[Impact of medical counselling on giving up smoking during pregnancy]. / Impacto del consejo médico para dejar de fumar durante la gestación.

OBJECTIVE: Women s tobacco consumption has increased in Spain in recent years, especially among women of reproductive age. This study aims to evaluate the impact of medical counselling integrated into pre-natal care on tobacco consumption during pregnancy and the period after delivery. DESIGN: Quasi-experimental intervention study.Setting. Hospital del Mar, Barcelona. PATIENTS: 219 patients who attended the Hospital del Mar for delivery during 1996 (control group) and 169 patients seen during their pregnancies at the same hospital in 1997 (intervention group). INTERVENTIONS: The control group patients had received normal care. The pregnant women in the intervention group received systematic structured counselling on giving up smoking, backed up by a special brochure composed for this purpose. MEASUREMENTS AND RESULTS: The intervention and control groups showed no statistically significant differences either in their social or demographic variables or in their tobacco consumption. In both groups the evolution of their smoking during pregnancy was determined during their pre-natal visits and six months after delivery through a telephone interview. 44 of the women in the control group (20.1%) gave up smoking before their first pre-natal visit, and 11 (5%) gave up during pregnancy. In the intervention group 26 (17.7%) had given up spontaneously and 16 (10.9%) gave up during pregnancy. Of those who gave up completely during pregnancy, 36.4% of women in the control group and 64.3% in the intervention group remained abstinent at six months (P=.002). CONCLUSIONS: Counselling at pre-natal check-ups to give up smoking lightly increases the number of women who give up and reduces significantly the number of post-delivery backsliders.

Impacto del consejo médico para dejar de fumar durante la gestación / Impact of medical counselling on giving up smoking during pregnancy

Objetivo. El consumo de tabaco entre las mujeres ha aumentado en España en los últimos años, especialmente entre los grupos en edad reproductiva. El objetivo del estudio es evaluar el impacto del consejo médico integrado en la atención prenatal sobre el consumo de tabaco durante el embarazo y en el posparto. Diseño. Estudio de intervención cuasiexperimental. Emplazamiento. Hospital del Mar de Barcelona. Pacientes. El grupo control estaba constituido por 219 pacientes que acudieron para atención al parto al hospital del Mar en 1996, el grupo de intervención, por 169 pacientes atendidas durante el embarazo en el mismo hospital en 1997.Intervenciones. Las pacientes del grupo control habían recibido atención habitual. Las gestantes del grupo de intervención recibieron de forma sistemática un consejo estructurado para dejar de fumar, reforzado por un folleto elaborado con esta finalidad. Mediciones y resultados. Los grupos de intervención y control no presentaban diferencias estadísticamente significativas en las variables sociodemográficas ni en el consumo de tabaco. En ambos grupos se determinó la evolución del hábito tabáquico durante el embarazo a lo largo de las visitas prenatales, y a los 6 meses posparto, a través de una entrevista telefónica. De las gestantes del grupo control, 44 (20,1 per cent) habían dejado de fumar antes de la primera visita prenatal y 11(5 per cent) lo hicieron durante el embarazo. En el grupo de intervención 26 (17,7 per cent) habían dejado de fumar espontáneamente y 16 (10,9 per cent) dejaron de fumar durante el embarazo. De las que dejaron de fumar completamente durante el embarazo, se mantenían abstinentes a los 6 meses el 36,4 per cent de las mujeres del grupo de control y el 64,3 per cent en el grupo de intervención (p = 0,002). Conclusiones. El consejo para dejar de fumar en la visita prenatal produce un aumento discreto en la proporción de abandonos, y una disminución significativa de las recaídas en el posparto. (AU)

Human immunodeficiency virus infection in pregnant women, transmission and zidovudine therapy.

OBJECTIVE: To determine the rate of mother to child transmission of HIV infection in women treated with zidovudine (ZDV). PATIENTS AND METHODS: A consecutive series of 52 HIV-positive pregnant women who either received antenatal care or delivered at our institution. Forty-three women were known to be HIV positive before delivery. Forty were treated with ZDV, 36 intravenously. Twelve had no antenatal care and one refused antenatal treatment. All neonates were treated with ZDV. RESULTS: The HIV transmission rate in children born to mothers treated with ZDV was 6.6%. This compares with a transmission rate of 14% before we used ZDV. All three mothers who transmitted infection had low compliance, initiated therapy late in pregnancy or had advanced disease. CONCLUSION: Our experience supports the idea that ZDV treatment has reduced HIV transmission rate.

Validez del consumo declarado de tabaco en el embarazo / Validity of pregnant women´s stated tobacco consumption

Objetivos. Analizarla relación entre el consumo de tabaco declarado por las embarazadas que declaran fumar antes de la gestación y los niveles de cotinina en orina al inicio y al final de la gestación. Diseño. Estudio observacional, longitudinal. Participantes. Grupo de estudio: 147 gestantes que acuden a primera visita de control prenatal a consultas externas del Hospital del Mar de Barcelona durante 1997. Grupo de control: 50 gestantes no fumadoras atendidas para control de embarazo durante 1997. Mediciones. Número de cigarrillos que declaran fumar al día en la primera visita de control en nuestro centro y en la última visita antes del parto. Niveles de cotinina en las orinas aportadas a dichas visitas. Resultados. La media de cotinina en las gestantes que declaran haber dejado de fumar es superior a la de las no fumadoras. Existe una relación lineal estadísticamente significativa entre el número de cigarrillos declarados y los niveles de cotinina en la primera visita y en la última visita de control gestacional, así como entre la variación de número de cigarrillos y niveles de cotinina entre ambas visitas. El valor predictivo negativo de la declaración del habito tabáquico es del 82,9 por ciento. Conclusiones. Se observa cierto grado de infradeclaración entre las gestantes fumadoras, si bien hay una buena correlación entre declaración de consumo y niveles de cotinina. La infradeclaración no aumenta a pesar del consejo reiterado para dejar de fumar, por lo que, a pesar de sus limitaciones, puede ser un indicador útil para evaluar el efecto de las intervenciones orientadas a promover el abandono del tabaquismo durante la gestación (AU)

[Validity of the declared tobacco consumption in pregnancy]. / Validez del consumo declarado de tabaco en el embarazo.

OBJECTIVES: To analyse the relationship between the stated consumption of tobacco by pregnant women who say they smoked before pregnancy and the levels of cotinine in their urine at the start and end of pregnancy. DESIGN: Observational, longitudinal study. PARTICIPANTS: During 1997. STUDY GROUP: 147 pregnant women at their first pre-natal visit to outclinics of the Hospital del Mar. CONTROL GROUP: 50 non-smoker pregnant women monitored during their pregnancy. MEASUREMENTS AND MAIN RESULTS: The numbers of cigarettes per day that they said they smoked on their first monitoring visit to our centre and at the last attendance before giving birth were recorded. Cotinine levels in the urine samples taken on these visits were measured. Mean cotinine in pregnant women who said they had given up smoking was higher than in non-smokers. There was a statistically significant linear relationship between the number of cigarettes stated and cotinine levels at the first and last pregnancy monitoring visits, as well as between the variation in the number of cigarettes and cotinine levels at these two visits. The negative predictive value of what they said about their tobacco habit was 82.9%. CONCLUSIONS: There was a certain under-declaration by pregnant smokers, although their statements of consumption and cotinine levels correlated closely. The under-declaration did not increase despite reiterated advice to stop smoking, which means that, despite its limitations, it could be a useful indicator for evaluating the effect of interventions aimed at stopping women smoking during pregnancy.