No abstract

Aims-This study examined whether voucher-based reinforcement therapy (VBRT) contingent on smoking abstinence during pregnancy is an effective method for decreasing maternal smoking during pregnancy and improving fetal growth.Design-A two-condition, parallel groups, randomized controlled trial was conducted.Setting-The trial was conducted in a university-based research clinic.Participants-A total of 82 smokers entering prenatal care participated in the trial.Intervention-Participants were randomly assigned to either contingent or non-contingent voucher conditions. Vouchers exchangeable for retail items were available during pregnancy and for 12 weeks postpartum. In the contingent condition, vouchers were earned for biochemically-verified smoking abstinence; in the non-contingent condition, vouchers were earned independent of smoking status.Measurements-Smoking outcomes were evaluated using urine-toxicology testing and selfreport. Fetal growth outcomes were evaluated using serial ultrasound examinations performed during the third trimester.Findings-Contingent vouchers significantly increased point-prevalence abstinence at the end-ofpregnancy (41% vs. 10%) and at the 12-week postpartum assessment (24% vs. 3%). Serial ultrasound examinations indicated significantly greater growth in terms of estimated fetal weight, femur length, and abdominal circumference in the contingent compared to the non-contingent conditions. Conclusions-These results provide further evidence that VBRT has a substantive contribution to make to efforts to decrease maternal smoking during pregnancy and provide new evidence on positive effects on fetal health.

We report results from a pilot study examining the use of vouchers redeemable for retail items as incentives for smoking cessation during pregnancy and postpartum. Of 100 study-eligible women who were still smoking upon entering prenatal care, 58 were recruited from university-based and community obstetric practices to participate in a smoking cessation study. Participants were assigned to either contingent or noncontingent voucher conditions. Vouchers were available during pregnancy and for 12 weeks postpartum. In the contingent condition, vouchers were earned for biochemically verified smoking abstinence. In the noncontingent condition, vouchers were earned independent of smoking status. Abstinence monitoring and associated voucher delivery was conducted daily during the initial 5 days of the cessation effort, gradually decreased to every other week antepartum, increased to once weekly during the initial 4 weeks postpartum, and then decreased again to every other week for the remaining 8 weeks of the postpartum intervention period. Contingent vouchers increased 7-day point-prevalence abstinence at the end-of-pregnancy (37% vs. 9%) and 12-week postpartum (33% vs. 0%) assessments. That effect was sustained through the 24-week postpartum assessment (27% vs. 0%), which was 12 weeks after discontinuation of the voucher program. Total mean voucher earnings across antepartum and postpartum were 397 US dollars (SD=414 US dollars) and 313 US dollars (SD=142 dollars) in the contingent and noncontingent conditions, respectively. The magnitude of these treatment effects exceed levels typically observed with pregnant and recently postpartum smokers, and the maintenance of effects through 24 weeks postpartum extends the duration beyond those reported previously.

Although academic achievement (WIAT scores) was most impaired in the special education group who showed lower performance over all as well as in reading and spelling, alcohol-affected youth showed significant deficits on mathematics subtests. There was no increased incidence of conduct problems in school records related to alcohol exposure.

Our results illustrate that DTI can be used in evaluating the integrity of corpus callosum in alcohol-exposed individuals. If future studies support these findings, diffusion anisotropy, represented by fractional anisotropy, has the potential to be used as a clinical marker in the diagnosis of FAS.