Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I, Room 3806, Ann Arbor, MI, 48109-2029, USA.
Department of Nutritional Sciences, University of Michigan, Ann Arbor, USA.
Reprod Health. 2018 May 2;15(1):72. doi: 10.1186/s12978-018-0516-5.
In India, tobacco use during pregnancy is not routinely addressed during antenatal care. We measured the association between tobacco use and anemia in low-income pregnant women, and identified ways to integrate tobacco cessation into existing antenatal care at primary health centers.
We conducted an observational study using structured interviews with antenatal care clinic patients (n = 100) about tobacco use, anemia, and risk factors such as consumption of iron rich foods and food insecurity. We performed blood tests for serum cotinine, hemoglobin and ferritin. We conducted in-depth interviews with physicians (n = 5) and auxiliary nurse midwives (n = 5), and focus groups with community health workers (n = 65) to better understand tobacco and anemia control services offered during antenatal care.
We found that 16% of patients used tobacco, 72% were anemic, 41% had iron deficiency anemia (IDA) and 29% were food insecure. Regression analysis showed that tobacco use (OR = 14.3; 95%CI = 2.6, 77.9) and consumption of green leafy vegetables (OR = 0.6; 95%CI = 0.4, 0.9) were independently associated with IDA, and tobacco use was not associated with consumption of iron-rich foods or household food insecurity. Clinics had a system for screening, treatment and follow-up care for anemic and iron-deficient antenatal patients, but not for tobacco use. Clinicians and community health workers were interested in integrating tobacco screening and cessation services with current maternal care services such as anemia control. Tobacco users wanted help to quit.
It would be worthwhile to assess the feasibility of integrating antenatal tobacco screening and cessation services with antenatal care services for anemia control, such as screening and guidance during clinic visits and cessation support during home visits.
在印度，产前护理期间通常不会处理孕妇的吸烟问题。我们评估了吸烟与低收入孕妇贫血之间的关联，并确定了在初级保健中心将戒烟纳入现有产前护理的方法。
我们对产前护理诊所的患者（n=100）进行了一项观察性研究，采用结构化访谈的方式了解他们的吸烟、贫血情况以及铁元素丰富的食物摄入和食物不安全等风险因素。我们进行了血清可替宁、血红蛋白和铁蛋白的血液检测。我们对医生（n=5）和辅助护士助产士（n=5）进行了深入访谈，并对社区卫生工作者（n=65）进行了焦点小组讨论，以更好地了解产前护理期间提供的烟草和贫血控制服务。
我们发现 16%的患者吸烟，72%的患者贫血，41%的患者缺铁性贫血（IDA），29%的患者食物不安全。回归分析表明，吸烟（OR=14.3；95%CI=2.6，77.9）和绿叶蔬菜的摄入（OR=0.6；95%CI=0.4，0.9）与 IDA 独立相关，吸烟与摄入富含铁的食物或家庭食物不安全无关。诊所具有筛查、治疗和随访贫血和铁缺乏症孕妇的系统，但没有筛查吸烟的系统。临床医生和社区卫生工作者有兴趣将烟草筛查和戒烟服务与当前的孕产妇保健服务（如诊所就诊时的筛查和指导以及家访时的戒烟支持）相结合。吸烟者希望获得帮助以戒烟。
评估将产前烟草筛查和戒烟服务与贫血控制的产前护理服务相结合的可行性，如在就诊期间进行筛查和指导，以及在家访期间提供戒烟支持，可能是值得的。
