Effects of microRNA-21 on endothelial-to-mesenchymal transition and its role in the pathogenesis of chronic obstructive pulmonary disease. / MicroRNA-21å¯¹å† çš®-间å è´¨è½¬åŒ–çš„å½±å“åŠå ¶åœ¨æ ¢æ€§é˜»å¡žæ€§è‚ºç–¾ç— å‘ç— æœºåˆ¶ä¸­çš„ä½œç”¨.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a disease characterized by persistent airflow restriction. This study aims to explore whether there is endothelial-to-mesenchymal transition (EndMT) in COPD mice and to explore the relationship between microRNA-21 (miR-21) and EndMT. METHODS: We established the COPD and the miR-21 gene knockout COPD animal model (both cigarette smoke-induced). Mice were divided into 3 groups (n=4): a control group, a COPD group, and a miR-21 knockout COPD (miR-21-/--COPD) group. Masson trichrome staining was used to observe the deposition of collagen around the perivascular. The relative protein levels and positions of endothelial cell markers including vascular endothelial-cadherin (VE-cadherin), endothelial nitric oxide synthase (eNOS), and platelet endothelial cell adhesion molecule-1 (CD31) as well as mesenchymal cell markers including α-smooth muscle actin (α-SMA) and neural cadherin (N-cadherin) in lung tissues were observed by immunohistochemical staining. RESULTS: Compared with the control group, the area of collagen fibril deposition was increased in the COPD group (P<0.05), the expression levels of VE-cadherin, eNOS, and CD31 were all decreased (all P<0.05), and the expression levels of α-SMA and N-cadherin were increased (both P<0.05). Compared with the COPD group, the miR-21-/--COPD group had a reduced area of collagen fiber deposition (P<0.05), the expression levels of VE-cadherin, eNOS, and CD31 were all increased (all P<0.05), and the expression levels of α-SMA and N-cadherin were decreased (both P<0.05). CONCLUSIONS: There is a EndMT process in cigarette smoke-induced COPD animal models.MiR-21 gene knockdown could reduce collagen deposition area and inhibit the EndMT process in COPD mice.

Progress in the effect of microRNA-21 on diseases via autophagy. / MicroRNA-21é€šè¿‡è‡ªå™¬å½±å“ç–¾ç— çš„ç ”ç©¶è¿›å±•.

Autophagy is a regulatory mechanism that packages damaged organelles, proteins, and pathogens to form vesicles and transports to lysosomes for degradation, enabling the recycle of useful components. Therefore, autophagy plays an important role in biological growth regulation and homeostasis. In the past two decades, growing evidence has shown that microRNA (miRNA) is closely related to autophagy. MiRNA-21 promotes or inhibits autophagy via regulating relevant pathways for different downstream target genes, and plays a role in tumors, ischemia-reperfusion injury, and other diseases.

Community violence and pregnancy health behaviors and outcomes.

OBJECTIVES: Community violence is associated with health-compromising behaviors (HCBs) and adverse general health and pregnancy outcomes. It is unknown whether these effects persist after adjusting for health behaviors. METHODS: Retrospective cohort study of 36,637 pregnancies, 2005-2009, using birth certificate/hospital discharge databases. Community violence rate = (nonaccidental injuries/total injuries) × 100%. ZIP codes were categorized into levels (CVL) by quartiles (lowest, 1, to highest, 4). Outcomes included HCBs (tobacco, alcohol, or drugs), fetal death, preterm birth, and infant small-for-gestational-age (SGA). Covariates included HCBs and maternal characteristics. RESULTS: The CVL median (interquartile range) was 5.5% (3.8%-8.8%). As CVL increased, rates of HCBs (8% vs 13% vs 14% vs 16%), fetal death (4 vs 5 vs 6 vs 8/1000 pregnancies), preterm birth (8% vs 9% vs 11% vs 13%), and infant SGA (8% vs 10% vs 13% vs 16%) increased. The odds of preterm birth (CVL1 = 1.00 [reference] vs CVL2 = 1.00 [0.88-1.14] vs CVL3 = 1.10 [0.96-1.26] vs CVL4 = 1.25 [1.09-1.42]) and infant SGA (CVL2 = 1.03 [0.93-1.17] vs CVL3 = 1.15 [1.01-1.30] vs CVL4 = 1.21 [1.07-1.38]) increased, after controlling for HCB. CONCLUSIONS: CVL is associated with fetal death, preterm birth, and infant SGA, independent of HCB. These findings may support the role of violence-reduction programs in improving pregnancy health behaviors and outcomes.

Luteolin suppresses inflammation and oxidative stress in chronic obstructive pulmonary disease through inhibition of the NOX4-mediated NF-κB signaling pathway.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with chronic inflammation that predominantly affects the lung and peripheral airways. Previous investigation has underlined the efficacy of luteolin in the treatment of inflammation-related symptoms. Accordingly, our study concentrates on unveiling the effect of luteolin on COPD. METHODS: Mice or A549 cells were treated with cigarette smoke (CS) to establish COPD models in vivo and in vitro. Then, the serum and bronchoalveolar lavage fluid of mice were harvested. The lung tissues of mice were subjected to hematoxylin-eosin staining to observe the degree of damage. The inflammation and oxidative stress factors level were calculated via enzyme-linked immunosorbent assay and quantitative real-time polymerase chain reaction. The expressions of nuclear factor-kappa B (NF-κB) pathway-related factors were detected by Western blot. RESULTS: In in vivo experiments, CS treatment reduced the weight of mice and promoted lung tissue damage, while luteolin attenuated the effect of CS on the mice. Moreover, luteolin inhibited the inflammation factors level, oxidative stress, and NADPH oxidase 4 (NOX4)-mediated NF-κB signaling pathway in CS-induced COPD mice. Similar results were obtained in in vitro experiments that luteolin alleviated CS-induced inflammation, oxidative stress, and NOX4-mediated NF-κB signaling pathway activation in CS-treated A549 cells. Besides, NOX4 overexpression offset the impacts of luteolin on the CS-induced A549 cells. CONCLUSION: Luteolin alleviates inflammation and oxidative stress in COPD via NOX4-mediated NF-κB signaling pathway, which provides a theoretical basis for the treatment of COPD with luteolin.

Spatial distribution and influencing factors of China's household biogas: evidence from provincial-level data.

To address the adjustment of the Chinese agricultural industry and to better promote the development of Chinese household biogas, this article summarizes and analyzes the spatial distribution characteristics and influencing factors of the type and number of biogas digesters, biogas production, biogas fermentation materials, and methods of fermentation residue utilization and ecological agriculture with household biogas by compiling a dataset covering 31 provincial administrative regions in China. The results show that hydraulic biogas digesters are distributed mainly in northwestern and northeastern China; in addition, continuously stirred biogas digesters and bottom-discharging biogas digesters are distributed mainly in southern and northern China, respectively. Because of temperature and population, the Sichuan and Henan Provinces have the highest number of biogas digesters and biogas production. The type of biogas fermentation materials depends on the local raw materials. Biogas slurry and residue are widely used as fertilizers; furthermore, biogas slurry is used for seed soaking in northeastern and southern China, and biogas residue is used as feed in central southern and northern China. The "Three-in-one" and "Four-in-one" biogas ecological models are used mostly in southern and northern China, respectively, and both are mainly affected by temperature. Finally, we propose various problems and countermeasures to enhance the development of the household biogas industry in China. Our findings are critical for China's policymakers to adopt effective measures for promoting the development of cleaner energy and the layout of the agricultural industry.

Smoking during pregnancy rates trends in a high smoking prevalence state, 1990-2009.

OBJECTIVE: To assess the trends for smoking during pregnancy for whites and blacks in Missouri, a state with a high prevalence of smoking, for the period 1990-2009. METHODS: Retrospective cohort study of annual pregnancy smoking rates recorded on birth certificates. Trends were assessed by regression analyses for all births, births to whites and blacks, births to whites and blacks in aggregate, and by zip codes within the combined jurisdictions of Kansas City, St Louis City, and St Louis County. Zip code smoking during pregnancy rates matched with the respective zip code race-specific population compositions were analyzed by chi-square tests. RESULTS: Smoking during pregnancy rates trends for whites and blacks differed significantly during the 2 decades. Although rates for whites declined over time, they were relatively stable from 1999 through 2007. Rates for blacks exhibited a steep decline in the early 1990s, remaining stable after 1995. Within the combined jurisdictions, rates for blacks who smoked during pregnancy surpassed those of whites beginning in 2001. The lack of prenatal care for either race was the only maternal characteristic consistently associated with lack of reduction in smoking during pregnancy. There also were no declines among young birth mothers of either race who had 12 or fewer years of education. Rates of smoking during pregnancy for blacks and whites were highest in zip codes with a ≥50% black population. CONCLUSIONS: Rates for smoking during pregnancy for whites and blacks in Missouri overall have not changed appreciably from 2000 to 2009. Beneficial antismoking during pregnancy effects that could reverse this trend may be achievable via improved access to prenatal care, especially for young, uneducated women.

An improved prognostic model for predicting the mortality of critically ill patients: a retrospective cohort study.

A simple prognostic model is needed for ICU patients. This study aimed to construct a modified prognostic model using easy-to-use indexes for prediction of the 28-day mortality of critically ill patients. Clinical information of ICU patients included in the Medical Information Mart for Intensive Care III (MIMIC-III) database were collected. After identifying independent risk factors for 28-day mortality, an improved mortality prediction model (mionl-MEWS) was constructed with multivariate logistic regression. We evaluated the predictive performance of mionl-MEWS using area under the receiver operating characteristic curve (AUROC), internal validation and fivefold cross validation. A nomogram was used for rapid calculation of predicted risks. A total of 51,121 patients were included with 34,081 patients in the development cohort and 17,040 patients in the validation cohort (17,040 patients). Six predictors, including Modified Early Warning Score, neutrophil-to-lymphocyte ratio, lactate, international normalized ratio, osmolarity level and metastatic cancer were integrated to construct the mionl-MEWS model with AUROC of 0.717 and 0.908 for the development and validation cohorts respectively. The mionl-MEWS model showed good validation capacities with clinical utility. The developed mionl-MEWS model yielded good predictive value for prediction of 28-day mortality in critically ill patients for assisting decision-making in ICU patients.

Secular trends in hospital emergency department visits for dental care in Kansas City, Missouri, 2001-2006.

OBJECTIVES: We determined the trends, risk factors, and costs of emergency department (ED) visits for dental complaints during a six-year period in Kansas City, Missouri (KCMO). METHODS: We used de-identified hospital discharge data from all facilities serving KCMO during 2001-2006. Using the International Classification of Diseases, Ninth Revision codes, we determined both counts and rates of ED visits related to toothache or tooth injury and analyzed the discharge diagnosis and costs of these visits. We used multivariable regression analysis to assess risk factors for the ED visits for dental complaints. RESULTS: We found a significant increasing trend in dental complaint visits during the six-year period (from 13.1% to 19.0%, p < 0.01). Dental caries accounted for 20.4%, pulpitis or periapical abscess accounted for 14.8%, dental injury accounted for 8.7%, temporomandibular joint (TMJ) disorders accounted for 1.5%, and all other unspecified dental diseases accounted for 54.6% of the ED visits for dental complaints. The mean charge was approximately $360 per visit and was highest for TMJ disorders ($747) and lowest for unspecified other dental diseases ($277). Self-pay (38.3%) and Medicaid (32.3%) constituted the majority of the payment sources. Multivariable regression analysis indicated that self-payers, nonwhite people, adults, people with lower family income, and weekends were associated with increased use of ED visits for dental complaints. CONCLUSIONS: There was a significant increasing trend in dental complaint-related ED visits. EDs have become an important site for people with dental problems to seek urgent care, particularly for individuals who self-pay or are on Medicaid.

Demographic risk factors affecting emergency room visits caused by benzodiazepine poisoning in Kansas City, Missouri, from 2001 to 2007.

OBJECTIVE: The study objective was to identify demographic risk factors associated with emergency room visits caused by benzodiazepine poisoning. METHODS: A retrospective study was conducted utilizing Missouri Hospital Discharge Data for Kansas City, Missouri, USA, for 2001-2007. The data included patients' demographics such as racial group, age, sex, health insurance status and annual income. Emergency room visits due to benzodiazepine poisoning were identified by ICD-9 code 969.4. The frequencies of patient visits were calculated according to categories of each demographic variable. Chi-square tests were used to assess the difference of emergency room visits among categories of each demographic variable. A multiple logistic regression analysis was performed, where the outcome variable was emergency room visits due to benzodiazepine poisoning (yes/no), and the independent variables were the demographic variables. KEY FINDINGS: Of 1317566 emergency room visits over the 7-year period, 562 were due to benzodiazepine poisoning. Seventy-seven per cent of these visits were made by patients who were white, of whom 53% were 30-49years old, 56% were female, 74% had health insurance and 44% lived in zip codes with median family incomes of $40000-59999. Chi-square tests were significant for racial group, age and annual income (P<0.01). In the logistic regression white patients were 73% more likely than black patients to have emergency room visits caused by benzodiazepine poisoning (P<0.01), with an odds ratio (95% confidence interval) of 5.63 (4.33-7.30). Compared with those aged 0-19 years, the odds ratio for patients aged 30-39 to have such visits was 2.73 (2.09-3.57), and the odds ratio for patients aged 40-49 was 2.84 (2.17-3.71). CONCLUSIONS: White patients and patients aged 30-49years were at higher risk for emergency room visits due to benzodiazepine poisoning. Health interventions such as medication review by pharmacists may reduce the risk of benzodiazepine poisoning for these patients.

Risk factors for recurrent small-for-gestational-age birth.

The factors associated with recurrent small-for-gestational-age birth (R-SGA) have not been previously studied in a multiracial population. This is a retrospective cohort study of 5932 black and white women who had consecutive singleton first and second births in a Midwestern metropolis, from 1995 through 2004, to measure the risk and determine the factors associated with R-SGA. The rates for second-born small-for-gestational-age birth and R-SGA were 10.3% and 4.0%, respectively. Compared with mothers of firstborns who were appropriate for gestational age, mothers of firstborns who were small for gestation age had a higher risk of second-born small-for-gestational-age infants (relative risk [RR] = 3.93; 95% confidence interval [95% CI] = 3.36 to 4.59). Among those with firstborns who were small for gestational age, the odds ratio (OR) and 95% CI of R-SGA were higher for lean body mass index + poor gain (2.83; 1.20 to 6.69), blacks (1.58; 1.09 to 2.29), and smokers (1.61; 1.05 to 2.47). R-SGA occurs in 4% of second births and is responsible for 40% of second-born small-for-gestational-age infants. R-SGA is potentially preventable because of its association with potentially modifiable factors such as smoking and weight gain in pregnancy.

Ponderal index of the newborn: effect of smoking on the index of the small-for-gestational-age infant.

The ponderal index (PI) is evaluated in the context of its distribution within a given population. Low PI (<10th percentile for gestational age) has been extensively studied but not much is known about the distribution and factors associated with a high (>90th percentile) PI among small-for-gestational-age (SGA) infants. This retrospective study of singleton live first births from 1990 to 2007 in a Midwestern city explores factors associated with a high PI, particularly among SGA infants. Independent variables included exposures (none, smoke, hypertension) and maternal and infant demographic characteristics. There were 45,453 births, 28 to 42 weeks' gestational age, 55% Whites and 51% male. Mean PI increased with gestational age and was highest among Hispanics and lower among SGA infants. High PI was present in 11% of appropriate-for-gestational-age and 4% of SGA infants. Among SGA infants, odds ratios (ORs) of high PI were higher for smoke exposure (1.21; 95% confidence interval 0.97, 1.87) and lower for males (0.66; 0.47, 0.93). In conclusion, the distribution of PI varies by exposures and of high PI by race/ethnicity/gender. SGA infants with high PI have relative surplus of mass, and ostensibly, adiposity, for their frame. There is a need to use PI in exploring and defining previously observed associations between SGA and adult-onset obesity/metabolic syndrome.

Excess Hispanic fetal-infant mortality in a midwestern community.

OBJECTIVE: We assessed excess fetal-infant mortality for Hispanic, non-Hispanic white, and non-Hispanic black populations in five contiguous counties of Missouri and Kansas. METHODS: We conducted a perinatal periods of risk (PPOR) assessment of fetal-infant mortality using electronic linked birth-death record files from 2001 through 2005. We generated an internal reference group in accordance with established PPOR protocol. We used Kitagawa analysis to determine whether excess deaths were due to birthweight distribution (a higher frequency of prematurity or growth retardation) or to higher mortality rates once born at that birthweight (birthweight-specific mortality). RESULTS: We found the excess fetal-infant death rates for Hispanic and non-Hispanic white populations to be similar and considerably lower than that for non-Hispanic black populations. Among Hispanic children, we judged 21.6% of fetal-infant mortality to be excess in relation to the reference population. Within the PPOR matrix, Hispanic excess mortality rates were distributed differently from those of non-Hispanic white and non-Hispanic black populations. Among Hispanic children, 93.6% of the excess mortality could be explained by low birthweight and birthweight-specific mortality, with the greatest contribution attributable to low birthweight. CONCLUSION: The excess fetal-infant mortality experience of Hispanic people in the five-county region was similar to that of the non-Hispanic white population, but was distributed differently in the PPOR model, which has significance regarding interventions targeting reductions in fetal-infant mortality.

Assessing awareness, knowledge and use of folic acid in Kansas women between the ages of 18 and 44 years.

UNLABELLED: Taking folic acid daily, before and during early pregnancy, has been proven to reduce neural tube birth defects (NTD). Unfortunately, many women fail to take it daily as recommended. OBJECTIVES: To assess women's self-reported awareness, knowledge and use of folic acid. Methods Data were obtained by cross-sectional, random digit-dialing, computer-assisted telephone interviews with 250 women in Kansas. Associations were determined by chi-squared analysis. RESULTS: Eighty-eight percent of childbearing age women in Kansas have a general awareness of folic acid, 20% have knowledge that it reduces birth defects, but only 25% report taking it daily. Awareness was associated with high school or greater education (P < .0001), incomes over $25,000 (P = 0.0003), being married (P = 0.0035), being white (P = 0.0135), having health insurance (P = 0.0152) and being capable of pregnancy (P = 0.0119). Knowledge that folic acid reduces birth defects was associated with being aware of the USPHS recommendation (P < .0001), being capable of pregnancy (P = 0.0043), being pregnant (P = 0.0061), and being aware of folic acid (P = 0.0379). Taking folic acid daily was associated with currently being pregnant (P = 0.0126). CONCLUSIONS: Women less likely to take folic acid on a daily basis were young, non-Caucasians who reported less education, less income and no health insurance. Based upon these data, multi-level education campaigns that specifically target lower-SES women should be considered.

Secular trends in excess fetal and infant mortality using perinatal periods of risk analysis.

Perinatal periods of risk (PPOR) provide an alternative analytical approach to studying infant mortality. Results can be used to focus community activities to improve infant and maternal health. This article demonstrates the use of PPOR to monitor trends in excess fetal and infant mortality related to disparities associated with race and ethnicity in Kansas City, MO (KC). Based on a comparison of PPOR analyses for 1996-2000 and 2001-2005, there was a 30% reduction in excess fetal and infant mortality in Kansas City and reductions for both non-Hispanic blacks (17%) and non-Hispanic whites (66.7%). However, the disparity ratio for excess mortality rates between non-Hispanic blacks and non-Hispanic whites nearly doubled. Prematurity, the most frequent cause of infant mortality in Kansas City during 2001-2005 accounted for 42.5% of the infant deaths. Being a teenage mother; having less than a high-school education; being unmarried; having an unintended pregnancy; being obese preconceptually; being diabetic; using substances such as tobacco or drugs during pregnancy; receiving late, inadequate or intermediate amounts of prenatal care; having a multifetal pregnancy; having a primary elective cesarean section; delivering a preterm infant or having a male infant; and being enrolled in Medicaid all increased the risk of infant death.

Fetal mortality: timing of racial disparities.

Whether or not racial disparities exist in fetal mortality rate (FMR) statistics depends upon the methodology used to calculate the rates. While there appears to be consensus that there is a black-white disparity in late gestation (> or = 28 weeks), the issue is unclear for early gestation (20-27 weeks). To clarify this issue, we assessed disparities in FMR for singleton fetal deaths and live births between non-Hispanic blacks and non-Hispanic whites in three counties of Missouri using gestational age- and weight-specific analyses. These analyses demonstrated statistically significant disparities for non-Hispanic whites when fetal deaths occurred < 28 weeks gestation and also at weights < 1,000 g. Statistically significant disparities for non-Hispanic blacks were not evident until gestation was > or = 32 weeks or weights were > or = 2,500 g. The results of these analyses were consistent with each other and suggest that the non-Hispanic black disparity in FMR is a late gestational issue. The lack of disparity for non-Hispanic blacks and the disparity for non-Hispanic whites during earlier gestation or with low weights were associated with the disparate rates for very preterm live birth.

Changes in smoking behavior between first and second pregnancies.

OBJECTIVE: To assess changes in maternal smoking behavior at the second pregnancy. METHODS: First and second birth certificates were matched for 5241 white and black mothers in Kansas City, Mo, who had singleton births between 1994 and 2003. RESULTS: The pregnancy-smoking quit rate was 24.9%, and the pregnancy-smoking initiation rate was 4.8%. CONCLUSION: Twenty-five percent of women who smoked and 5% of women who did not smoke during their first pregnancy changed their behavior during their second pregnancy. These findings reflect a minimal net shift in pregnancy-smoking between pregnancies and support the importance of persistent antismoking socialization that is independent of a pregnant woman's previous pregnancy-smoking status.

Failure to embrace the barrier/condom use message.

The objective of this study was to examine the consistency of barrier/condom use among men who have sex with men in the Kansas City metropolitan area. The authors sought to determine if barrier/condom usage patterns were associated with the type of sex act and whether it was insertive or receptive, HIV testing frequency, and number of sexual partners. Data were extracted from a 2003 community health assessment of the gay, lesbian, bisexual, and transgendered community in the metropolitan area. The health assessment instrument was anonymous, self-administered, and distributed at events in that community. Responses from 623 men indicated that consistent use of a barrier/condom was low regardless of the sex act. There was no relationship between barrier/condom usage patterns and HIV testing frequency for any sex act or the number of sex partners, with the exception of anal intercourse. The authors concluded that a different approach is needed to translate the barrier/condom use message into a behavioral response.

Term-gestation low birth weight and health-compromising behaviors during pregnancy.

OBJECTIVE: To estimate the association between term-gestation low birth weight (term-LBW) rates and increasing numbers of health-compromising behaviors during pregnancy. METHODS: Retrospective cohort study of 78,397 term live births in Kansas City, Missouri, 1990-2002. Information on maternal and newborn characteristics was obtained form birth certificate records. Health-compromising behavior, specifically, smoking, alcohol, and drug use, was classified by the numbers and combinations of behaviors engaged in during pregnancy. Covariates included race, age, interconception interval, education, Medicaid status, medical risk factors, adequacy of prenatal care, and marital status. RESULTS: The cohort was 61% white, 16% less than 20 years of age, 45% on Medicaid, 24% with medical risk factor, and 45% single pregnant women. Overall term-LBW rate was 3.3%, and it increased with numbers of health-compromising behaviors: 2.6% (none), 5.5% (1), 10.8% (2), and 18.5% (3), P < .001. Unadjusted odds ratio (OR) for term-LBW increased with increasing numbers of behaviors (OR 1.0 [none]; 2.3, 95% confidence interval 2.0-2.4 [smoking]; 0.9, 0.6-1.4 [alcohol]; 2.1, 1.5-3.0 [drugs]; 4.6, 3.6-5.8 [smoking + alcohol]; 4.4, 3.6-5.4 [smoking + drugs]; 4.2, 1.5-11.9 [drugs + alcohol]; 8.4, 6.2-11.5 [smoking + alcohol + drugs]). However, on adjusting for covariates, smoking, alone (OR 2.3, 2.0-2.5) or in combinations with other behaviors (OR 4.4, 3.4-5.7 [smoking + alcohol]; 2.0, 1.6-2.6 [smoking + drugs]; and 3.3, 2.2-4.7 [smoking + alcohol + drugs]) remained the major risk factor for term-LBW. CONCLUSION: Smoking alone or in combination with alcohol and/or drug use is associated with term-LBW among women who engage in health-compromising behaviors. The effect is especially pronounced when smoking is combined with alcohol consumption.

Are fewer women smoking during pregnancy?

OBJECTIVE: To determine whether pregnancy-smoking rates have changed in last decade. METHODS: Retrospective cohort study of 67,395 pregnancies in Kansas City over 2 epochs, 1993-1997 and 1998-2002, using computer files of birth certificates. RESULTS: Overall pregnancy-smoking rates decreased from 18.1% (95% CI=17.7-18.5%) to 14.2% (13.8-14.5%). Among smokers, there was a distribution shift toward light smoking; light [39% (38.9-40.3%) vs 49% (47.6-50.4%)], moderate [36.8% (34.8%-38.8%) vs 34.4% (32.1-36.7%)], and heavy [23.1% (21.9-26.3%) vs 16.6% (14-19.1%)]. CONCLUSIONS: The results suggest decreasing heavier smoking. However, the trend toward light smoking suggests decreasing self-reporting. These findings highlight the dilemma in using self-reports for public health policy and emphasize the importance of antismoking socialization for all pregnancies.