Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
S Afr Med J. 2020 Oct 28;110(11):1100-1104. doi: 10.7196/SAMJ.2020.v110i11.14667.
Although women are informed about the dangers of drinking and smoking during pregnancy when they book for antenatal care, it is uncertain whether this advice is accepted, or whether attempts are made to apply it in subsequent pregnancies.
To assess how pregnant women respond to the advice to refrain from smoking and drinking during pregnancy in subsequent pregnancies.
Research staff were trained to obtain accurate prospective information on smoking and drinking during pregnancy in a prospective study, using well-standardised methods. Care was taken to inform participants about the dangers of smoking and drinking during pregnancy. They were also given pamphlets on these dangers in their own language and a list of telephone numbers where they could find help to quit should they need it. This information was repeated at subsequent study visits (ranging from 1 to 3, depending on the gestational age at which they enrolled). Gestational age was determined by early ultrasound. Z-scores of birthweight for gestational age were determined according to the INTERGROWTH-21st study. Pregnancy outcomes of women who enrolled twice (n=888) or three times (n=77) in the Safe Passage Study were compared with those of women in the first enrolment (n=889).
The proportion of drinkers did not change significantly (p=0.058) from the first to the second and third enrolments (63.8%, 59.0% and 54.6%, respectively). A similar trend was found for smokers (73.3%, 72.2% and 68.4%, respectively). Cannabis use was reported by 15.1%, 9.7% and 12.0% (p<0.005) of women, respectively, and use of methamphetamine by 10.1%, 6.6% and 12.7% (p<0.005). There was an increase in the rate of preterm births from 15.5% to 17.5% and 24.7%, respectively, but the increase was not significant. Although mean birthweight was lower in the third enrolment compared with the second, the difference was not significant. The z-score of birthweight for gestational age was significantly lower in the second enrolment compared with the first.
Detailed information on the adverse effects of smoking and drinking during pregnancy was not effective in the population studied. Other methods to reduce or stop these toxic exposures should therefore be investigated. A short inter-pregnancy interval, as demonstrated by three enrolments in 7.5 years, is associated with preterm labour and fetal growth restriction, and is probably indicative of the role played by confounders such as poor socioeconomic conditions and drug exposure during pregnancy.
尽管女性在预约产前护理时被告知怀孕期间饮酒和吸烟的危害，但尚不确定她们是否接受了这一建议，或者是否试图在后续妊娠中应用这一建议。
评估孕妇在后续妊娠中对怀孕期间戒烟和戒酒的建议的反应。
研究人员接受了培训，以便使用经过良好标准化的方法，在一项前瞻性研究中准确获取怀孕期间吸烟和饮酒的前瞻性信息。我们非常注意告知参与者吸烟和饮酒在怀孕期间的危害。还向他们提供了有关这些危害的小册子，以及他们可以在需要时寻求帮助戒烟的电话号码。这些信息在随后的研究访问中重复（范围从 1 到 3 次，具体取决于他们入组时的孕龄）。孕龄通过早期超声确定。根据 INTERGROWTH-21 研究，确定了按胎龄计算的出生体重 z 分数。在“安全通道研究”中两次（n=888）或三次（n=77）入组的女性的妊娠结局与首次入组的女性（n=889）进行了比较。
从第一次到第二次和第三次入组，饮酒者的比例（63.8%、59.0%和 54.6%）没有显著变化（p=0.058）。吸烟者的趋势相似（分别为 73.3%、72.2%和 68.4%）。报告分别有 15.1%、9.7%和 12.0%（p<0.005）的女性使用大麻，有 10.1%、6.6%和 12.7%（p<0.005）的女性使用冰毒。早产率分别从 15.5%上升到 17.5%和 24.7%，但增加不显著。尽管第三次入组的平均出生体重低于第二次入组，但差异无统计学意义。与第一次入组相比，第二次入组的胎龄出生体重 z 分数显著降低。
在研究人群中，关于怀孕期间吸烟和饮酒的不良影响的详细信息并不有效。因此，应研究减少或停止这些有毒物质暴露的其他方法。在 7.5 年内三次入组表明，妊娠间隔较短与早产和胎儿生长受限有关，这可能表明社会经济条件差和怀孕期间接触毒品等混杂因素的作用。
