Page 83 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

Intervention Description
Counseling method “Smoke-free children” developed by Swedish child centers191. Based upon a client- centered approach. Based on the principles developed by Greenberg et al192. Delivered by a child health nurse. Contacts at child health centers.
Aimed at increasing self-efficacy. Five key elements: (1) asking what the mothers themselves know about the effects of smoking on children. (2) suggesting to the mothers that they register how much tobacco smoke there is in the child’s proximity. (3) discussing the results of the mothers’ survey and asking what they think about present smoking habits and whether they heave suggestions about possible changes. (4) supporting any attempt they might carry out to change smoking habits and discussing problems that may emerge. (5) supporting women who have stopped smoking during pregnancy to continue to refrain from smoking.
Home visiting program during hospitalization (5 min), home visit at 1 wk pp (15 min) and 2 follow-up telephone calls or home visits (15 min). Delivered by a nurse. Based on the principles of motivational interviewing193 194, Use of the US public health service clinical practice guideline: 5A’s177 178. Use of the 5 A’s of asking if the women smoked, advising her to quit, assessing her willingness to quit, assisting her in quitting and arranging a follow-up. Topics included: relapse prevention, stress management, skills building, trigger avoidance, relapse rehearsal, pp depression. 4- part intervention: pp hospitalization: brief intervention (congratulations and encouragement) home visit at 1 wk pp (smokers: 5A’s, non-smokers: encouragement and further problem solving) and 2 follow-up telephone calls or home visits (same status-dependent content).
Counseling delivered by nurse and the pediatric provider: during the hospital stay (15-30 min), 2wk pp and at 2 “well baby” visits (2 and 4 mo pp). The nurse delivered counseling during the first visit, the pediatric
Baseline values
Self-reported number of cigarettes:
I: 13.1 (6.5) C: 10.8 (5.7) Biochemically validated number of cigarettes:
I: 12.7 (6.6), n=22
C: 8.4 (3.9), n=8
Mean cotinine level:
I: 185 ng/mL C: 245 ng/mL
All women had quit smoking during pregnancy: 100% abstinence
Weight Loss
In the I group, the number of self- reported cigarettes smoked was reduced with 0.3 at follow-up, compared to 2.6 in the C group (p<0.05). Mothers reported more smoking in the I group than in the C group.
When biochemically validated, the number of cigarettes smoked in the I group increased with 0.2, while the number of smoked cigarettes in the C group decreased with 1.3 however, salivary cotinine levels indicated a decrease of 20 ng/mL cotinine in the I group compared to a n increase of 101 ng/mL in the C group (p=0.03).
Weak correlations between self- reported smoking and cotinine- levels were found.
Smoking abstinence at 3 mo pp was 26.4% in the I group, compared to 12.4% in the C group (OR 2.4, 95% CI 1.16-4.98).
Smoking abstinence at 6 mo pp was 21.5% in the I group compared to 10.2% in the C group (OR 2.5, 95% CI 1.13-5.71).
Smoking abstinence at both 3 and 6 mo pp was 18.2% in the I group compared to 5.2% in the C group (OR 2.4, 95% CI 1.16-4.93). Biochemically verified (salivary cotinine level < 14 ng/mL).
41% of the women in the I group relapsed to smoking (any smoking during the last 7 d), compared to 37% of the women in the C group
3.1 Effect of Postpartum Lifestyle Interventions| 81
287 quitters
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