Rigotti Nancy A, Park Elyse R, Chang Yuchiao, Regan Susan
Tobacco Research & Treatment Center, Department of Medicine, and Institute for Health Policy, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Obstet Gynecol. 2008 Feb;111(2 Pt 1):348-55. doi: 10.1097/01.AOG.0000297305.54455.2e.
To assess how often pregnant and postpartum smokers use medications and how often obstetric providers recommend them.
We analyzed end-of-pregnancy and 3-month postpartum surveys of 296 pregnant smokers enrolled in a randomized controlled trial of telephone counseling for smoking cessation that did not include medication. Patients were asked whether any obstetric provider discussed cessation medication and whether they had used medication.
At end of pregnancy, 29.3% of respondents reported discussing a cessation medication with their obstetric providers, more often nicotine replacement (26.5%) than bupropion (12.2%) (P=.001). Ten percent of trial respondents used a medication while pregnant (7.4% nicotine replacement, 3.4% bupropion, P=.023). Obstetricians discussed medication with 29.4% of smokers at the postpartum visit; 14.3% of postpartum smokers used medication. Contrary to guidelines, women who smoked more cigarettes per day or had already tried quitting during pregnancy were not more likely to use medication or to discuss medication with their provider. Medication use was associated with older age, more education, living with a partner, a previous birth, having an obstetric provider who discussed medication, and having private health insurance in a state whose Medicaid program did not cover cessation medications (all P<.05).
Pregnant women are more reluctant to use cessation medications than clinical guidelines recommend. More pregnant smokers might use cessation medications if their obstetricians discussed them routinely and if health insurance covered their cost.
II.
评估孕期及产后吸烟者使用戒烟药物的频率以及产科医护人员推荐使用这些药物的频率。
我们分析了296名参与一项不包括药物治疗的戒烟电话咨询随机对照试验的孕期吸烟者在妊娠末期和产后3个月的调查情况。询问患者是否有产科医护人员讨论过戒烟药物以及他们是否使用过药物。
在妊娠末期，29.3%的受访者报告与产科医护人员讨论过戒烟药物，其中使用尼古丁替代疗法的比例（26.5%）高于安非他酮（12.2%）（P = 0.001）。10%的试验受访者在孕期使用过药物（7.4%使用尼古丁替代疗法，3.4%使用安非他酮，P = 0.023）。产科医生在产后访视时与29.4%的吸烟者讨论过药物；14.3%的产后吸烟者使用过药物。与指南相悖的是，每天吸烟更多或在孕期已经尝试过戒烟的女性使用药物或与医护人员讨论药物的可能性并不更高。药物使用与年龄较大、受教育程度较高、与伴侣同住、有过生育史、有讨论过药物的产科医护人员以及在医疗补助计划不涵盖戒烟药物的州拥有私人健康保险相关（所有P < 0.05）。
孕妇使用戒烟药物的意愿低于临床指南的推荐。如果产科医生常规讨论戒烟药物且健康保险涵盖其费用，可能会有更多孕期吸烟者使用戒烟药物。
II级。
