Study objective -To test the stress hypothesis by characterising women during their first pregnancy who continue to smoke in early pregnancy in comparison with women who quit smoking, with special reference to psychosocial factors like social network, social support, demands, and control in work and daily life. Design -The study is based on a cohort of primigravidas followed during pregnancy. Data were collected by self administered questionnaires during the pregnant womens' first antenatal visit at about 12 weeks.Setting -The study was performed in the antenatal clinics in the city ofMalmo, Sweden.Participants -The participants were all primigravidas living in the city of Malmo, Sweden, over a one year period, 1991-92.A total of 872 (87.7%) of the 994 invited women agreed to participate. The population of this study on smoking includes all primigravidas who at the time of conception were smoking (n=404, 46.3%).Main results -At the first antenatal visit (63-6% (n =257) of the prepregnancy smokers were still smoking (a total smoking prevalence of 29-5%). The pregnant smokers were on average younger and had a lower educational level. The highest relative risk (RR) of continued smoking was found among unmarried women RR 2-7 (95% confidence interval) (1.5, 4.8), women having unplanned pregnancies RR 2-2 (1-2, 4.0) and those with a low social participation RR 1-6 (1.0, 2-7), low instrumental support RR 2-6 (1.2, 6.0), low support from the child's father RR 2-1 (1.0, 4.2) and those exposed to job strain RR= 2-3 (1.1,4-8). The In recent years great attention has been paid to the dangers of smoking during pregnancy. In spite ofthis, many pregnant women continue to smoke. In Sweden the prevalence of smoking among all pregnant women was 21 8% in 1992 (Swedish Medical Birth Registry -personal communication). A study from two big cities in Denmark showed a prevalence of 44% in 1987, and 81% ofthese women were still smoking at the end of pregnancy.9 One Norwegian study in 1989 showed a smoking prevalence of 46% 3 months before pregnancy, and 84% of the women were still smoking at the time of the first medical check up. '0 In a Swedish study, 32% of the pregnant women in one big city were daily smokers at the time of conception and by the time oftheir antenatal visit, 2 months later, 77% reported that they were still smoking."1 Women's smoking has been seen as related to social deprivation, stress, and disadvantage.2 13 Persistent smoking during pregnancy is found to be related to low household incomes, living in rented accommodation, being unmarried, and having a husband or partner in manual employment.'4 High parity number, not living with the infant's father, and daily passive smoking at home are also associated with an increased risk for continued smoking.'5 Other important predictors of unsuccessful smoking cessation are a high level of smoking before pregnancy and high coffee consumption.9Women experiencing depression and those with psychosocial difficulties in daily domestic roles also have higher rates of pe...

Objective: To describe how men from the Middle East experience Swedish maternity and child health care. An integral part of the aim of this study has also been to describe the experiences of men from the Middle East when becoming and being a father in Sweden. Design, setting and participants: an exploratory, qualitative study using focus-group discussions and individual interviews, with a semi-structured interview guide and content analysis. A total of 16 men participated. Ten Arabicspeaking men from the Middle East living in Sweden participated in three focus-group discussions. Six men from the Middle East living in Sweden, and speaking Swedish, participated in individual interviews. Findings: three main categories were developed: meeting empathic professionals; finding new positions within the family; and experiencing social demands. Key conclusions and implications for practice: seeing their partners being met individually and with empathy by midwives and child health-care nurses encouraged men to become involved in areas not previously open to them (i.e. pregnancy, childbirth and the care of babies and young children). As the women often lacked knowledge of Swedish, they depended on the help of their partners when meeting maternity and child health-care professionals. The men found the experience of living in an alien country difficult. They were often unemployed, felt they were a burden to their wives after emigrating to Sweden, and that they were no longer a suitable role model for their children.

This study showed that psychosocial factors, most probably linked to a disadvantaged social situation, could be the theoretically most important focus for preventing SGA in immigrant women. This could also further support a hypothesis of a link between psychosocial stress and SGA in general. However, this should not exclude the need for intervention in the antenatal care system in terms of specially tailored support and education.

Objective To test the stress hypothesis that women who give birth to small for gestational age infants lack important psychosocial coping resources, such as a sufficient social network, social support and control in daily life.Design A prospective cohort study of nulliparous pregnant women.Setting Antenatal care units in the city of Malmo, Sweden.Population All women (n = 994) during a one year period (1991)(1992) were invited, and 872 (8707%) participated. This study was restricted to pregnancies resulting in singleton live birth (n = 826); 6.7% of infants were classified as small for their gestational age.Methods Self-administered questionnaires were given to all women at the time of their first antenatal visit.Main outcome measures The classification of small for gestational age was based on a gender-specific intrauterine growth reference curve. Newborn babies were classified as being small for gestational age if their birthweight was > 2 SD below the mean weight for gestational age.Lack of psychosocial resources, such as social stability, social participation, emotional and instrumental support, all increased the likelihood of delivering an infant that was small for gestational age. The odds ratios when controlled for demographic background factors, lifestyle factors and anthropomorphic measures were: OR 1.7 (95% CI 0-9-3.3) for women with poor social stability; OR 2.2 (95% CI 1 . 1 4 4 ) for women with poor social participation; OR 2.6 (95% CI 1.2-5.7) for women with poor instrumental support; and OR 1.5 (95% CI 04-24) for women with poor emotional support. Simultaneous exposure to a poor total network index, as well as a poor total support index showed a significantly increased odds ratio for having a small for gestational age baby: OR 3.3 (95% CI 16-67) and OR 2-7 (95% CI 1.3-5.6), respectively. A synergy index of 9.0 and 6.8 supported the assumption of an interaction between immigrant status and poor total network or poor total support, in a synergistic direction.The findings support the stress-hypothesis that a lack of psychosocial resources might increase the risk of giving birth to a baby that is small for gestational age. Results Conclusions INTRODUCTIONIntrauterine growth retardation, resulting in low birthweight for a given gestational age, is a main concern in obstetrics. Small for gestational age birthweight has frequently been used to define intrauterine growth retardation, but we still lack sufficient insight into the causes of why babies are born small for their gestational age. Different maternal factors are found to be related to intrauterine growth retardation, such as parity', age', race1, prepregnancy weighP, height's4, educational levels.6, i n~o m e~.~, as well as alcohol intake1g6, and ~rnoking'-~.~-~.Psychosocial resources, such as social network and social support, are important for maintaining good healthlo. A major area of research on social networks, social support and health is stress and stressful life e~ents'l-'~. Selye" described the General Adaptation response to any type of ...

OBJECTIVES: This study tested the hypothesis that women who deliver small-for-gestational-age infants are more often exposed to passive smoking at home or at work. METHODS: Among a 1-year cohort of nulliparous women in the city of Malmö, Sweden 872 (87.7%) women completed a questionnaire during their first prenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n = 826), 6.7% of infants were classified as small for their gestational age. RESULTS: Passive smoking in early pregnancy was shown to double a woman's risk of delivering a small-for-gestational-age infant, independent of potential confounding factors such as age, height, weight, nationality, educational level, and the mother's own active smoking (odds ratio [OR] = 2.7). A stratified analysis indicated interactional effects of maternal smoking and passive smoking on relative small-for-gestational-age risk. CONCLUSIONS: Based on an attributable risk estimate, a considerable reduction in the incidence of small-for-gestational-age births could be reached if pregnant women were not exposed to passive smoking.