Ir Med J. 2006 Oct;99(9):283



Abstract
This was a questionnaire-based study of 151 postnatal women. We found 42% of women were smokers prior to pregnancy and only 37% of these women succeeded in quitting smoking during pregnancy. Success in quitting was significantly related to the number of cigarettes smoked (p<0.05). However, 71% of pregnant smokers were aware of the associated risks. Alcohol was consumed by 89% of women and 10% admitted to binge drinking during pregnancy. Only 44% of the study group were aware of the associated risks of alcohol. We propose that we need to change our social acceptance of these behaviours before pregnancy, and provide support to those women during pregnancy.

Introduction
Recent data shows that, in Ireland, 33% of young women smoke cigarettes and 77% consume alcohol¹. A USA survey estimated that 12.9% of pregnant women smoked, (9-42% depending on social class) ². Nearly 40% of these women attempted to stop smoking³ and felt under “significant social pressure” to stop smoking during their pregnancy⁴. A 1992 Rotunda Hospital survey revealed that 63% of pregnant women smoked and only 5% stopped during the pregnancy. Furthermore, 89% of pregnant women consumed alcohol and 11% stopped during the pregnancy⁵.

The risks of cigarette smoking during pregnancy include miscarriage, premature labour, premature rupture of the membranes, abruption, intrauterine growth restriction, increased perinatal morbidity/mortality, and an increased risk of SIDS⁶. Alcohol consumption during pregnancy can lead to fetal growth restriction, premature delivery and fetal alcohol syndrome⁷.

We sought to analyse the prevalence of smoking and alcohol consumption, patient-awareness of the associated risks and to consider factors that might influence abstinence during pregnancy.

Method
This was a questionnaire-based study of postnatal inpatients at the Rotunda Hospital, July-September 2003. We addressed smoking and alcohol consumption prior to and during the antecedent pregnancy. Data was analysed using SPSS and employed Chi-squared statistical tests.

Results
Overall, 151 women completed the questionnaire. The mean age was 31 years (range 15–43) and 53% (n=80) of women were married. The range of parity was 0-7, with 57 nulliparous women (38%).

Smoking
Sixty-three women (42%) were smokers prior to pregnancy. The average birth-weight for smokers’ infants was 3.2 kg, compared to 3.6 kg for non-smokers’ (p<0.01). Of these 63 women, 23 (37%) succeeded in stopping smoking. Furthermore, 26 women (41%) reported a decrease, 9 (14%) reported no change and 5 (8%) reported an increase in the amount smoked. Of these 63 smokers, 12 (19%) smoked <10 cigarettes, 28 (44%) smoked 10-19 and 23 (37%) smoked 20 or more, with an average of 14 cigarettes.

The notable influencing factor on the 23 women who succeeded in quitting was the number of cigarettes smoked prior to pregnancy. The mean number smoked by those who succeeded was 10.7/day, compared to 16.6 for those who did not succeed (p=0.02). Factors which were not significant were age, or if the woman’s partner smoked.

When asked, which factors would cause them to restart smoking (even outside of pregnancy), “stress” (14/40 (35%)), “craving” (9/40 (23%)) and “social surroundings” (6/40 (15%)) were cited.

When those who smoked during pregnancy, were asked how smoking may affect the fetus, 45/63 (71%) could identify at least one risk. Thirty-six (36/63) (57%) were informed of this risk by either by a health-worker, friends, family or by leaflet. This influenced behaviour in 15/36 women (42%). Overall, 79/151 women (52%) thought smoking was more harmful than alcohol during pregnancy, 27 (18%) thought alcohol was more harmful than smoking, 42 (28%) thought both were harmful and 3 (2%) were unaware that either behaviour had an associated risk.

Alcohol
Of those interviewed, 134 women (89%) consumed alcohol. The mean alcohol consumption for these 134 women was 4.4 drinks/week. The number of women who admitted to binge-drinking (>6 units/session) was 15 (10%). Over half, (85 /151 (56%)) were unaware that alcohol was harmful in pregnancy. Advice about the associated risks of alcohol was received from a health-care professional by 42 women (28% of the total group) and of these, 30/42 (71%), reported that this did not alter their behaviour.

Discussion
This study reveals that most smokers, (71%), are aware of the risk of smoking, but there is considerable ignorance regarding the risk of alcohol consumption in pregnancy, with only 44% being aware of the risks. Even being informed of the risk, does not alter behaviour in 58% of smokers and 71% of drinkers. We suggest that influencing social acceptance of these behaviours in Ireland is paramount, which includes, but extends beyond all health-care workers.

This study has identified factors for improving smoking cessation rates. Firstly, we need to reduce consumption - before pregnancy. Secondly, stress during pregnancy needs to be directly targeted. We could consider offering programmes including coping and time-management skills training, in parallel with antenatal smoking cessation projects. Support for these women during one of the most stressful periods of their lives may be cost-effective in the long-term from a public health-care perspective.

Correspondence:
M Geary
Master, Rotunda Hospital,
Parnell Square, Dublin 1.
Tel: 01 8730700
Fax: 01 8730932
Email: [email protected]
References

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