A longitudinal, observational study of women who persisted in smoking in successive pregnancies.

BACKGROUND: This longitudinal study examined the profile and pregnancy-related behaviours of women who reported smoking in two successive pregnancies when they presented for prenatal care in a large maternity hospital. METHODS: Using the hospital electronic medical records, women who delivered two successive singleton pregnancies during the years 2011-15 were analyzed. Standardized data were computerized by a midwife at the first prenatal visit, following delivery and before discharge. RESULTS: Over the 5 years, 6647 women delivered twice. Overall 5754 (86.6%) were persistent non-smokers in both pregnancies, 609 (9.2%) were persistent smokers in both pregnancies and between pregnancies 202 (3.0%) quit and 82 (1.2%) started smoking. Compared with persistent non-smokers, persistent smokers had higher rates of reported illicit drug use, alcohol consumption and psychological problems and lower rates of planned pregnancy, folic acid supplementation and breastfeeding in both pregnancies (all P < 0.001). In persistent smokers, folic acid supplementation practices deteriorated and illicit drug use increased in the subsequent pregnancy. CONCLUSIONS: We found that approximately one in 10 women smoked in two consecutive pregnancies. Furthermore, compared with non-smokers, persistent smokers were more likely to report other health behaviours associated with adverse pregnancy outcomes and may require additional multidisciplinary support.

A web-based dietary intervention in early pregnancy and neonatal outcomes: a randomized controlled trial.

BACKGROUND: Maternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes. METHODS: Women <18 weeks gestation were recruited at their convenience. The control group received standard care. In addition to standard care, the intervention group received access to an evidence-based nutrition website, customized to the preferences of pregnant women. RESULTS: Of the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy nutrition advice but engagement was not sustained. Access to the website was not associated with any improvement in clinical outcomes (P > 0.05). CONCLUSIONS: We found that provision of a customized website providing nutrition information, did not improve neonatal outcomes. Future studies should explore whether redesign with website interactivity or embedding information on popular digital platforms sustains women's engagement and modifies dietary behaviour.

Maternal anaemia and folate intake in early pregnancy.

Background: The World Health Organization recommends that women take 400 µg of folate supplementation daily throughout pregnancy. We examined the relationship between total folate intake from the diet and supplements at the first prenatal visit and haematological indices at this visit and subsequently. Methods: Women were recruited at their convenience and in addition to clinical and sociodemographic details, detailed questionnaires on dietary intakes and supplementation consumption were completed under supervision. A full blood count and serum and red blood cell (RBC) folate levels were taken. Results: Of the 502 women studied, 97.5% had inadequate total dietary folate intake at the first visit, but, 98.2% were taking folic acid (FA) supplementation. Only 1.8% (n = 9) had anaemia at their first visit (with no case of macrocytosis). Subsequently, 212 women had a further Hb sample in the third trimester and 8.5% (n = 18) were anaemic and 43.4% (89/205) were anaemic postnatally. There was a relationship between the development of anaemia postnatally and lower RBC folate levels at the first visit (P = 0.02). Conclusions: In a country where FA food fortification remains voluntary, these findings support the recommendation that women should start FA supplementation before pregnancy and continue FA after the first trimester.

Preferences of women for web-based nutritional information in pregnancy.

OBJECTIVES: During pregnancy, women are increasingly turning to web-based resources for information. This study examined the use of web-based nutritional information by women during pregnancy and explored their preferences. STUDY DESIGN: Cross-sectional observational study. METHODS: Women were enrolled at their convenience from a large maternity hospital. Clinical and sociodemographic details were collected and women's use of web-based resources was assessed using a detailed questionnaire. RESULTS: Of the 101 women, 41.6% were nulliparous and the mean age was 33.1 years (19-47 years). All women had internet access and only 3% did not own a smartphone. Women derived pregnancy-related nutritional information from a range of online resources, most commonly: What to Expect When You're Expecting (15.1%), Babycenter (12.9%), and Eumom (9.7%). However, 24.7% reported using Google searches. There was minimal use of publically funded or academically supported resources. The features women wanted in a web-based application were recipes (88%), exercise advice (71%), personalized dietary feedback (37%), social features (35%), videos (24%) and cooking demonstrations (23%). CONCLUSIONS: This survey highlights the risk that pregnant women may get nutritional information from online resources which are not evidence-based. It also identifies features that women want from a web-based nutritional resource.

A National Audit of Smoking Cessation Services in Irish Maternity Units.

There is international consensus that smoking cessation in the first half of pregnancy improves foetal outcomes. We surveyed all 19 maternity units nationally about their antenatal smoking cessation practices. All units recorded details on maternal smoking at the first antenatal visit. Only one unit validated the self-reported smoking status of pregnant women using a carbon monoxide breath test. Twelve units (63%) recorded timing of smoking cessation. In all units women who reported smoking were given verbal cessation advice. This was supported by written advice in 12 units (63%), but only six units (32%) had all midwives trained to provide this advice. Only five units (26%) reported routinely revisiting smoking status later in pregnancy. Although smoking is an important modifiable risk factor for adverse pregnancy outcomes, smoking cessation services are inadequate in the Irish maternity services and there are variations in practices between hospitals.

The diagnosis of gestational diabetes mellitus (GDM) using a 75 g oral glucose tolerance test: A prospective observational study.

AIMS: Screening for Gestational Diabetes Mellitus (GDM) is controversial. This prospectivestudy compared different sets of diagnostic cut-off points for plasma glucose measurements following a 75 g Oral Glucose Tolerance Test (OGTT). METHODS: Women who had maternal risk factors for GDM were recruited at their convenience attheir first prenatal visit and consented to a one-step OGTT at 26-28 weeks gestation.All women fulfilling the World Health Organization (WHO) 2013 diagnostic criteriareceived standard care for GDM. RESULTS: Of the 202 women, 139 (69%) had one risk factor for GDM and 63 (31%) had > 1.Using the WHO criteria, 53% (n = 108) had GDM compared with 35% (n = 71) usingCanadian criteria and 18% (n=36) using National Institute for Health Care Excellencecriteria (NICE) criteria (both p<0.001). Of the 108 women, 50% (n = 54) requiredpharmacological treatment to control hyperglycaemia. If the Canadian criteria wereapplied, 11/54 (20.4%) women would not have received hypoglycaemics. If the NICEcriteria were applied, 36/54 (66.7%) women would not have received hypoglycaemics.Maternal insulin, HOMA-IR and C-peptide measured at the time of the OGTT showed evidence of increased insulin resistance in women who had GDM based on the WHOcriteria but who had a normal OGTT based on the Canadian or NICE criteria. CONCLUSIONS: Under stringent research conditions, our study suggeststhat the Canadian and, in particular, the NICE criteria are not identifying women who may benefit fromimproved glycaemic control. These findings support the need for the planned review of the NICE guidelines on GDM in 2020.

Five year trends in maternal smoking behaviour reported at the first prenatal appointment.

BACKGROUND: Maternal smoking is a key modifiable risk factor in preventing adverse pregnancy outcomes such as intrauterine growth restriction, preterm birth and stillbirth. AIM: This observational study examined annual trends of maternal smoking reported at the first prenatal visit in women who delivered in a large university maternity hospital for the 5 years 2011-2015. METHODS: We examined clinical and sociodemographic data computerised routinely for women who presented for prenatal care at the hospital between 2011 and 2015. Multinomial logistic regression was used to determine the maternal characteristics, health behaviours and psychiatric history associated with smoking behaviours. RESULTS: Of the 42,509 women the mean age was 31.4 ± 5.5 years, mean Body Mass Index (BMI) was 25.6 ± 5.1 kg/m2, and 39.5% were nulliparas. Overall, 52.6% reported they had never smoked, 34.9% were ex-smokers, 10.5% smoked ≤10 cigarettes per day, 1.9% smoked ≥11 cigarettes per day and 0.1% smoked e-cigarettes. Between 2011 and 2015 the prevalence of maternal cigarette smoking decreased from 14.3 to 10.9% (P < 0.001). Smoking during pregnancy was most strongly associated with younger age, multiparity, unemployment, unplanned pregnancy, a history of psychiatric problems, alcohol intake and illicit drug usage. CONCLUSIONS: The number of women who reported smoking at the first prenatal visit decreased annually. Amongst women who continue to smoke during pregnancy, there is a clustering of adverse lifestyle behaviour and psychological problems that may need to be addressed if smoking cessation interventions are going to succeed in improving fetal programming.