The aim of this study was to describe anthropometric, clinical, socio-demographic characteristics and lifestyle habits of pregnant smokers in comparison to pregnant nonsmokers. During years 1999–2003, 1,435 pregnant smokers and 4,772 pregnant nonsmokers were interviewed after delivery with a questionnaire. They were recorded clinical, anthropometric and socio-demographic data, smoking status, labor outcome, maternal and fetal hemoglobin concentrations for each patient. The two groups were comparable in anthropometric and clinical characteristics, duration of pregnancy
and mode of delivery, except for birth weights, which were significantly lower in newborns of smokers. Maternal hemoglobin concentrations were significantly lower in smokers, but fetal hemoglobin concentrations were significantly higher in babies of smokers. The proportion of pregnant women who smoked during pregnancy was higher among urban women, among women with lower educational level and among unemployed subjects in comparison with nonsmokers. The pregnant women who smoked during pregnancy were more often caffeine and alcohol consumers. To further reduce smoking during pregnancy it is important to continue to promote smoking cessation among teenagers

Ante Klobučar

Ante Radić

Damir Buković

Dinko Hauptman

Lada Šumilin

Tomislav Strinić

English

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Coll. Antropol. 29 (2005) 2: 611–614UDC 618.2:613.84(497.5)''1999/2003''Original scientific paperSocio-Demographic Characteristics andLifestyle Habits of Pregnant Women SmokersTomislav Strini}1, Damir Bukovi}2, Lada [umilin1, Ante Radi}1, Dinko Hauptman2 and Ante Klobu~ar31 Department of Obstetrics and Gynecology, University Hospital Split, Split, Croatia2 Department of Obstetrics and Gynecology, School of Medicine, University of Zagreb, Zagreb, Croatia3 Department of Obstetrics and Gynecology, School of Medicine, General Hospital »Sveti Duh«, University of Zagreb, Zagreb,CroatiaA B S T R A C TThe aim of this study was to describe anthropometric, clinical, socio-demographic characteristics and lifestyle hab-its of pregnant smokers in comparison to pregnant nonsmokers. During years 1999–2003, 1,435 pregnant smokers and4,772 pregnant nonsmokers were interviewed after delivery with a questionnaire. They were recorded clinical, anthro-pometric and socio-demographic data, smoking status, labor outcome, maternal and fetal hemoglobin concentrationsfor each patient. The two groups were comparable in anthropometric and clinical characteristics, duration of preg-nancy and mode of delivery, except for birth weights, which were significantly lower in newborns of smokers. Maternalhemoglobin concentrations were significantly lower in smokers, but fetal hemoglobin concentrations were significantlyhigher in babies of smokers. The proportion of pregnant women who smoked during pregnancy was higher among ur-ban women, among women with lower educational level and among unemployed subjects in comparison with non-smokers. The pregnant women who smoked during pregnancy were more often caffeine and alcohol consumers. To fur-ther reduce smoking during pregnancy it is important to continue to promote smoking cessation among teenagers.Key words: lifestyle habits, pregnant women, smokers, antropometry, socio-demographic characteristicsIntroductionIn the industrialized countries smoking tobacco isthe single most important preventable risk factor fordisease and death. Excess morbidity and excess mortal-ity as a result of smoking have been documented forabout forty different diseases1. The effects of cigarettesmoking on pregnancy are well documented. When apregnant woman smokes she exposes her fetus to a formof passive smoking. The effect of smoking on birth-weight was reported first by Simpson in 19572. Childrenof smokers weigh 250–350 grams less than children ofnon smokers3–6. Smoking also increases the risk of blee-ding during pregnancy, spontaneous abortion, pretermbirth, fetal growth retardation, perinatal death andsudden infant death3–10. Furthermore, smoking duringpregnancy has been associated with intellectual and de-velopmental impairment in childhood6–9.The goal of this study was to determine associationsocio-demographic characteristics and lifestyle habitswith smoking in pregnancy.Subjects and MethodsThis prospective study was conducted at Departmentof Obstetrics and Gynecology, Clinical Hospital in Split,Croatia, between March 1999 and October 2003. Thehospital ethics committee approved the protocol, and in-formed consent was obtained from all women. We testedwomen after delivery and they were selected randomly.Excluded were multiple pregnancies, preeclampsia, ma-ternal diabetes or other chronic disease, newborns withmalformations, Rh isoimmunization, women with incor-rect gestational age and labours longer than 24 hours.All mothers were routinely recommended to take irontablets as prophylaxis. The study subjects made up twosubgroups after delivery; in the first were smokers, andin the second were nonsmokers. All of the smokingmothers who had stopped smoking before pregnancywere analyzed together with nonsmoking mothers. Thewomen were classified as smokers if they smoked one ormore cigarettes daily during pregnancy.611Received for publication August 28, 2005The pregnant women who stopped smoking duringpregnancy were not elaborated. All women were inter-viewed with questionnaire, and blood samples weretaken for determination fetal and maternal hemoglobinconcentrations. This questionnaire provided informationon the woman's age, height, woman's weight recordedlate in pregnancy, obstetric history, alcohol and caffeineintake during pregnancy, smoking habits, marital sta-tus, education and employment status. Gestational agewas calculated from the last menstrual period and con-firmed by ultrasonographic assessment before 12 weeksgestation. Civil status was classified into two groups:women who reported to be married to or cohabitant withthe father, and women who were single. The question-naire was completed by 6,207 (98%) of the 6,346 womeninvited to participate in this investigation. There were1,435 smokers and 4,772 nonsmokers. Blood for hemoglo-bin was collected as capillary samples from mothers andneonates after delivery, and measured by cyanmethe-moglobin method.Mean values were expressed as arithmetic mean (X)and scatter as standard deviation (SD). For compari-sons of metric or categorical variables between two sub-groups Student t test or 2 test was used. In single vari-able comparisons the p values less than 0.05 wereconsidered statistically significant.ResultsTable 1 shows the characteristics of the study popu-lation. The smokers were anthropometricaly matched tothe nonsmokers, and the differences in the number ofparity between both subgroups were not observed. Du-ration of pregnancy between smokers and nonsmokerswas similar. Maternal hemoglobin concentrations weresignificantly lower in smokers (118±19 g/L) in compari-son to nonsmokers (129±21 g/L, p<0.05). On the otherhand, fetal hemoglobin concentrations were significant-ly higher in newborns of smokers (147±26 g/L) com-pared to neonates of nonsmokers (136 ± 26 g/L, p<0.05).Birth weights were significantly lower in newborns ofwomen who smoked (3209±445 g) compared to babies ofnonsmokers (3474±765 g, p<0.05). Smoking was foundto give a mean reduction of 265 g in estimated birth-weight among babies to women smoking. There werenot observed the differences in duration of pregnancyand mode of delivery between smokers and nonsmokers.In Table 2 are given socio-demographic and lifestylecharacteristics for smoking and non-smoking mothers.The proportion of pregnant women who smoked duringpregnancy was higher among urban people (p<0.01),among women with low educational level (p<0.01) andamong unemployed subjects (p<0.01) compared withnonsmokers. The nonsmokers were more often rural fe-male inhabitants (p<0.01), more often with high leveleducation (p<0.01) and more often they were employed(p<0.01) than smokers. Table 2 shows that smokerswere more often alcohol and caffeine consumers (p<0.01)compared with nonsmokers.DiscussionSmoking during pregnancy has a well documentednegative effect on fetal growth and has been related toother adverse pregnancy outcomes. However, possibleinteractions between smoking and other risk factorshave not been well studied. Since the 1970s the propor-tion of smoking mothers has fallen in most Scandina-vian countries11. In 1989 The Norwegian Cancer Societylaunched a national campaign against smoking duringpregnancy12. Eriksson et al. found an overall reductionin the proportion of pregnant smokers in Norway from34% in 1987 to 22% in 199413. In 1993, however, 20% ofmothers in Sweden were still smoking at the start oftheir pregnancy11. In Croatia, we have seen no suchcampaigns14,15. Most authors found that smoking is as-sociated with lower birthweight2–6, and our findings areconsistent. There is a clear dose-response associationT. Strini} et al.: Pregnant Smokers and Lifestyle Habits, Coll. Antropol. 29 (2005) 2: 611–614612TABLE 1CLINICAL AND ANTHROPOMETRIC CHARACTERISTICS OF PREGNANT SMOKERS AND PREGNANT NONSMOKERSSmokersN=435NonsmokersN=4772pAge (years, X±SD) 26.7±7.2 27.3±8.4 ns**Height (cm, X±SD) 166±6.7 165±6.9 ns**Weight (kg, X±SD) 73.8±11.2 75.1±10.6 ns**Parity (X±SD) 2.2±0.9 2.3±0.9 ns*Duration of pregnancy (days, X±SD) 261±27 266±25 ns*Maternal hemoglobin (g/L, X±SD) 118±19 129±21 <0.05*Fetal hemoglobin (g/L, X±SD) 147±26 136±26 <0.05*Birthweight (g, X±SD) 3209±445 3474±765 <0.05*Mode of deliveryVaginal (%) 82 86 ns*Abdominal (%) 18 14 ns** 2-test, **t-testbetween smoking and birthweight. It is uncertain whe-ther smoking interacts with hematologic parameters inpregnancy. We observed the significantly lower concen-tration of maternal hemoglobin in smokers comparedwith nonsmokers, but the significantly higher hemoglo-bin concentrations in newborns of smokers comparedwith neonates of women who not smoke. Our findingsare similar to data of a few investigators9,16. However,others have found no interaction between maternal orfetal hemoglobin levels and smoking17. Also, we foundthat smoking among pregnant women was associatedwith residence, education, employment status, alcoholand caffeine intake. This is in accordance with findingsfrom other studies on the determinants of smoking inpregnancy2–6,10–13. Especially, in a meta-analysis of 26published studies, Patrick and coworkers found a sameresults18. The association between smoking and caffeineintake has often been explained from a social point ofview as coffee drinking and smoking provide an oppor-tunity to relax.The results from the present study might be an extraargument to advise pregnant women not to smoke or toquit smoking during pregnancy. Pregnancy has been re-garded, with good reason, as a golden opportunity forgiving up smoking. A large proportion of women stopsmoking or cut down their cigarette consumption at thestart of pregnancy, but the majority continue to smokedespite a high motivation to give up. In preventivehealth care, high priority has been attached to gettingwomen to stop smoking during pregnancy. Norwegianstudy of smoking women showed that a large proportionof women wished for more information and greater per-sonal involvement from doctors and midwives on thesubject12. The importance of involving the woman's par-tner in advice on smoking has also been stressed11.In conclusion, this data may be relevant for publichealth services to reduce smoking among pregnant wo-men. Simultaneously, health personnel such as generalpractitioners, midwives and obstetricians have madegreat efforts to inform pregnant women about the nega-tive effects of smoking on maternal and fetal health andabout the benefits of quitting smoking. To further re-duce smoking during pregnancy it is important to con-tinue to promote smoking cessation among teenagers.R E F E R E N C E S1. SECKER-WALKER, R. H., L. J. SOLOMON, B. S. FLYNN, J. M.SKELLY, S. S. LEPAGE, G. D. GOODWIN, Am. J. Obstet. Gynecol., 171(1994) 1347. — 2. SIMPSON, W. J., Am. J. Obstet. Gynecol., 73 (1957)808. — 3. LI, C. Q., R. A. WINDSOR, L. PERKINS, R. L. GOLDEN-BERG, J. B. LOWE, J. A. M. A., 269 (1993) 1519. — 4. WEN, S. W., R. L.GOLDENBERG, G. R. CUTTER, H. J. HOFFMAN, S. P. CLIVER, R. O.DAVIS, Am. J. Obstet. Gynecol., 162 (1990) 53. — 5. STEYN, D. W., H. J.ODENDAAL, Lancet, 350 (1997) 1267. — 6. JAUNIAUX, E., G. J. BUR-TON, Obstet. Gynecol., 79 (1992) 645. — 7. CHELMOW, D., D. E. AN-DREW, E. R. BAKER, Obstet. Gynecol., 87 (1996) 703. — 8. JAZAYERI,A., J. C. TSIBRIS, W. N. SPELLACY, Obstet. Gynecol., 92 (1998) 61. —9. YERUCHIMOVICH, M., S. DOLLBERG, D. GREEN, F. B. MIMOU-T. Strini} et al.: Pregnant Smokers and Lifestyle Habits, Coll. Antropol. 29 (2005) 2: 611–614613TABLE 2SOCIODEMOGRAPHIC CHARACTERISTICS AND LIFESTYLE HABITS AMONG PREGNANT SMOKERS AND PREGNANT NONSMOKERSSmokers(N=1435)Nonsmokers(N=4772)p*Urban (%) 82 64 <0.01Rural (%) 18 36 <0.01Educational level (%)Low 27 19 <0.01Medium 52 46 nsHigh 21 35 <0.01Marital status (%)married-cohabiting 97 98 nssingle 3 2 nsEmployment status (%)Working 44 57 <0.01Unemployed 48 34 <0.01Student 8 9 nsAlcohol intake (%)Yes 22 9 <0.01No 78 91 <0.05Caffeine intake (%)Yes 99 76 <0.01No 1 24 <0.001*2-testNI, Obstet. Gynecol., 93 (1999) 403. — 10. WISBORG, K., T. B. HENRI-KSEN, M. HEDEGAARD, N. J. SECHER, Br. J. Obstet. Gynaecol., 103(1996) 800. — 11. HAKANSSON, A., L. LENDAHLS, C. PETERSSON,Acta Obstet. Gynecol. Scand., 78 (1999) 217. — 12. WISBORG, K., T. B.HENRIKSEN, M. HEDEGAARD, N. J. SECHER, Acta Obstet. Gynecol.Scand., 77 (1998) 836. — 13. ERIKSSON, M. K., A. K. SALVESEN, K.HAUG, H. S. EIK-NES, Acta Obstet. Gynecol. Scand., 75 (1996) 355. —14. STRINI], T., D. BUKOVI], D. KARELOVI], A. DESPOT, N. BU-KOVI], E. GIUDICI, H. SILOVSKI, Coll. Antropol., 26 (2002) 245. —15. STRINI], T., D. BUKOVI], I. BILONI], I. HIR[, A. DESPOT, A.BO]AN, Coll. Antropol., 27 (2003) 55. — 16. GRUSLIN, A., S. L. PER-KINS, R. MANCHANDA, N. FLEMING, J. J. CLINCH, Obstet. Gyne-col., 95 (2000) 561. — 17. ZAREN, B., G. LINDMARK, P. BERGSJO,Acta Obstet. Gynecol. Scand., 76 (1997) 933. — 18. PATRICK, D. L., A.CHEADLE, D.C. THOMPSON, P. DIEHR, T. KOEPSELL, S. KINNE.Am. J. Public Health, 84 (1994) 1086.T. Strini} et al.: Pregnant Smokers and Lifestyle Habits, Coll. Antropol. 29 (2005) 2: 611–614614T. Strini}Department of Obstetrics and Gynecology, University Hospital Split, Spin~i}eva 1, 21000 Split, CroatiaSOCIODEMOGRAFSKE KARAKTERISTIKE I @IVOTNE NAVIKE TRUDNICA PU[A^ICAS A @ E T A KCilj rada bio je utvrditi antropometrijske, klini~ke, sociodemografske karakteristike i `ivotne navike trudnicapu{a~ica i usporediti ih s trudnicama nepu{a~icama. Izme|u 1999–2003 godine upitnikom je intervjuirano 1,435trudnica pu{a~ica i 4,772 trudnica nepu{a~ica. Zabilje`eni su klini~ki, antropometrijski i sociodemografski podaci,podaci o pu{enju, ishodu poroda i odre|ivana je koncentracija hemoglobina majkama i novoro|en~adi. Obje skupinebile su sli~ne u antropometrijskim i klini~kim zna~ajkama, trajanju trudno}e i na~inu poroda. Porodna te`ina novo-ro|en~adi pu{a~ica bila je zna~ajno manja, ni`a i koncentracija hemoglobina u majki pu{a~ica, ali koncentracija fetal-nog hemoglobina bila je zna~ajno vi{a u novoro|en~adi pu{a~ica. Broj pu{a~ica trudnica bio je zna~ajno vi{i me|ugradskim `enama, onima s ni`om razinom obrazovanja i me|u nezaposlenima. Tako|er, trudnice pu{a~ice zna~ajno~e{}e su u`ivale kavu i alkohol. Za daljnje smanjenje pu{enja u trudno}i va`no je nastaviti promovirati prestanakpu{enja me|u maloljetnicama.

Socio-Demographic Characteristics and Lifestyle Habits of Pregnant Women Smokers

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