Correlates of smoking cessation at pregnancy onset among Hispanic women in Massachusetts

PURPOSE: To examine factors associated with smoking cessation at pregnancy onset in Hispanic women. DESIGN: Cross-sectional analysis of baseline data from the prospective Latina Gestational Diabetes Mellitus Study. SETTING: Public obstetrical practices of a medical center in Massachusetts, 2000-2004. SUBJECTS: A total of 351 Hispanic (predominantly Puerto Rican) prenatal care patients who smoked in the year prior to pregnancy. MEASURES: At enrollment, interviewers collected self-reported cigarette smoking prior to and during pregnancy and sociodemographic, health, and acculturation factors. ANALYSIS: Logistic regression and backward elimination procedures were used to determine factors independently associated with quitting. RESULTS: Forty-five percent of women reported quitting smoking at pregnancy onset. In multivariate analyses, women born outside the United States, women with a family history of diabetes, and non-Puerto Rican Hispanics were 32% to 54% more likely to quit smoking. Women with high stress, women with marijuana use, and parous women were 23% to 49% less likely to quit. Women who smoked 20+ cigarettes/d in prepregnancy were less likely to quit smoking (relative risk  =  .44; 95% confidence interval .27, .65) compared with light smokers. Age, income, body mass index, language preference, prepregnancy exercise, and alcohol consumption were not associated with quitting. CONCLUSIONS: Non-U.S. birthplace, family history of diabetes, and non-Puerto Rican ethnicity were associated with quitting smoking at pregnancy onset in Hispanic women. Prepregnancy marijuana use and smoking, parity, and stress were associated with continued smoking

Correlates of high perceived stress among pregnant Hispanic women in Western Massachusetts.

Prenatal psychosocial stress has been associated with adverse pregnancy outcomes, even after controlling for known risk factors. This paper aims to evaluate correlates of high perceived stress among Hispanic women, a group with elevated rates of stress during pregnancy. We conducted this analysis among 1,426 pregnant Hispanic women using data from Proyecto Buena Salud, a prospective cohort study conducted in Western Massachusetts. Cohen\u27s Perceived Stress Scale (PSS-14) validated in English and Spanish was administered in early (mean = 12.4 weeks gestation), mid (mean = 21.3 weeks gestation) and late (mean = 30.8 weeks gestation) pregnancy at which time bilingual interviewers collected data on socio-demographic, acculturation, behavioral, and psychosocial factors. High perceived stress was defined as a PSS score \u3e30. Young maternal age (odds ratio (OR) = 0.6; 95 % confidence interval (CI) 0.4-0.9 for \u3c19 vs. 19-23 years), pre-pregnancy consumption of alcohol (OR = 2.2; 95 % CI 1.4-3.5 for \u3e12 drinks/month vs. none) and smoking (OR = 2.2; 95 % CI 1.3-3.7 for \u3e10 cigarettes/day vs. none) were associated with high perceived stress during early pregnancy. Furthermore, higher annual household income (OR = 0.4; 95 % CI 0.1-0.9 for \u3e$30,000 vs. \u3c$15,000), greater number of adults in the household (OR = 1.8; 95 % CI 1.1-3.0 for ≥3 vs. 1) and language preference (OR = 0.6; 95 % CI 0.4-0.9 for Spanish vs. English) were associated with high stress during mid-pregnancy. Likewise, annual household income was inversely associated with high stress during late pregnancy. Our results have important implications for incorporation of routine screening for psychosocial stress during prenatal visits and implementation of psychosocial counseling services for women at high risk

Dietary behaviors, physical activity, and cigarette smoking among pregnant Puerto Rican women

BACKGROUND: Few studies have examined predictors of meeting health guidelines in pregnancy among Latina women. OBJECTIVE: We assessed dietary behaviors, physical activity, and cigarette smoking in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 prenatal care patients. DESIGN: Self-reported information on lifestyle factors, demographics, medical history, and physical activity was collected by bilingual interviewers during pregnancy. Fruit/vegetable intake was determined by summing the reported consumption of specific fruit and vegetables on a food-frequency questionnaire designed for this population and then adjusted for reported total daily servings. RESULTS: Approximately 13% of women met physical activity guidelines [\u3eor=10 metabolic equivalents (MET)-h/wk], 19% met fruit/vegetable guidelines (7 servings/d), 21% of women smoked, and 1.4% consumed alcohol during pregnancy. In multivariate analyses, Spanish-language preference, an indicator of less acculturation, was associated with an approximately 40% less likelihood of both smoking [odds ratio (OR): 0.6; 95% CI: 0.4, 0.8] and meeting physical activity guidelines (OR: 0.6; 95% CI: 0.3, 1.0). College education was associated with a 2-fold greater likelihood of meeting fruit/vegetable guidelines (OR: 2.2; 95% CI: 1.1, 4.3) and a lower likelihood of smoking (OR: 0.2; 95% CI: 0.1, 0.4). A history of adverse pregnancy outcome was associated with a \u3e4-fold greater likelihood of meeting physical activity guidelines. Smoking in pregnancy was associated with a decreased likelihood of meeting the fruit/vegetable guidelines (RR: 0.5; 95% CI: 0.3, 0.9). CONCLUSION: Factors related to engagement in prenatal health behaviors should be addressed in the design of targeted intervention strategies in this underserved and rapidly growing population

Physical activity, sedentary behavior and risk of hypertensive disorders of pregnancy in Hispanic women

OBJECTIVE: Prior studies of the association between physical activity and hypertensive disordersof pregnancy have been conflicting; the majority focused on leisure-time activity only, did not usephysical activity questionnaires validated for pregnancy, and were conducted in primarily non-Hispanic white populations. METHODS: We prospectively evaluated this association among 1240 Hispanic women in Proyecto Buena Salud. The Pregnancy Physical Activity Questionnaire, validated for use in pregnancy, was used to assess pre- and early pregnancy sports/exercise, household/caregiving, occupational and transportation activity. Diagnoses of hypertensive disorders of pregnancy were based on medical record abstraction and confirmed by the study obstetrician. RESULTS: A total of 49 women (4.0%) were diagnosed with a hypertensive disorder of pregnancy, including 32 women (2.6%) with pre-eclampsia. In age-adjusted analyses, high levels of earlypregnancy household/caregiving activity were associated with reduced risk of total hypertensivedisorders (OR = 0.4, 95% CI 0.1-0.9) and pre-eclampsia (OR = 0.3, 95% CI 0.1-0.9) relative to low levels; however, these findings were no longer statistically significant in multivariable models. Pre-pregnancy activity and pattern of activity from pre- to early-pregnancy were not significantly associated with risk. Finally, sedentary behavior was not significantly associated with hypertensivedisorders. CONCLUSION: Findings from this prospective study of Hispanic women were consistent with those of prior prospective cohorts indicating that physical activity prior to and during earlypregnancy does not significantly reduce risk of hypertensive disorders of pregnancy

Predictors of excessive and inadequate gestational weight gain in Hispanic women

Factors influencing gestational weight gain are incompletely understood, particularly among Hispanic women. We assessed medical, sociodemographic, behavioral, and psychosocial predictors of overall gestational weight gain, as well as gains below, within, or above the range recommended by the Institute of Medicine (IOM) within a prospective study of 770 Hispanic (predominantly Puerto Rican) prenatal care patients at a large tertiary care facility in Western Massachusetts. One third of women gained within the recommended range, 22% gained below, and 45% gained above the range. In multivariate analysis, women in the highest category of BMI (P(trend)\u3c0.001) and parity (P(trend)\u3c0.001) gained on average 9 lbs less than those in the lowest category. Increasing time in residence in the continental United States (P(trend)\u3c0.01) as well as a number of prenatal care visits (P(trend)=0.03) were positively associated with weight gain. Overweight women (odds ratio (OR)=2.2, 95% confidence interval (CI) 1.3, 3.8) and those over age 30 years (OR=2.5, 95% CI 1.2, 5.0) were more likely to gain above the IOM range as compared to normal-weight women and those aged 20-24, respectively. Women with \u3c10 years of residence in the United States were 50% less likely to gain above the IOM range as compared to third-generation women (95% CI 0.3, 0.9). Findings identify determinants of gestational weight gain which can form the basis of targeted interventions in this rapidly growing ethnic group

Use and outcomes of venous thromboembolism prophylaxis after spinal fusion surgery

BACKGROUND: The number of spinal fusion operations in the USA is rapidly rising, but little is known about optimal venous thromboembolism prophylaxis after spinal surgery. OBJECTIVES: To examine the use of and outcomes associated with venous thromboembolism prophylaxis after spinal fusion surgery in a cohort of 244 US hospitals. PATIENTS/METHODS:  We identified all patients with a principal procedure code for spinal fusion surgery in hospitals participating in the Premier Perspective database from 2003 to 2005, and searched for receipt of pharmacologic prophylaxis (subcutaneous unfractionated heparin, low molecular weight heparin, or fondaparinux) and/or mechanical prophylaxis (compression devices and elastic stockings) within the first 7 days after surgery. We also searched for discharge diagnosis codes for venous thromboembolism and postoperative hemorrhage during the index hospitalization and within 30 days after surgery. RESULTS: Among 80,183 spinal fusions performed during the time period, cervical fusions were the most common (49.0%), followed by lumbar fusions (47.8%). Thromboembolism prophylaxis was administered to 60.6% of patients within the first week postoperatively, with the most frequent form being mechanical prophylaxis alone (47.6%). Of the 244 hospitals, 26.2% provided prophylaxis to ≥ 90% of their patients undergoing spinal fusion; however, 33.2% provided prophylaxis to fewer than 50% of their patients. The rate of diagnosed venous thromboembolism within 30 days after surgery was 0.45%, and the rate of postoperative hemorrhage was 1.1%. CONCLUSIONS:  Substantial variation exists in the use of thromboembolism prophylaxis after spinal fusion surgery in the USA. Nevertheless, overall rates of diagnosed thromboembolism after spinal fusion appear to be low. © 2011 International Society on Thrombosis and Haemostasis

Physical activity patterns during pregnancy in a diverse population of women.

BACKGROUND: Participation in physical activity during pregnancy may reduce the risk of gestational diabetes mellitus and preeclampsia and help prevent excess maternal weight gain. However, studies describing patterns and correlates of activity during pre