Psychosocial predictors of smoking and exercise during pregnancy

Rodriguez, Alina; Bohlin, Gunilla; Lindmark, Gunilla

doi:10.1080/713683039

Cited by 42 publications

(50 citation statements)

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“…Smoking during pregnancy cooccurs with numerous potential confounding variables that are related to childhood outcomes, including maternal psychiatric symptoms of hostility, depression (Anda et al, 1990;Fergusson, Goodwin, & Horwood, 2003;Rodriguez, Bohlin, & Lindmark, 2000;Schuetze & Eiden, 2006;Whiteman, Fowkes, Deary, & Lee, 1997), and anxiety (Parton et al, 1998), and Attention-Deficit Hyperactivity Disorder (ADHD) (Flick et al, 2006;Goodwin, Keyes, & Simuro, 2007;Kodl Middlecamp & Wakschlag, 2004). Pregnant smokers are also more likely to be young, poor, unmarried, and engage in other risky health behaviors during pregnancy, including alcohol and other drug use, and have suboptimal nutrition (Baghurst, Tong, Woodward, & McMichael, 1992;Breslau, 1995;Dani & Harris, 2005;Pickett, Wilkinson, & Wakschlag, 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Using Propensity Score Modeling to Minimize the Influence of Confounding Risks Related to Prenatal Tobacco Exposure

Fang

Johnson

Chevalier

et al. 2010

Nicotine &Amp; Tobacco Research

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Introduction: Despite efforts to control for confounding variables using stringent sampling plans, selection bias typically exists in observational studies, resulting in unbalanced comparison groups. Ignoring selection bias can result in unreliable or misleading estimates of the causal effect. Methods:Generalized boosted models were used to estimate propensity scores from 42 confounding variables for a sample of 361 neonates. Using emergent neonatal attention and orientation skills as an example developmental outcome, we examined the impact of tobacco exposure with and without accounting for selection bias. Weight at birth, an outcome related to tobacco exposure, also was used to examine the functionality of the propensity score approach.Results: Without inclusion of propensity scores, tobacco-exposed neonates did not differ from their nonexposed peers in attention skills over the first month or in weight at birth. When the propensity score was included as a covariate, exposed infants had marginally lower attention and a slower linear change rate at 4 weeks, with greater quadratic deceleration over the first month. Similarly, exposure-related differences in birth weight emerged when propensity scores were included as a covariate. Conclusions:The propensity score method captured the selection bias intrinsic to this observational study of prenatal tobacco exposure. Selection bias obscured the deleterious impact of tobacco exposure on the development of neonatal attention. The illustrated analytic strategy offers an example to better characterize the impact of prenatal tobacco exposure on important developmental outcomes by directly modeling and statistically accounting for the selection bias from the sampling process.

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Section: Discussionmentioning

confidence: 99%

Using Propensity Score Modeling to Minimize the Influence of Confounding Risks Related to Prenatal Tobacco Exposure

Fang

Johnson

Chevalier

et al. 2010

Nicotine &Amp; Tobacco Research

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Section: Nih Public Accessmentioning

confidence: 99%

“…Trait hostility consistently predicts higher smoking rates in both men and women (e.g., Lipkus, Barefoot, Williams & Siegler, 1994;Siegler, Person, Barefoot & Williams, 1992;Whiteman, Fowkes, Deary, & Lee, 1997). In addition, one recent study found that hostility during the first trimester predicted smoking during the second and third trimesters (Rodriquez, Bohlin & Lindmark, 2000).The importance of considering negative affect of pregnant smokers is underscored by the rapidly increasing body of literature that shows a range of nonoptimal developmental outcomes among the infants and children of women with increased levels of depression and hostility. Independent of cigarette smoking, parents who exhibit higher levels of depression are less sensitive caregivers, more likely to display flatter affect during mother-child interactions and to provide less stimulation to their infants (Cohn & Campbell, 1992;del Carmen, Pederson, Huffman, & Bryan, 1993;Field, 1992;Howard et al, 1995;Jameson, Gelfand, Kuczar, & Teti, 1997;Weinberg & Tronick, 1998).…”

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confidence: 92%

The association between prenatal exposure to cigarettes and infant and maternal negative affect

Schuetze

Eiden

2007

Infant Behavior and Development

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This study examined the association between prenatal exposure to cigarettes and infant and maternal negative affect. Participants were 115 mother-infant dyads (69 prenatally exposed to cigarettes and 46 nonexposed). Infant and maternal negative affect were both assessed during the neonatal period (2-4 weeks of age) and again at 7 months of infant age. Results indicated that only prenatal exposure to cigarettes predicted infant negative affect. Infants who were prenatally exposed to more cigarettes had higher levels of negative affect at both time points. Furthermore, regression analyses indicated that both infant and maternal negative affect during the neonatal period predicted maternal negative affect at 7 months of age. These results highlight the importance of considering the reciprocal relationship between infant and maternal behavior when examining developmental outcomes among infants prenatally exposed to cigarettes.Keywords prenatal exposure to cigarettes; infant negative affect; maternal negative affect; cross-lagged panel design Prenatal exposure to cigarettes has consistently been associated with adverse perinatal outcomes (Abel, 1980;Fried & O'Connell, 1987;Fried & Oxorn, 1980;Olsen, Pereira, & Olsen, 1991). In addition, a growing body of research has documented an association between prenatal exposure to cigarettes and deficits in affective behaviors and regulation. Exposed infants have been found to show deficits in arousal and attention throughout the first year of life (Franco et al., 1999;Franco et al., 2000;Fried & Makin, 1987;Jacobson, Fein, Jacobson, Schwartz & Dowler, 1984;Picone, Allen, Olsen, & Ferris, 1982;Saxton, 1978;Schuetze & Eiden, 2006;Schuetze & Zeskind, 2001;Streissguth, Barr, & Martin, 1983). Studies have also found differences in affective behaviors among exposed infants as compared to nonexposed infants as early as the neonatal period and persisting into childhood. Specifically, studies with infants and toddlers who were prenatally exposed to cigarettes have found evidence of increased irritability (Brook, Brook & Whiteman, 2000;Jacobson et al., 1984 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Corneal, 2001;Ramsay, Bendersky, & Lewis, 1996;Schuetze & Zeskind, 2001). The extent to which these effects are due to the direct, teratological impact of prenatal exposure to cigarettes or are mediated by other maternal factors that are associated with maternal smoking is not clear. NIH Public AccessPrevious studies highlight the importance of examining both direct and indirect pathways to the development of affect among cigarette-expo...

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“…The emphasis was on brisk walking, which is popular among pregnant smokers. 62 As a further option, a home-based antenatal exercise digital versatile disc (DVD) and booklet were provided. In addition, participants were given a pedometer for monitoring their daily steps (Digi-Walker SW-200; Great Performance Ltd, London, UK).…”

Section: Methodsmentioning

confidence: 99%

The London Exercise And Pregnant smokers (LEAP) trial: a randomised controlled trial of physical activity for smoking cessation in pregnancy with an economic evaluation

Ussher

Lewis

Aveyard

et al. 2015

Health Technol Assess

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BackgroundSmoking during pregnancy is the main preventable cause of poor birth outcomes. Improved methods are needed to help women to stop smoking during pregnancy. Pregnancy provides a compelling rationale for physical activity (PA) interventions as cessation medication is contraindicated or ineffective, and an effective PA intervention could be highly cost-effective.ObjectiveTo examine the effectiveness and cost-effectiveness of a PA intervention plus standard behavioural support for smoking cessation relative to behavioural support alone for achieving smoking cessation at the end of pregnancy.DesignMulticentre, two-group, pragmatic randomised controlled trial and economic evaluation with follow-up at the end of pregnancy and 6 months postnatally. Randomisation was stratified by centre and a computer-generated sequence was used to allocate participants using a 1 : 1 ratio.Setting13 hospitals offering antenatal care in the UK.ParticipantsWomen between 10 and 24 weeks’ gestation smoking five or more cigarettes a day before pregnancy and one or more during pregnancy.InterventionsParticipants were randomised to behavioural support for smoking cessation (control) or behavioural support plus a PA intervention consisting of supervised treadmill exercise plus PA consultations. Neither participants nor researchers were blinded to treatment allocation.Main outcome measuresThe primary outcome was self-reported, continuous smoking abstinence between a quit date and end of pregnancy, validated by expired carbon monoxide and/or salivary cotinine. Secondary outcomes were maternal weight, depression, birth outcomes, withdrawal symptoms and urges to smoke. The economic evaluation investigated the costs of the PA intervention compared with the control intervention.ResultsIn total, 789 women were randomised (n = 394 PA,n = 395 control). Four were excluded post randomisation (two had been enrolled twice in sequential pregnancies and two were ineligible and randomised erroneously). The intention-to-treat analysis comprised 785 participants (n = 392 PA,n = 393 control). There was no significant difference in the rate of abstinence at the end of pregnancy between the PA group (7.7%) and the control group (6.4%) [odds ratio for PA group abstinence 1.21, 95% confidence interval (CI) 0.70 to 2.10]. For the PA group compared with the control group, there was a 33% (95% CI 14% to 56%), 28% (95% CI 7% to 52%) and 36% (95% CI 12% to 65%) significantly greater increase in self-reported minutes of moderate- and vigorous-intensity PA from baseline to 1 week, 4 weeks and 6 weeks respectively. Accelerometer data showed that there was no significant difference in PA levels between the groups. There were no significant differences between the groups for change in maternal weight, depression, withdrawal symptoms or urges to smoke. Adverse events and birth outcomes were similar between the groups except for there being significantly more caesarean births in the control group than in the PA group (28.7% vs. 21.3%;p < 0.023). The PA intervention was less costly than the control intervention by £35 per participant. This was mainly attributable to increased health-care usage in the control group. However, there was considerable statistical uncertainty around this estimate.ConclusionsDuring pregnancy, offering an intervention combining supervised exercise and PA counselling does not add to the effectiveness of behavioural support for smoking cessation. Only 10% of participants had PA levels accessed by accelerometer and it is, therefore, unclear whether or not the lack of an effect on the primary outcome is the result of insufficient increases in PA. Research is needed to identify the smoking populations most suitable for PA interventions and methods for increasing PA adherence.Trial registrationCurrent Controlled Trials ISRCTN48600346.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 84. See the NIHR Journals Library website for further project information.

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Psychosocial predictors of smoking and exercise during pregnancy

Cited by 42 publications

References 61 publications

Using Propensity Score Modeling to Minimize the Influence of Confounding Risks Related to Prenatal Tobacco Exposure

Using Propensity Score Modeling to Minimize the Influence of Confounding Risks Related to Prenatal Tobacco Exposure

The association between prenatal exposure to cigarettes and infant and maternal negative affect

The London Exercise And Pregnant smokers (LEAP) trial: a randomised controlled trial of physical activity for smoking cessation in pregnancy with an economic evaluation

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