Nurses can plan a critical role in identifying at-risk women (smoking, strong Chance beliefs) while providing a clear message that taking action and modifying high-risk behaviors can reduce risk for adverse pregnancy outcome.

The effects of prenatal secondhand smoke exposure on preterm birth and neonatal outcomes.

OBJECTIVE: To examine the relationship between prenatal secondhand smoke (SHS) exposure, preterm birth and immediate neonatal outcomes by measuring maternal hair nicotine. DESIGN: Cross-sectional, observational design. SETTING: A metropolitan Kentucky birthing center. PARTICIPANTS: Two hundred and ten (210) mother-baby couplets. METHODS: Nicotine in maternal hair was used as the biomarker for prenatal SHS exposure collected within 48 hours of birth. Smoking status was confirmed by urine cotinine analysis. RESULTS: Smoking status (nonsmoking, passive smoking, and smoking) strongly correlated with low, medium, and high hair nicotine tertiles (ρ=.74; p<.001). Women exposed to prenatal SHS were more at risk for preterm birth (odds ratio [OR]=2.3; 95% Confidence Interval [CI] [.96, 5.96]), and their infants were more likely to have immediate newborn complications (OR=2.4; 95% CI [1.09, 5.33]) than nonexposed women. Infants of passive smoking mothers were at increased risk for respiratory distress syndrome (RDS) (OR=4.9; 95% CI [1.45, 10.5]) and admission to a Neonatal Intensive Care Unit (NICU) (OR=6.5; CI [1.29, 9.7]) when compared to infants of smoking mothers (OR=3.9; 95% CI [1.61, 14.9]; OR=3.5; 95% CI [2.09, 20.4], respectively). Passive smokers and/or women with hair nicotine levels greater than .35 ng/ml were more likely to deliver earlier (1 week), give birth to infants weighing less (decrease of 200-300 g), and deliver shorter infants (decrease of 1.1-1.7 cm). CONCLUSIONS: Prenatal SHS exposure places women at greater risk for preterm birth, and their newborns are more likely to have RDS, NICU admissions, and immediate newborn complications.

Measuring prenatal secondhand smoke exposure in mother-baby couplets.

INTRODUCTION: Pregnant women often underreport their smoking status and extent of secondhand smoke (SHS) exposure. Biomarker confirmation is the recommended method to assess smoking behaviors and SHS exposure in both mothers and infants. OBJECTIVES: The primary aims are to (a) examine the relationship between smoking behaviors and SHS exposure in mother-baby couplets using maternal and infant hair nicotine and maternal urine cotinine analyses and (b) determine whether there is an association between maternal and infant hair nicotine samples obtained shortly after birth. DISCUSSION: A cross-sectional study with a multiethnic sample of 210 mother-baby couplets assessing SHS exposure. RESULTS: The level of maternal hair nicotine (MHN) was significantly different among three groups: nonsmoking, nonsmoking/passive exposed, and smoking (p < .0001), with nonsmoking and nonexposed women having the lowest level. Urine cotinine was strongly associated with self-reported smoking status (rho = .88; p < .0001). Maternal and infant hair nicotine were correlated, although MHN correlated more strongly with smoking status (rho = .46, p < .0001) than infant hair nicotine (rho = .39, p < .0001). CONCLUSIONS: MHN was a more precise biomarker of prenatal SHS exposure than infant hair nicotine; mothers' urine cotinine was strongly correlated with self-reported smoking status.

Postpartum smoking relapse and secondhand smoke.

OBJECTIVE: There has been an abundance of research evaluating prenatal and postnatal smoking abstinence programs. However, few researchers have tested postpartum relapse interventions that address secondhand smoke (SHS) exposure. Pregnant women exposed to SHS are more likely to relapse. This article explores the similarities and differences among postpartum interventions that incorporate SHS education. Generating knowledge about the components of postpartum relapse prevention interventions that do and do not achieve prolongation of abstinence is integral to the development of effective SHS interventions that help women achieve lifelong abstinence. METHODS: We used a methodological review of 11 randomized, controlled trials testing the efficacy of relapse prevention interventions that address SHS exposure. We compared intervention strength, biomarker validation of home smoking and SHS, as well as abstinence and relapse rates. We examined three predictors of postpartum relapse: (1) partner smoking in the home, (2) adoption of home smoking restrictions, and (3) motivation/confidence to remain abstinent. RESULTS: Findings revealed a need for more comprehensive SHS interventions and a clear delineation of abstinence/relapse terminology. Biomarker validation of home smoking and SHS was primarily measured by self-report, passive nicotine monitors, and hair nicotine levels. Furthermore, studies using nurse- and pediatrician-led interventions resulted in the lowest relapse rates. CONCLUSION: A comprehensive intervention that specifically prioritizes parental education on the health effects of SHS on the family, empowerment of the mother and family members to remain abstinent and adopt a smoke-free home smoking policy, and partner influence on smoking could result in a significant reduction in postpartum relapse rates.

Nursing research in community-based approaches to reduce exposure to secondhand smoke.

Secondhand smoke (SHS) is the third leading cause of preventable death in the United States and a major source of indoor air pollution, accounting for an estimated 53,000 deaths per year among nonsmokers. Secondhand smoke exposure varies by gender, race/ethnicity, and socioeconomic status. The most effective public health intervention to reduce SHS exposure is to implement and enforce smoke-free workplace policies that protect entire populations including all workers regardless of occupation, race/ethnicity, gender, age, and socioeconomic status. This chapter summarizes community and population-based nursing research to reduce SHS exposure. Most of the nursing research in this area has been policy outcome studies, documenting improvement in indoor air quality, worker's health, public opinion, and reduction in Emergency Department visits for asthma, acute myocardial infarction among women, and adult smoking prevalence. These findings suggest a differential health effect by strength of law. Further, smoke-free laws do not harm business or employee turnover, nor are revenues from charitable gaming affected. Additionally, smoke-free laws may eventually have a positive effect on cessation among adults. There is emerging nursing science exploring the link between SHS exposure to nicotine and tobacco dependence, suggesting one reason that SHS reduction is a quit smoking strategy. Other nursing research studies address community readiness for smoke-free policy, and examine factors that build capacity for smoke-free policy. Emerging trends in the field include tobacco free health care and college campuses. A growing body of nursing research provides an excellent opportunity to conduct and participate in community and population-based research to reduce SHS exposure for both vulnerable populations and society at large.