published_or_final_version / Public Health / Master / Master of Public Health

Approximately 10% of women use cocaine and 20% smoke cigarettes during pregnancy. Animal studies indicate that both cocaine and nicotine are neuroteratogenic agents, although findings with humans are inconsistent. Studies with human infants have been plagued by unreliable subject identification procedures, poor control over confounding factors, and invalid measures of CNS integrity. The literature on prenatal cocaine and nicotine use is reviewed and two studies are presented along with an intriguing case report. The effects of maternal prenatal cocaine use (Study 1) and two levels of cigarette smoking (Study 2) on newborn information processing ability were examined using an auditory habituation-recovery paradigm. Case-control designs were employed in which subjects were individually matched on a number of maternal and infant factors. Cocaine exposure was determined by newborn meconium analysis, urine analysis, and maternal self-report. Maternal smoking was determined by self-report and a variation of the bogus pipeline method. Fetal cocaine- and nicotine-exposure were associated with differential impairments in neonatal information processing. Cocaine-exposed newborns exhibited deficits on measures of habituation and recovery to novelty. Dose-response effects of nicotine-exposure were evident on measures of orientation and habituation, but recovery to novelty was not consistently affected. The results imply that fetal cocaine-exposure severely impairs neonatal auditory information processing ability, whereas fetal tobacco-exposure is associated with deficits in information-processing which may be secondary to impairments in arousal regulation. These auditory processing deficits may be related to the later language impairments reported in follow-up studies with cocaine-and tobacco-exposed infants. Following the two studies, a case is presented of an infant born to a woman who reported using large amounts of cocaine throughout pregnancy, although the infant's meco

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published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The interrelation among maternal dietary intake, pregravid weight, amount and pattern of gestational weight gain and cigarette smoking in influencing the balance between fetal growth and maternal postpartum weight retention was in investigated in 1,330 healthy participants in the PEI Nutritional Counselling Program. Among nonsmokers, gestational weight gain was the main predictor of postpartum weight retention and explained 65.3% of its variability, while explaining only 4.7% of infant birth weight variability. Women with higher postpartum weight retention gained more weight during pregnancy and most of the difference between higher and lower weight retention groups occurred in the first 20 weeks. When comparing infant size between smoking and nonsmoking mothers, birth weight increased linearly with maternal weight gain in all weight status groups except in overweight nonsmokers where birth weight reached a plateau at weight gains $>$17 kg. Among smokers, infant length increased at a higher rate with weight gain than nonsmokers. Although higher weight gains seemed to partially mitigate the effect of smoking on the risk of small-for-gestational-age (SGA) infants, such risk remained $>$10% at elevated weight gains among underweight smokers. The effects of smoking in reducing maternal and infant weights were not mediated by lower energy intake, as smokers consumed more energy than nonsmokers after controlling for physical activity and pregravid weight. The independent relative risks of SGA infants due to maternal smoking, pregravid underweight and low weight gain, were 3.23, 1.80 and 1.72 respectively, implying that smoking has the greatest effect on SGA. Based on current smoking prevalence in Canada, the population etiologic fraction of SGA due to the direct effect of smoking is 30.8%; approximately twice that for maternal underweight or low weight gain. Efforts to increase infant birth weight through higher maternal weight gain would require impractically high ene

The purpose of this study was to determine the relationship- between prenatal weight gain relative to initial weight and change in smoking habits relative to prepregnancy smoking habits on infant birth weight. The convenience sample was 100 women who had been prenatal clients at a clinic for low income women and who delivered term infants during a one year period. Women were selected who had term deliveries and were without medical problems during the pregnancy.Prepregnancy weight-for-height was determined using the 1959 Metropolitan Life Insurance Table. Weight gain throughout the pregnancy was charted on the appropriate graph. Changes in smoking habits during the pregnancy were evaluated verbally. Roy's Adaptation Model was the conceptual framework for this study. The physiological mode of this model depicts people as individuals who are constantly adapting to a changing environment. Procedures for the protection of human subjects were followed.The first research question illustrated that women who gained adequate weight and reduced or quit smoking had infants with higher birth weights. The second research question showed that, overall, women who quit or reduced the amount smoked early in pregnancy had infants with higher birth weights than women who quit or reduced later in pregnancy or-who did not change smoking habits. The third research question determined that nonsmokers had infants with higher birth weights than smokers.Women who smoke will have infants with lower birth weights than those that do not smoke. Women with inadequate weight gains during pregnancy are more likely to have infants: with lower birth weights than women with adequate weight gains. Health care providers must be able to relay, the risks of inadequate weight gain and smoking to pregnant women. / School of Nursing

Understanding how women learn during pregnancy is the foundation for planning prenatal education programs. To date, adult educators have not investigated, in any depth, the learning process during pregnancy. The purpose of this study was to examine learning during pregnancy and relate this learning to learning outcomes. The principal research questions were: "What are the learning patterns of pregnant women?" and "What is the relationship between learning and health behavior of pregnant women?" It is unknown whether learning during pregnancy is directly associated with behavior or mediated through health beliefs. The objectives of this research were to identify pregnant women's health behaviors, learning patterns, and health beliefs. The three health behaviors examined in this study were eating, drinking, and smoking. These behaviors were operationalized in terms of their outcomes: weight gain, alcohol consumption, and tobacco use. These factors are amenable to an education intervention and are behavioral risk factors associated with low birth weight. The process of investigating learning patterns consisted of identifying: what was learned during the pregnancy, which resources were utilized, what advice was given, what amount of time was spent in learning, who initiated the learning episodes, and what learning transaction types emerged. Determining learning transaction types was based upon an adaptation of Tough's (1979) concept of planners and Knowles's concept of self-directed learners. The process of investigating health beliefs consisted of identifying pregnant women's concerns, perceived risk, perceived use of the information, and perceived barriers, defined according to an adaptation of the Health Belief Model. The principal hypotheses of the study were: (1) self-initiated learning will be positively correlated with knowledge scores, (2) self-initiated learning will be positively correlated with ideal health behaviors, and (3) health beliefs will be positively correlated with ideal health behaviors: ideal weight gain during pregnancy, reduced alcohol consumption, and reduced cigarette smoking. The research, an ex post facto design, involved a one hour structured interview with women within the week following delivery of their infants in hospital. A proportional sample of 120 primigravidas was selected from seven hospitals with average number of monthly births greater than 100. Reporting of results was based upon 120 interviews conducted as part of the main sample and eight interviews conducted during the pilot study. Pilot responses were included because these responses were similar to responses provided by the main sample, with the exception of health belief data. One case was excluded from the sample, making for N = 127. Data analyses were based upon the entire sample N = 127, with the exception of health belief measures. Since alcohol and smoking health belief questions were administered to drinkers and smokers and since health belief measures related to weight gain, alcohol, and smoking were missing data, health belief analyses were based upon N=123 for weight gain, N = 88 for alcohol, and N = 43 for smoking. Women had spent an average of forty-one hours learning about weight gain, alcohol consumption, and tobacco use during pregnancy. The principal resources used were: reading materials, physicians, family members, and prenatal classes. The majority of pregnant women had engaged in other-initiated learning episodes in the one to one setting, that is with a health professional, family member, or friend. Self-initiated learning about weight gain was associated with higher knowledge scores and ideal prenatal weight gain (p≤0.05); and, weight gain health beliefs were negatively correlated with ideal prenatal weight gain (p≤0.05). Finding a negative correlation, in contrast to the predicted positive correlation, may have been due to the fact that in a retrospective study the behavior precipitated reporting of health beliefs. Other-initiated learning about alcohol was associated with higher knowledge scores and reduced alcohol intake (p≤0.05); however, alcohol health beliefs were not associated with reduced alcohol intake. For smoking, neither self-initiated nor other-initiated learning was associated with knowledge scores or reduced cigarette smoking; however, a low degree of perceived risk was predictive of reduced cigarette smoking (p≤0.05). Knowledge about tobacco use was positively correlated with health beliefs, suggesting that learning may be indirectly related to smoking behaviors. This study contributes to the knowledge about learning during pregnancy by providing a descriptive profile of learning patterns during pregnancy, and by examining the relationship between learning, health beliefs, and behavior. Fostering a learning environment which stimulates self-initiated learning may assist women reach ideal weight gain during pregnancy. For alcohol, encouraging health professionals, family members, and friends to initiate learning about the hazards of consuming alcohol during pregnancy seems warranted. Self-initiated learning may not be superior to other-initiated learning but may be topic specific, due to the nature of the health behaviors examined. Identification of women's smoking health beliefs seems warranted during prenatal education. Further research is required to better understand the role of learning with respect to changing smoking behaviors during pregnancy. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

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Background: Cigarette smoking is a leading preventable factor associated with complications in pregnancy including preterm birth and low birthweight. Past interventions have raised cessation rates by approximately 6% overall (Lumley et al. 2009). Methods: A three-part literature review, two qualitative studies with a total of 36 participants, and the development of an intervention to promote smoking cessation during pregnancy were completed. Central to the design of the research was the creation of the theoretical basis which was developed in line with recommendations from the MRC Framework for Complex Interventions (Craig et al. 2008, Campbell et al. 2000). For part one of the literature review, 24 qualitative and 44 quantitative studies were re-analysed to complete a mixed-methods secondary analysis of the active ingredients in interventions to promote smoking cessation during pregnancy. Part two consisted of an exploration of psychological models and constructs which are likely to predict or influence smoking behaviour during pregnancy. The final part was a discussion regarding the modes of delivery by which an intervention could feasibly be delivered. Qualitative interviews were carried out with participants from stakeholder groups to fill in gaps in literature and determine the acceptability and feasibility of the proposed intervention. The intervention was created using the theoretical basis developed from the findings. Further qualitative interviews, a focus group, and heuristic evaluation were used to determine the acceptability and usability of the intervention for the target group of pregnant smokers. Results and Conclusions: Findings from this work are potentially relevant for a wide range of behaviours and behavioural interventions. An intervention which has a strong grounding in theory and evidence, and is acceptable and feasible for the target group and in clinical practice was developed using evidence gathered in this thesis.