Linking birth records to hospital admission records enhances the identification of women who smoke during pregnancy

Tran, Duong Thuy; Roberts, Christine L.; Havard, Alys; Jorm, Louisa

doi:10.1111/1753-6405.12213

Cited by 16 publications

(23 citation statements)

References 43 publications

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“…The proportion of women who started smoking during the second pregnancy (3.6%) was lower than those being reported in US studies (4.8–6.2%) but higher than the finding from a Norwegian study (2.3%) . It is an encouraging finding that the trend in quitting increased over the study period, which is consistent with a decline in prevalence of smoking in the general female population and in the overall obstetric population in Australia during the study period . These findings are likely to reflect the effectiveness of Australia's tobacco‐control public health interventions, and the efforts of the health system to promote smoking cessation among pregnant women …”

Section: Discussionsupporting

confidence: 70%

“…The recording of maternal smoking in perinatal records and hospital admission records has been validated previously (medical records as the gold standard), with respective sensitivities of 89.6% and 66.2%, respective positive predictive values of 96.1% and 93.0%, and specificities of 99.0% . Our algorithm to combine smoking information from the two sources of data has similar utility to using medical records in identifying pregnant smokers . A total of 846 women (0.5%) with an unknown smoking status in either the first ( n = 395) or second pregnancy ( n = 469) were excluded.…”

Section: Methodsmentioning

confidence: 91%

“…The main advantage of the current study was the use of whole‐of‐population data collected over a 10‐year period. Linking perinatal data to hospital admission data allowed not only greater identification of pregnant smokers but also the examination of various determinants of maternal smoking across pregnancies. Very few studies have investigated the role of maternal medical diagnoses, mode of delivery, the timing of the initial antenatal attendance, and adverse outcomes of the index pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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

Tran

Roberts

Jorm

et al. 2014

BJOG

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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.

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Section: Discussionsupporting

confidence: 70%

Section: Methodsmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

Tran

Roberts

Jorm

et al. 2014

BJOG

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“…Compared with all women giving birth in 2005 to 2012, a higher proportion of women included in this study belonged to low (37.3% vs 23.0%) or middle socio‐economic group (SES) (40.5% vs 33.9%), delivered in a public hospital (93.6% vs 75.8%), and had their first antenatal visit after the first trimester (35.7% vs 29.6%). Included women also had a higher prevalence of smoking during pregnancy (27.2% vs 12.2%), noting that smoking is under‐recorded in the NSW PDC …”

Section: Resultsmentioning

confidence: 98%

Utilisation of teratogenic medicines before and during pregnancy in Australian women

Raichand

Pearson

Zoëga

et al. 2019

Aust NZ J Obst Gynaeco

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Background:Given the potential hazards of teratogenic medicines, to a fetus exposed in utero, monitoring their use around pregnancy is imperative. Aim: To measure utilisation of teratogenic medicines (Therapeutic GoodsAdministration's category D or X) in women who gave birth in New South Wales, Australia, during pregnancy and the 24 months prior. Materials and Methods:We used linked population-based datasets including dispensing and perinatal data for all deliveries in NSW between 2005 and 2012. We included pregnancies among concessional beneficiaries only, with complete ascertainment of dispensing claims. Pre-pregnancy and during-pregnancy periods were based on birth dates and gestational age. We determined prevalence of exposure using percent of pregnancies in which women had at least one dispensed teratogenic medicine in three-month time periods. Results:The study included 191 588 pregnancies (145 419 women). Prevalence of exposure to D/X medicines anytime during pregnancy was 2.0% (<20 pregnancies category X), decreasing from pre-pregnancy (3.8-6.0%) to first trimester (1.5%), further decreasing in second and third trimesters (0.8% and 0.6% respectively). We observed large reductions in antibiotic prevalence but only modest reductions for psychotropics and antilipidemic agents (all category D). Our results suggest higher use of potentially teratogenic medicines (category D) than those strictly contraindicated for use (category X), during pregnancy. Overall, use was higher in the first trimester than the rest of pregnancy. The high prevalence of potentially contraindicated psychotropics in all three trimesters may suggest a higher benefit-to-risk ratio and warrants future research focusing on the reasons for their prescribing to pregnant women.

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“…The beginning and end points of cohort entry ensure that dispensing data were available for at least 1 year prior to conception and deliveries in 2012 did not disproportionately include pregnancies with gestation shorter than 40 weeks. Maternal smoking status in pregnancy was derived from either perinatal or maternal hospital admission data [25]. During the study period, there were changes in maternal smoking items in the perinatal data collections (2010 in WA and 2011 in NSW).…”

Section: Study Populationmentioning

confidence: 99%

Use of smoking cessation pharmacotherapies during pregnancy is not associated with increased risk of adverse pregnancy outcomes: a population-based cohort study

Tran

Preen

Einarsdóttir

et al. 2020

BMC Med

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Background: Varenicline, bupropion and nicotine replacement therapy (NRT) are three effective pharmacotherapies for smoking cessation, but data about their safety in pregnancy are limited. We assessed the risk of adverse perinatal outcomes and major congenital anomalies associated with the use of these therapies in pregnancy in Australia. Methods: Perinatal data for 1,017,731 deliveries (2004 to 2012) in New South Wales and Western Australia were linked to pharmaceutical dispensing, hospital admission and death records. We identified 97,875 women who smoked during pregnancy; of those, 233, 330 and 1057 were exposed to bupropion, NRT and varenicline in pregnancy, respectively. Propensity scores were used to match exposed women to those who were unexposed to any smoking therapy (1:10 ratio). Propensity scores and gestational age at exposure were used to match varenicline-exposed to NRT-exposed women (1:1 ratio). Time-dependent Cox proportional hazards models estimated hazard ratios (HR) with 95% confidence intervals (95% CI) for any adverse perinatal event (a composite of 10 unfavourable maternal and neonatal outcomes) and any major congenital anomaly. Results: The risk of any adverse perinatal event was not significantly different between bupropion-exposed and unexposed women (39.2% versus 39.3%, HR 0.93, 95% CI 0.73-1.19) and between NRT-exposed and unexposed women (44.8% vs 46.3%, HR 1.02, 95% CI 0.84-1.23), but it was significantly lower in women exposed to varenicline (36.9% vs 40.1%, HR 0.86, 95% CI 0.77-0.97). Varenicline-exposed infants were less likely than unexposed infants to be born premature (6.5% vs 8.9%, HR 0.72, 95% CI 0.56-0.92), be small for gestational age (11.4% vs 15.4%, HR 0.68, 95% CI 0.56-0.83) and have severe neonatal complications (6.6% vs 8.2%, HR 0.74, 95% CI 0.57-0.96). Among infants exposed to varenicline in the first trimester, 2.9% had a major congenital anomaly (3.5% in unexposed infants, HR 0.91, 95% CI 0.72-1.15). Varenicline-exposed women were less likely than NRT-exposed women to have an adverse perinatal event (38.7% vs 51.4%, HR 0.58, 95% CI 0.33-1.05).

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Linking birth records to hospital admission records enhances the identification of women who smoke during pregnancy

Cited by 16 publications

References 43 publications

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

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

Utilisation of teratogenic medicines before and during pregnancy in Australian women

Use of smoking cessation pharmacotherapies during pregnancy is not associated with increased risk of adverse pregnancy outcomes: a population-based cohort study

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