Change in smoking status during two consecutive pregnancies: a population‐based cohort study

Abstract

Objective To investigate changes in tobacco smoking in two consecutive pregnancies and factors associated with the change.Design Population-based cohort study.Setting New South Wales, Australia, 2000-10.Population A total of 183 385 women having first and second singleton pregnancies.Methods Descriptive and multivariable logistic regression analyses of perinatal data linked to hospital admission data.Main outcome measures Proportion of women smoking during their first pregnancy who quit by their second, and of women not smoking in their first pregnancy who did smoke during their second.Results Among 22 761 smokers in the first pregnancy, 33.5% had quit by their second. Among 160 624 non-smokers in their first pregnancy, 3.6% smoked during their second. Women who were aged ≥25 years, were married, born in a non-English speaking country, used private obstetric care, and lived in a socio-economically advantaged area were more likely to quit or less likely to start smoking in the second pregnancy. Smokers who had gestational hypertension (adjusted odds ratio [OR] 1.36, 95% confidence interval [95% CI] 1.23-1.51), a large-for-gestationalage infant (OR 1.66, 95% CI, 1.46-1.89), and a stillbirth (OR 1.44, 95% CI 1.06-1.94) were more likely to quit, whereas smokers whose infant was small-for-gestational-age (OR 0.65, 95% CI 0.60-0.70) or admitted to special care nursery (OR 0.87, 95% CI 0.81-0.94) were less likely to quit. Among non-smokers in the first pregnancy, the risk of smoking in the second pregnancy increased with late antenatal attendance (e.g. ≥26 weeks, OR 1.30, 95% CI 1.14-1.48), gestational diabetes (OR 1.25, 95% CI 1.07-1.45), preterm birth (e.g. spontaneous, OR 1.25, 95% CI 1.10-1.43), caesarean section (e.g. prelabour, OR 1.13, 95% CI 1.01-1.26), and infant small-for-gestational-age (OR 1.37, 95% CI 1.26-1.48) or required special care nursery (OR 1.14, 95% CI 1.06-1.23). Inter-pregnancy interval of ≥3 years was associated with either change in smoking status.Conclusions Most smokers continue to smoke in their next pregnancy, even among those who experienced poor outcomes. Intensive interventions should be explored and offered to women at the highest risk.

Maternal smoking behaviour across the first two pregnancies and small for gestational age birth: Analysis of the SLOPE (Studying Lifecourse Obesity PrEdictors) population-based cohort in the South of England

“…We found similar a similar percentage of women smoked at the start of both of their first two pregnancies to those reported elsewhere [ 36 , 37 ]. Whilst the time between pregnancies, where a women is still in relatively intense contact with healthcare professionals, is the ideal time to focus on the health of the entire family, particularly for mothers with a previous history of SGA birth, this is obviously a missed opportunity.…”

FIGO's ethical recommendations on female sterilisation will do more harm than good: a commentary

“…While this may happen sometimes, some examples, arguable, show the veracity of this opinion, that is, not using medical prophylaxes or insecticide-treated bed nets means wanting malaria, not taking or collecting one's anti-HIV or antiepilepsy medication reliably is a craving for AIDS or convulsions, not taking folic acid before and during early pregnancy means desiring a child with spina bifida, travelling by SUV to fitness training indicates a desire for the polar ice caps to melt and not refraining from tobacco use is choosing cancer or a growth retarded baby. 36 …”

Maternal smoking during pregnancy: Trends and determinants in the conception to community study

“…In one study in New South Wales, Australia, of 22 761 women recorded as smokers during their first pregnancy, 33.5% quit by their second pregnancy 12 . This change appeared to be influenced by adverse events in the first pregnancy such as gestational hypertension, large‐for‐gestational‐age baby, and stillbirth 12 . Other studies have demonstrated similar proportions of women quitting between pregnancies ranging from 24.9% 13,14 to 42.0% 13,15 in different samples of women.…”

“…There are surprisingly limited data on how smoking status changes either within or between pregnancies. In one study in New South Wales, Australia, of 22 761 women recorded as smokers during their first pregnancy, 33.5% quit by their second pregnancy 12 . This change appeared to be influenced by adverse events in the first pregnancy such as gestational hypertension, large‐for‐gestational‐age baby, and stillbirth 12 .…”