Perception of pregnant individuals, health providers and decision makers on interventions to cease substance consumption during pregnancy: a qualitative study.

BACKGROUND: Despite multiple recommendations and strategies implemented at a national and international level, cigarette smoking, alcohol consumption, and cannabis use during pregnancy remains high in most countries. The objective of this study was to examine key stakeholders' perception of the treatment interventions adopted in Spain, to identify political, organizational and personal factors associated with successful implementation, and to propose strategies for improvement. METHODS: A qualitative study with a phenomenological approach was conducted in 2022. The target groups were: (1) clinical decision makers in the field of addiction science, (2) health professionals who carry out treatment interventions, and (3) pregnant individuals who use tobacco, alcohol or cannabis. Two focus groups and eight in-depth interviews were conducted, recorded, and transcribed. Exploratory analysis and inductive open coding was performed, codes were merged into categories, and subcategories were identified. RESULTS: The analysis resulted in 10 subcategories which were further merged into three main categories: (1) Degree of adoption and utility of treatment interventions implemented; (2) Needs and demands with respect to the organization of treatment interventions; and, (3) Personal barriers to and facilitators for treatment. Respondents reported that despite multiple national and regional cessation initiatives, treatment interventions were rarely adopted in clinical practice. Health care administrators demanded reliable records to quantify substance use for better planning of activities. Health care professionals advocated for additional time and training and both echoed the importance of integrating cessation interventions into routine prenatal care and creating in-house specialized units. The difficulty in quitting, lack of awareness of risk for foetus and child and the controversial advice were identified as barriers by pregnant individuals. CONCLUSIONS: Consistent with previous work, this study found that cessation strategies implemented by the health authorities are not effective if they are not accompanied by organizational and behavioral changes. The current study identifies a set of factors that could be pivotal in ensuring the success of treatment interventions targeting tobacco, alcohol and cannabis use among pregnant individuals.

Consideraciones para el diseño e implementación de las intervenciones para la cesación de consumo de tabaco, alcohol y cannabis en el embarazo. Un estudio cualitativo / Considerations for the design and implementation of interventions for the cessation of tobacco, alcohol and cannabis use in pregnancy: A qualitative study

Objetivo: Explorar la opinión de distintos actores clave, en relación con los requisitos que deberían cumplir las intervenciones de cesación de consumo de tabaco, alcohol y/o cannabis durante el embarazo para que puedan ser implementadas y resulten aceptables y útiles. Diseño: Estudio cualitativo con aproximación fenomenológica. Sitio: Se realizó en España en 2022. Participantes: Gestores, profesionales sanitarios, embarazadas consumidoras de tabaco, alcohol y/o cannabis y sus parejas también consumidoras. Métodos: Los datos se recogieron mediante grupos focales y entrevistas en profundidad, hasta alcanzar la saturación del discurso y se transcribieron de manera exacta. Se realizó un análisis exploratorio y codificación abierta inductiva, se fusionaron los códigos en categorías y se identificaron subcategorías. Resultados: Se identificaron cuatro categorías y 18 subcategorías. Los resultados apuntan a que las intervenciones deberían de ser multicomponente. Entre las intervenciones más aceptadas por parte de las mujeres embarazadas y sus parejas, las consultas específicas de cesación, la información, el apoyo de un igual (aunque no precisan de qué manera) y los incentivos económicos. Entre otras opciones a considerar, la cooximetría, propuesta por gestores para obtener un registro objetivo. Conclusiones: Se extrae que esta intervención debe realizarse a nivel de la atención prenatal realizada en atención primaria. Existen dudas respecto de la frecuencia, fin y seguimiento de esta intervención multicomponente, así como a la posibilidad de incorporar a las parejas.(AU)

Objective: To explore the opinion of different key stakeholders regarding the requirements that tobacco, alcohol and/or cannabis cessation interventions should meet to be implemented and to be acceptable and useful during pregnancy. Design: A qualitative study with phenomenological approach. Site: The study was conducted in Spain in 2022. Participants: Decision makers, health professionals, pregnant women using tobacco, alcohol and/or cannabis and their partners who are also users. Methods: Data were collected through focus groups and in-depth interviews, until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were conducted, codes were merged into categories and subcategories were identified. Results: Four categories and 18 subcategories were identified. The results suggest that interventions should be multicomponent. Among the interventions most accepted by pregnant women and their partners were specific cessation consultations, information, peer support (although they did not specify how) and financial incentives. Among other options to consider, co-oximetry, proposed by managers to obtain an objective register. Conclusions: The conclusion is that this intervention should be carried out at the level of prenatal care in primary care. There are doubts regarding the frequency, purpose, and follow-up of this multicomponent intervention, as well as the possibility of incorporating couples.(AU)

[Considerations for the design and implementation of interventions for the cessation of tobacco, alcohol and cannabis use in pregnancy: A qualitative study]. / Consideraciones para el diseño e implementación de las intervenciones para la cesación de consumo de tabaco, alcohol y cannabis en el embarazo. Un estudio cualitativo.

OBJECTIVE: To explore the opinion of different key stakeholders regarding the requirements that tobacco, alcohol and/or cannabis cessation interventions should meet to be implemented and to be acceptable and useful during pregnancy. DESIGN: A qualitative study with phenomenological approach. SITE: The study was conducted in Spain in 2022. PARTICIPANTS: Decision makers, health professionals, pregnant women using tobacco, alcohol and/or cannabis and their partners who are also users. METHODS: Data were collected through focus groups and in-depth interviews, until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were conducted, codes were merged into categories and subcategories were identified. RESULTS: Four categories and 18 subcategories were identified. The results suggest that interventions should be multicomponent. Among the interventions most accepted by pregnant women and their partners were specific cessation consultations, information, peer support (although they did not specify how) and financial incentives. Among other options to consider, co-oximetry, proposed by managers to obtain an objective register. CONCLUSIONS: The conclusion is that this intervention should be carried out at the level of prenatal care in primary care. There are doubts regarding the frequency, purpose, and follow-up of this multicomponent intervention, as well as the possibility of incorporating couples.

[Perception of dating violence among adolescents. Transversal study.] / Percepción de violencia en el noviazgo entre los adolescentes. Estudio transversal.

OBJECTIVE: The violence produced in the context of dating is known as dating violence. Currently, it is a widespread problem in adolescence and there is a great lack of knowledge about the beliefs/attitudes that help perpetuate this phenomenon. This study aimed to assess how adolescents perceive dating violence. Additionally, to estimate the observed frequency of exposure of adolescents to different dating violence items, assessing the differences according to sex and educational level. METHODS: A cross-sectional study was carried out in 2022 among high school students coming from Spain (Galician Region) The data was collected by means of an anonymous online questionnaire. A descriptive analysis of the data obtained was conducted. The observed frequency of adolescents' exposure to different items of dating violence and identification of violence was estimated. Fisher's exact test was used to compare the proportions according to sex and educational level. RESULTS: 410 students were included. 99% of the women perceived that it is not normal to control their partner's clothing compared to 88% of the men; in relation to the control of friendships these percentages were 87.6% and 73.1% and with respect to criticism of the partner 54.7% vs 67.9%, respectively in women and men. 46.8% of the students admitted knowing of cases in which they sent several messages a day to find out what their partner was doing. 21.7% referred to be aware of cases who felt fear of the partner. CONCLUSIONS: The perception of dating violence by women is higher. The largest differences between men and women are in the items of the control domain.

OBJETIVO: La violencia en la pareja que se produce en adolescentes se conoce con el nombre de violencia en el noviazgo. Actualmente, es un problema generalizado en la adolescencia y existe un gran desconocimiento al respecto de las creencias/actitudes que están ayudando a perpetuar este fenómeno. El objetivo de este estudio fue conocer la percepción de los adolescentes sobre esta violencia y estimar la frecuencia observada de exposición a diferentes ítems de violencia en el noviazgo, valorando las diferencias según sexo y nivel educativo. METODOS: Se realizó en 2022 un estudio transversal en cuatro centros educativos públicos de Galicia (España) que impartían Educación Secundaria Obligatoria y Bachillerato. El muestreo de los centros fue de conveniencia. Se invitó a los estudiantes a contestar un cuestionario anónimo. Se estimó la frecuencia observada de exposición del estudiantado a diferentes ítems de violencia en el noviazgo y de identificación de la violencia. Para comparar las proporciones en función del sexo y del nivel educativo se empleó la prueba exacta de Fisher. RESULTADOS: Se incluyeron 410 estudiantes. El 99% de las mujeres percibieron que no es normal controlar la vestimenta de la pareja frente al 88% de los hombres; en relación con el control de las amistades, estos porcentajes fueron del 87,6% y el 73,1%, en mujeres y hombres, respectivamente. Con respecto a las críticas a la pareja, estos porcentajes fueron del 54,7% frente al 67,9%, respectivamente en mujeres y hombres. El 46,8% del estudiantado admitió conocer casos que enviaban varios mensajes al día para saber qué estaba haciendo la pareja. El 21,7% refirió conocer casos que sentían miedo de su pareja. CONCLUSIONES: La percepción de violencia en el noviazgo es mayor por parte de las mujeres. Las mayores diferencias entre hombres y mujeres se observan en los ítems del dominio control.

[Physical activity in the regional health plans in Spain: a review of proposals]. / La actividad física en los planes de salud autonómicos de España. Una revisión de propuestas.

OBJECTIVE: To identify if the regional government health plans in Spain include specific objectives and measures related to physical activity. METHOD: Institutional websites were scanned to identify the most recent health plan of each regional government. The information included in the health plans on objectives and measures and the population groups targeted by these measures was extracted. The search was completed on 24 January 2022. RESULTS: Sixteen health plans were identified of which six are in force in 2022; 15 of these have incorporated specific objectives and measures on physical activity. Most of the actions are focus on general population, children-adolescents and elderly population. The plans of Cantabria, the Comunitat Valenciana and País Vasco cover physical activity more widely, proposing measures for seven of the eight identified population groups. CONCLUSIONS: Most of the health plans include measures related to physical activity and target two or more population groups. The objectives, specific measures and population groups were highly heterogeneous. This study could serve to prompt regional governments to review their health plans, update them and improve them in terms of physical activity. It seems advisable that the different health plans should have a homogeneous framework of proposals related to the promotion of physical activity.

Actividad física en el embarazo y puerperio: prevalencia y recomendaciones de los profesionales sanitarios / Physical activity during pregnancy and postpartum: prevalence and healthcare professionals recommendations

Objetivo: Valorar los cambios en la realización de actividad física (AF) en el embarazo y después del parto y explorarlo en función de la edad y el nivel de estudios. Analizar si los profesionales sanitarios dieron recomendaciones sobre la AF. Diseño: Estudio observacional. Sitio: La información procede del Sistema de Información sobre Conductas de Riesgo de Galicia. Participantes: La población objetivo fueron mujeres gallegas (18-49 años) que dieron a luz entre septiembre-2015 y agosto-2016. Medidas principales: Se estimó la prevalencia de realización de caminatas, ejercicio físico (EF) y recomendaciones de realización de la AF en tres momentos (pre-embarazo, embarazo y tras parto). Resultados: Las caminatas aumentaron 34,0% durante el embarazo y el ejercicio disminuyó 21,0%. Tras el parto las caminatas disminuyeron 37,0% y el ejercicio 32,0%, en comparación con el embarazo. Las mujeres de menor edad y con menor nivel educativo son las que realizan menos AF; 72,6 y 22,1% de las mujeres declaró que un profesional sanitario les recomendó AF durante el embarazo y tras el parto, respectivamente. Conclusión: La AF realizada durante el embarazo es fundamentalmente la caminata, y preocupa su abandono tras el parto. Los profesionales sanitarios recomiendan AF principalmente durante el embarazo, pero poco tras el parto. Para mejorar estas prevalencias sería conveniente el refuerzo de la acción sanitaria.(AU)

Objective: To assess changes in physical activity (PA) during pregnancy and after giving birth and to explore this according to age and educational level. To analyze whether the health professionals gave recommendations on PA. Design: Observational study. Site: Information is derived from the Galician Risk Behavior Information System. Participants: The target population was Galician women (aged 18-49 years) who delivered between september-2015 and august-2016. Main measurements: The prevalence of walking, physical exercise and PA recommendations were estimated for three moments (pre-pregnancy, pregnancy and after delivery). Results: Walking during pregnancy increased by 34,0% and the performance of physical exercise decreased by 21,0%. After delivery, walking decreased by 37,0% and physical exercise decreased by 32,0% compared to pregnancy. Women of younger age and lower educational level were those who performed less PA. 72,6% and 22,1% of women declared that a healthcare professional recommended PA during pregnancy and after delivery, respectively. Conclusion: The PA performed by women during pregnancy is mainly walking, and there is a concern about the abandonment of PA practice after delivery. Healthcare professionals recommend PA mainly during pregnancy, but little is recommended after delivery. It may be desirable for the improvement of this prevalence to reinforce health action.(AU)

[Physical activity during pregnancy and postpartum: prevalence and healthcare professionals recommendations]. / Actividad física en el embarazo y puerperio: prevalencia y recomendaciones de los profesionales sanitarios.

OBJECTIVE: To assess changes in physical activity (PA) during pregnancy and after giving birth and to explore this according to age and educational level. To analyze whether the health professionals gave recommendations on PA. DESIGN: Observational study. SITE: Information is derived from the Galician Risk Behavior Information System. PARTICIPANTS: The target population was Galician women (aged 18-49 years) who delivered between september-2015 and august-2016. MAIN MEASUREMENTS: The prevalence of walking, physical exercise and PA recommendations were estimated for three moments (pre-pregnancy, pregnancy and after delivery). RESULTS: Walking during pregnancy increased by 34,0% and the performance of physical exercise decreased by 21,0%. After delivery, walking decreased by 37,0% and physical exercise decreased by 32,0% compared to pregnancy. Women of younger age and lower educational level were those who performed less PA. 72,6% and 22,1% of women declared that a healthcare professional recommended PA during pregnancy and after delivery, respectively. CONCLUSION: The PA performed by women during pregnancy is mainly walking, and there is a concern about the abandonment of PA practice after delivery. Healthcare professionals recommend PA mainly during pregnancy, but little is recommended after delivery. It may be desirable for the improvement of this prevalence to reinforce health action.

Abandono de la lactancia materna en Galicia: ¿cuándo se produce y por qué? / Cessation of breastfeeding in Galicia: when is it happening and why?

Introduction: International organizations recommend maintaining breastfeeding at least until 6 months after the birth of the child. However, the prevalence of breastfeeding at 6 moths in Europe is below the recommendations. The aims of this study are to estimate the prevalence of breastfeeding cessation month by month and to ascertain the reasons associated with the cessation during the first 12 months of life in galician women. Methods: The information analysed comes from the Health Risk Behaviour Information System conducted in 2016, which included women who had given birth in the previous 12 months (n = 6436) in Galicia (Spain). The prevalence of breastfeeding cessation was estimated and the age of the child at the time of cessation was collected. The causes of abandonment were classified into 5 global categories and the frequencies were estimated. Results: A total of 5,177 mothers of 3- to 16-month-old babies were included. At the age of 12 months, 33.8% of the children were still breastfed. The main reason for cessation of breastfeeding was hypogalactia (46.5%), followed by being back to work (24.1%). After birth to 4 months, hypogalactia and health problems were the principal reasons of cessation; between 4 and 7 months after birth, hypogalactia and returning to work or studies were the most important reasons; and after 7 months, rejection by the baby became important. Conclusion: The cessation of breastfeeding during the first year of life is due mainly to preventable causes. It is necessary to improve maternal health education, both during and after the pregnancy, as well as to develop effective work-life balance measures. (AU)

Introducción: Las organizaciones internacionales recomiendan mantener la lactancia materna (LM) durante los primeros 6 meses de vida. En Europa, la prevalencia de LM a los 6 meses está por debajo de las recomendaciones. Los objetivos son estimar la prevalencia de cese de LM mes a mes y conocer los motivos asociados al abandono de la LM durante el primer año de vida en Galicia. Metodología: Los datos proceden de la encuesta del Sistema de Información sobre Conductas de Riesgo para la Salud 2016 que incluyó a mujeres que habían dado a luz en los 12 meses previos (n = 6.436) en Galicia (España). Se estimaron las prevalencias de cese de LM en función de la edad del niño. Se clasificaron las causas de abandono en cinco categorías y se estimaron las frecuencias. Resultados: Se incluyeron a 5.177 madres con niños de 3-16 meses. Al año de vida, el 33,8% de los niños mantenían LM. La razón principal del abandono fue la hipogalactia (46,5%), seguida de la vuelta al trabajo (24,1%). Hasta los 4 meses, la hipogalactia y los problemas de salud fueron los motivos principales; entre los 4-7 meses, la vuelta al trabajo y la hipogalactia; y después de los 7 meses, el rechazo del bebé y la vuelta al trabajo. Conclusión: El abandono de la LM durante el primer año de vida es principalmente debido a causas prevenibles. Es imprescindible mejorar la educación en salud de las madres, tanto durante como después del embarazo, así como desarrollar medidas de conciliación eficaces. (AU)

Maternal smoking in pregnancy and blood pressure during childhood and adolescence: a meta-analysis.

Arterial hypertension during childhood or adolescence is rising, and smoking during pregnancy may constitute a modifiable risk factor. This study aims to evaluate the effect of maternal smoking during pregnancy on diastolic (DBP) and systolic blood pressure (SBP) in childhood and adolescence. A bibliographic search was conducted in PubMed, Embase, and CENTRAL databases in March 2022. Meta-analysis was performed with the difference in mean-adjusted SBP/DBP of children and adolescents aged 3-17 years, according to maternal smoking/non-smoking in pregnancy. A random effects model was applied; a leave-one-out analysis and meta-analysis by subgroups were performed. A modified Newcastle-Ottawa scale was used to assess the quality of the studies. Evidence levels were rated using the GRADE system. Fifteen studies were included in the meta-analysis; all of them evaluated the mean-adjusted SBP difference in children or adolescents (N = 73,448), and 6 also that of DBP (N = 31,459). Results showed that maternal smoking during pregnancy significantly increased SBP (ß = 0.31 mmHg 95% CI 0.14-0.49). A greater increase in mean-adjusted SBP was observed in those studies that completed the recruitment before 1990, were conducted in non-European countries, used standard mercury or manual sphygmomanometry, adjusted for birth weight, and were in the lowest quality subgroup. No significant association was found for DBP. The GRADE level of evidence was low for SBP and very low for DBP. CONCLUSION: Smoking in pregnancy might increase SBP in childhood and adolescence. Due to the low level of evidence, solid inferences cannot be drawn about the clinical relevance of these findings. WHAT IS KNOWN: • AHT is the leading cause of premature death among adults worldwide. • Deleterious effects derived from SHS exposure on children's health have been documented since early 1970. To date, there are contradictory results about the effects of prenatal SHS exposure on children's BP. WHAT IS NEW: • Smoking in pregnancy may increase SBP during childhood and adolescence. • Maternal smoking during pregnancy could have greater influence on their offspring's SBP than on DBP.

La actividad física en los planes de salud autonómicos de España. Una revisión de propuestas / Physical activity in the regional health plans in Spain: a review of proposals

Objetivo: Conocer si en España los planes de salud autonómicos incluyen objetivos y medidas específicas relacionados con la actividad física. Método: Se realizó una búsqueda en las páginas web institucionales para identificar el plan de salud más reciente de cada comunidad autónoma. Se extrajo la información que incluían los planes de salud sobre objetivos y medidas, y grupos poblacionales a los que se dirigían dichas medidas. La búsqueda se completó el 24 de enero de 2022. Resultados: Se identificaron 16 planes de salud, de los cuales seis están vigentes en 2022; de estos, 15 incorporaban objetivos y medidas específicas sobre actividad física. La mayor parte de las acciones van destinadas a población general, población infanto-juvenil y personas mayores. Los planes de Cantabria, la Comunidad Valenciana y el País Vasco incluyen la actividad física de forma más extensa, proponiendo medidas para siete de los ocho grupos poblacionales identificados. Conclusiones: La mayor parte de los planes de salud incluyen medidas en relación con la actividad física y las dirigen a dos o más grupos poblacionales. La heterogeneidad en cuanto a objetivos, medidas específicas y grupos poblacionales es alta. Este estudio puede ayudar a las comunidades autónomas a revisar su plan de salud, actualizarlo y mejorarlo en materia de actividad física. Es conveniente que los diferentes planes de salud tengan un marco de propuestas homogéneo relacionado con la promoción de la actividad física. (AU)

Objective: To identify if the regional government health plans in Spain include specific objectives and measures related to physical activity. Method: Institutional websites were scanned to identify the most recent health plan of each regional government. The information included in the health plans on objectives and measures and the population groups targeted by these measures was extracted. The search was completed on 24 January 2022. Results: Sixteen health plans were identified of which six are in force in 2022; 15 of these have incorporated specific objectives and measures on physical activity. Most of the actions are focus on general population, children-adolescents and elderly population. The plans of Cantabria, the Comunitat Valenciana and País Vasco cover physical activity more widely, proposing measures for seven of the eight identified population groups. Conclusions: Most of the health plans include measures related to physical activity and target two or more population groups. The objectives, specific measures and population groups were highly heterogeneous. This study could serve to prompt regional governments to review their health plans, update them and improve them in terms of physical activity. It seems advisable that the different health plans should have a homogeneous framework of proposals related to the promotion of physical activity. (AU)

Condicionantes del parto pretérmino en Galicia / Determinants of preterm birth in Galicia

Introducción: los recién nacidos prematuros tienen más riesgo de padecer complicaciones tras el nacimiento, siendo la prematuridad la principal causa de muerte en los recién nacidos. El objetivo principal del estudio es caracterizar los partos pretérmino en Galicia. Material y métodos: en 2016, se realizó en Galicia un estudio transversal enmarcado en el Sistema de Información sobre Conductas de Riesgo (SICRI). La población objetivo fue la de las mujeres de 18-49 años que dieron a luz en Galicia entre septiembre de 2015 y agosto de 2016 (n = 18 822) y sus hijos nacidos vivos (n = 19 204). La recogida de información se realizó entre noviembre de 2016 y enero de 2017 mediante entrevista telefónica asistida por ordenador (sistema CATI). Se estimó la prevalencia de parto pretérmino (<37 semanas) en global y en función de las variables de interés. Se ajustó un modelo de regresión logística para identificar las variables asociadas al parto pretérmino. Resultados: se obtuvo información de 6436 mujeres de 18 a 49 años. La tasa de respuesta fue del 76%. En 2016, el 7,9% de los partos en Galicia fueron pretérmino. La prevalencia aumentó con la edad de la mujer. La prevalencia más elevada se observó entre las mujeres con un embarazo múltiple. Se identificaron como factores que aumentan la probabilidad de parto pretérmino características obstétricas y conductas de riesgo para la salud. La asistencia a clases de preparación al parto y el aumento de más de 12 kg de peso durante el embarazo se identificaron como factores que disminuyen la probabilidad de tener un parto pretérmino. Conclusiones: en Galicia, 8 de cada 100 partos son pretérmino. Algunos de los factores identificados como condicionantes del parto pretérmino son modificables, por lo que los profesionales de la salud deberían tenerlos en cuenta en la atención al embarazo (AU)

ntroduction: premature infants are at higher risk of complications after birth, and prematurity is the leading cause of death in the neonatal period. The main objective of this study was to characterize preterm births in Galicia, Spain.Material and methods: in 2016, we carried out a cross-sectional study in Galicia using the Risk Behavior Information System, or SICRI. The study universe consisted of all Galician women aged 18 to 49 years who gave birth between September-2015 and August-2016 (n=18 822) and their liveborn infants (n=19 204). Data were collected between November 2016 and January 2017 through computer-assisted telephone interviews with participants. We estimated the prevalence of preterm birth (before 37 weeks of gestation), overall and based on different variables. We fitted a logistic regression model to identify variables associated with preterm birth.Results: we obtained information from 6436 women aged 18 to 49 years. The response rate was 76%. In 2016, 7.9% of births in Galicia were preterm. The prevalence increased with age. The highest prevalence was found in women with multiple pregnancies. Obstetric characteristics such as multiple pregnancy and primiparity and risk behaviours were identified as factors that increase the probability of preterm birth. Attendance to childbirth classes and a pregnancy weight gain greater than 12 kg were identified as protective factors.Conclusions: in Galicia, 8 out of 100 births are preterm. Some of the identified factors that increase the risk of preterm birth are modifiable, and health providers should take them into account in prenatal care. (AU)