The smoking behaviour of a randomly selected group of pregnant Maltese females attending the Antenatal clinic at Karin Grech Hospital, Malta was studied during the first four months of 1988. The group was also screened with regard to educational attainment, occupation and attitudes to smoking. It was found out that 45.4%, used to smoke before getting pregnant while 22.6% still smoked during their current pregnancy. The reasons for and the duration of the smoking habit are among the findings that are discussed.peer-reviewe

Bonnici, Dorianne

Cacciottolo, Joseph M.

Serracino-Inglott, Anthony

English

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......., · , I\\altt'-sc I\\c(\ical Jourllal 37 volUIlH' I Issuc 11 1~)H9 Smoking Behaviour in Pregnant Maltese Females \)oricllllJ(' BOllnici, Josepl) CC:lcciottolo and Alltl10ny Serracino Inglott ABSTRACT The smoking behaviour of a randomly selected group of pregnant Maltese females attending the Antenatal clinic at Karin Grech Hospital, Malta was studied during the first four months of 1988. The group was also screened with regard to educational attainment, occupation and attitudes to smoking. It was found out that 45.4')1, used to smoke before getting pregnant while 22.6% still smoked during their current pregnancy. The reasons for and the duration of the smoking habit are among the findings that are discussed. INTRODUCTION Over 30 years ago, the first reports discussing the hazards of smoking in pregnancy were published. I More recently there were firm indications that even moderate smoking causes low birthweight. Maternal smoking during pregnancy gives rise to retarded fetal growth, resulting in an average weight 200g less than that of children born to non-smoking mothers. This weight deficiency is related to the number of cigarettes smoked during pregnancy rather than to the number of cigarettes smoked before pregnancy began. > :I There may also be an increased risk of congenital malform­ations in those children whose mothers smoke during pregnancy. When the pregnant mother smokes, the risk of perinatal death increases by 28'1b. Children whose mother smoked during pregnancy have been shown to lag behind non-exposed children both with regard to intellectual developQ1ent as well as general physical health. 4 The smoking habit is quit~ widespread among the younger age-groups of Maltese females, as has been shown through a national population survey. "The aim ofthis study was to investigate the prevalence of smoking among pregnant females, past smoking habits and the age at which such individuals started to smoke. METHOD In order to study smoking behaviour in pregnant Maltese females, an observational study was set up and screening was held at the Antenatal clinic, Karin Grech Hospital, Malta. New cases visit the clinic daily in order to be registered, assessed and referred for later visits to either their own general practitioner or the polyclinic closest to their home. Therefore, this eliminated the possib­ility of screening the same patient repeat­ RESULTS edly. The average number of pregnant The age ranges for the pregnant individualswomen attending the clinic for the first time surveyed varied from 14 to 44 years. Thefrom Monday to Friday was around 20 per mean age was 28.3 years. The highestday. number of individuals were in the 25 - 29 year category. (38.7%, n=70) (table 1). This The first four months of the year 1988 were tallies precisely with the national rates chosen. From each month, a single week where the rate has been the same for the was randomly selected so as to obtain a past four years. 6 In all, 22.6% (n=41) sample from each month; then from each continued to smoke during their current week, 3 days were randomly selected so as to pregnancy, of which 16.0% (n=29) were recruit a sample size of approximately 200 regular smokers while 6.6% (n= 12) admitted individuals. Random sampling was done by to smoking occasionally. The rest (77.4% a simple mechanical device and the n=140) stated that they had never smoked following weekdays were selected from the during their current pregnancy. (table 2). Smoking Behaviour in Pregnant Maltese Females TABLES Age ranges in yea rs < 15 15-19 20-24 25-29 30-34 Clfi-39 40-44 Total n 1 7 :,:, 70 50 17 :l Ltll 171 ) 0.5 3.9 18.2 38.7 27.6 9.4 1.7 LOO Table 1 - NUMBER OF INDIVIDUALS SURVEYED BY AGE-GROUPS (Pt)Smoking behaviour n Regular smokers 16.0 29 Occasional smokers 6.6 12 Non-smokers 77.4 140 Table 2 - SMOKING PA'ITERN DURING CURRENT PREGNANCY respective months: January 19, 21, 22, Department ofPharmacy, February 9, 10, 11, March 15, 16, 18 and University ofMalta. April 19, 21,22. Dorianne Bonnici Pharmacy Student Anthony Serracino Inglott B.Pharm., Ph.D., Assoc.Prof.All the 181 pregnant females who visited the clinic on the randomly selected days were interviewed. Before embarking on the St. Luke's Hospitalactual survey, a small pilot study involving Joseph Cacciottolo22 persons was carried out in order to test and refine the questionnaire and screening M.D., M.R.C.P(U.K.), M.R.C.S. methods. Consultant Physician Maltese Me<iical./(lllrJlaI40 VolulIle I Issuc II IDHD Of the individuals who did not smoke during their current pregnancy, 45.4 'Vr, (n=64) admitted that they used to smoke: 27.0% (n=38) on a regular basis while 18.4% (n=26) occasionally. (table 3). In fact, 62.5.'!{, (n=40) stopped long before they knew they were pregnant while 37.5% (n=24) stopped on discovering that they were pregnant. Various reasons for smoking were put forward . The main ones were relaxation, enjoymen t, stress and weight reduction. The majority (46.3%, n=19) claimed that they -smoked mainly as a response to stressful situations. (table 4). Table 5 shows that initiation of smoking most commonly started in the teenage years. A large percentage of females surveyed had in fact attempted to quit smoking (63.4%, n=26). Smoking behaviour Regular smokers Occasional smokers Non-smokers still smoked during their current pregnancy had not succeeded to stop for a variety of reasons, among them lack of will power but also perhaps because their partner also smoked. In fact overall, only about 35% of the spouses were non-smokers. A large amount of females start smoking between the ages of 15 - 19 years and this trend towards early initiation of smoking may have a significant impact on the future health of such females as many ofthe health risks associated with smoking increase with earlier onset of smoking and therefore duration of the smoking habit. There is strong evidence in this study that females use what they term the sedative effect of smoking as almost 50% of the individuals claim that they smoke in order to control stress or as a response to it. It has (x ) n 27.0 :l8 18.4 26 54.6 76 Table 3 - SMOKING PATTERN OF THE NON-SMOKING GROUP BEFORE CURRENT PREGNANCY Declared reason % n Relaxation 19.5 8 Enjoyment 31.7 13 To control stress 46.::; 19 To reduce weight 2.5 Table 4 - REASONS FOR SMOKING DURING PREGNANCY Age ranges Smokers 	 Ex-Smokers lll) 10 ­ 14 39. 0 15 ­ 19 fl1.2 20 - 24 4.9 25 - 29 4.9 n (,l;f) n 16 10.9 7 21 57.8 37 2 23.5 15 2 7.8 5 Table 5 - AGE RANGES FOR INITIATION OF THE SMOKING HABIT FOR THE DECLARED SMOKERS AMONG THE INDIVIDUALS SURVEYED (IRRESPECTIVE OF WHETHER THEY HAD STOPPED SMOKING OR NOT). DISCUSSION The above results give information about the smoking behaviour in pregnant Maltese female. The percentage ofmaternal smoking in the study was 22.65% (n=41) and it is reasonable to assume that the smoking characteristic would remain the same even after the mother would have given birth. The number of individuals who stated that they had tried to quit (63.4%, n=26) suggest that they must know about the adverse effects of smoking and they do accept the fact that smoking is a health hazard not only to themselves but also to their developing fetus. Those individuals who also been stated by many individuals surveyed that anxiety and stress were induced by the different roles they had to assume, such as that of a wife, mother, housekeeper and at times that of a working woman. Intrafamily, "in-law" tensions and lack of privacy were also some ofthe reasons that were informally mentioned during the interview. It seems that pregnant Maltese smokers are generally aware of the ill-effects of smoking especially during pregnancy and this study supports this view i.e. 37.5% (n=24) of females did actually stop smoking on discovering they were pregnant while a much higher percentage attempted to stop. (63.4%, n=26). The role of family physicians, obstetricians and nurses is crucial if the prevalence of smoking during pregnancy is to be reduced. Their explicit advice based on scientific evidence is usually heeded by the pregnant woman who places her trust in them, while practical help should also be offered when appropriate in order to reinforce any attempt to stop smoking. Emphasis should be made repeatedly so that women stop smoking as soon after conception as possible, not only for the future well-being of their offspring but also in order that they may safeguard their own health. The authors are grateful for the secretarial assistance provided by Miss I Mulvaney and for the co-operation shown by the staff at the Antenatal clinic, Karin Grech Hospital. REFERENCES l. Simpson W.J . A preliminary report on cigarette smoking and the incidence of prematurity. Am J Obst Gynecol 1957 ; n 808-815. 2. Dougherty CRS, Jones AD. The deter­minants of birthweight. Am J Obstet Gynecol 1982; 144; 190-199. 3. World Health Organisation. Controlling the smoking epidemic; Technical Report Series 636, WHO Geneva 1979; 23-25. 4. Elwood PC, 	Sweetnam PM, Gray OP, Davies DP, Wood PDP. Growth of children from 0-5 years: with special reference to mother's smoking in preg­nancy. Annals of Human Biology 1987; 14: 543-557. 5. Cacciottolo J.M. Tobacco smoking in Malta; A major hazard to the well being of the community. Health Promotion Newsletter, Health Education Unit, Malta 1988; 3: 5. 6. Demographic Review of the Maltese Islands 1987. Central Office of Statif'­tics, Malta, 1988 . The copyright of this article belongs to the Editorial Board of the Malta Medical Journal. The Malta Medical Journal’s rights in respect of this work are as defined by the Copyright Act (Chapter 415) of the Laws of Malta or as modified by any successive legislation. Users may access this full-text article and can make use of the information contained in accordance with the Copyright Act provided that the author must be properly acknowledged.  Further distribution or reproduction in any format is prohibited without the prior permission of the copyright holder. This article has been reproduced with the authorization of the editor of the Malta Medical Journal (Ref. No 000001)  

A preliminary report on cigarette smoking and the incidence of prematurity.

Demographic Review of the Maltese Islands 1987. Central Office of Statif' tics,

Growth of children from 0-5 years: with special reference to mother's smoking in preg nancy. Annals of Human Biology

The deter minants of birthweight.

Tobacco smoking in Malta; A major hazard to the well being of the community. Health Promotion Newsletter, Health Education Unit,

World Health Organisation. Controlling the smoking epidemic;

Smoking behaviour in pregnant Maltese females

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Smoking behaviour in pregnant Maltese females

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