Lopez William D, Konrath Sara H, Seng Julia S
Research Center for Group Dynamics, Institute for Social Research, University of Michigan, 6134, 426 Thomson Street, Ann Arbor, MI 48106, USA.
J Obstet Gynecol Neonatal Nurs. 2011 Jul-Aug;40(4):422-31. doi: 10.1111/j.1552-6909.2011.01261.x. Epub 2011 Jun 3.
To examine the relationship between trauma history, posttraumatic stress disorder (PTSD), coping, and smoking in a diverse sample of pregnant women, some of whom are active smokers.
Secondary analysis from a prospective study on PTSD and pregnancy outcomes.
Maternity clinics at three health systems in the midwestern United States.
Women age 18 or older (1,547) interviewed at gestational age fewer than 28 weeks.
Participants were classified at nonsmokers, quitters (stopped smoking during pregnancy), and pregnancy smokers. Demographic, trauma, and pregnancy factors, substance use, and use of tobacco to cope were compared across groups. Logistic regression assessed the influence of these factors on being a smoker versus a nonsmoker and a quitter versus a pregnancy smoker.
Smokers differed from nonsmokers on all demographic risk factors (being African American, being pregnant as a teen, having lower income and less education, and living in high-crime areas), had higher rates of current and lifetime PTSD, and were more likely to report abuse as their worst trauma. Pregnancy smokers had lower levels of education, were more likely to classify their worst trauma as "extremely troubling," and were more likely to exhibit PTSD hyperarousal symptoms. In regression models, smoking "to cope with emotions and problems" doubled the odds of continuing to smoke while pregnant even after accounting for several relevant risk factors.
Smoking behavior in pregnancy may be influenced by the need to cope with abuse-related PTSD symptoms. Clinicians should consider using trauma-informed interventions when working with tobacco-using pregnant women.
在不同的孕妇样本中研究创伤史、创伤后应激障碍（PTSD）、应对方式与吸烟之间的关系，其中一些孕妇为现吸烟者。
对一项关于PTSD与妊娠结局的前瞻性研究进行二次分析。
美国中西部三个医疗系统的妇产科诊所。
年龄在18岁及以上的女性（1547名），在孕28周前接受访谈。
将参与者分为非吸烟者、戒烟者（孕期戒烟）和孕期吸烟者。对各组的人口统计学、创伤和妊娠因素、物质使用情况以及用吸烟来应对的情况进行比较。逻辑回归分析评估这些因素对成为吸烟者与非吸烟者以及戒烟者与孕期吸烟者的影响。
吸烟者与非吸烟者在所有人口统计学风险因素上存在差异（非裔美国人、青少年怀孕、收入较低、受教育程度较低以及生活在高犯罪率地区），当前和终生患PTSD的比例更高，并且更有可能将虐待报告为最严重的创伤。孕期吸烟者受教育程度较低，更有可能将其最严重的创伤归类为“极其困扰”，并且更有可能表现出PTSD的过度觉醒症状。在回归模型中，“为应对情绪和问题”而吸烟使孕期继续吸烟的几率增加了一倍，即使在考虑了几个相关风险因素之后也是如此。
孕期吸烟行为可能受到应对与虐待相关的PTSD症状需求的影响。临床医生在为吸烟的孕妇提供治疗时应考虑采用具有创伤知情理念的干预措施。
