Smoking in Pregnancy
Clinical implementation or practice of smoking during pregnancy: Research Evidence
Introduction
Smoking during pregnancy is not a new issue of today’s society, the presence of smoking is clearly known from several pregnant women over the years as regardless of race and status and that smoking of these women from the time they were pregnant does imply to the alarming truth of smoking activity and the pressing attention do not bring good health to the woman as well as to the child, to the innocent offspring inside her womb. Recognizing the fact that, smoking is truly dangerous to one’s health as according to several government awareness campaigns and advertisements, the need to be aware and support several smoking interventions is a must have, keeping away pregnant women of the use of cigarettes for smoking and to possibly help these women quit smoking and promote healthy and effective lifestyle from within success of the intervention as possible. In addition, research evidence for smoking during pregnancy was constantly evident as several acceptable studies have been presented and documented and various proponents collaborate and integrate ideas and concepts to help in bring out effective intervention programs as well as several sessions of counseling focusing on pregnant women who engaged themselves into habitual acts of smoking activity, not aware that it has serious negative effects on their health and most of all to the offspring they are conceiving.
The Rationale
The core rationale behind recommending in smoking cessation intervention is simple, that is to help pregnant women stop smoking activity totally and places a useful guidelines for women health and awareness during pregnancy, not to smoke and not to even think of engaging into smoking as other pregnant women does, saving mindsets and educate pregnant women of the value of clean health and living not just in pregnancy but in all years of life. Research is not complete in the aspect of gaining in ideal knowledge to bring society together, for health providers to go hand in hand and impose campaigns for alleviating smoking during pregnancy as research have found that education oriented disparities in smoking grew over in health care contacts and that the disparities rose sharply with an increasing number of clinical and social risk factors and indeed, comprehensive smoking cessation intervention is adamant upon promoting integration across pregnancy and health care unit that persuades pregnant women efforts to quit smoking and other vices if there is any.
Research Evidence: Analysis, Critique and Methodological Information
Based on research evidences along with meta analysis instances, there is a need to recommend smoking cessation intervention as a way of understanding, resolving at the same time avoid pregnant women from smoking, one research have noted that, “ smoking cessation interventions offer healthcare providers their greatest opportunity to improve future health of the people (US Department of Health and Human Services, 1989). The treating of smokers, helping them to quit slowly but surely with perseverance such as Tengs, Adams, Pliskin, et al. (1995, p. 393), have asserted that “smoking cessation treatment is one of cost-effective, lifesaving treatments available and has been called the gold standard of preventive interventions (Eddy, 1992) as being true for women who quit smoking during their period of pregnancy and that, for each dollar spent on prenatal smoking cessation, approximately are saved in the healthcare costs, savings reach for about when healthcare costs over such years of life as known (Marks, Koplan, Hogue and Dalmat, 1990).
For proof of clinical practice of smoking during pregnancy, there are some research documents adhering to certain effects of smoking truth during pregnancy. Thus, the known maternal smoking in pregnancy can be associated with highest educational qualification from age 23 as found after such adjustment for confounding intervention from within socioeconomic factors (Fogelman and Manor, 1988). Thus, clinical observations by Kandel et al. (1994) have “appear to support a one concept assimilating children of mothers who smoke are more likely to smoke themselves than are children of fathers who smoke; daughters of mothers who smoked during pregnancy can be four times more likely to smoke too (p. 1412). For research evidence preciseness, methodological information of certain study extends much weight keeping in a valid and reliable understanding of certain studies presented gaining in ample relevance to smoking interventions during pregnancy for example, maternal smoking during pregnancy were being ascertain in retrospection through the use of certain self-administered questionnaire as outlined, smoking during pregnancy does place an important implication for respecting health and body composition in ideal pregnancy stage and its development.
The following are some researches done related to smoking during pregnancy and its underlying critique assimilation for keeping in a better means of applying as well as executing smoking cessation interventions, there was Windsor and Orleans (1986) upon recognizing as well as describing guidelines and standards to evaluate smoking cessation intervention quality of research among pregnant women, the allowing of research as there is value based towards some systematic review of experiment oriented research through initializing methodological criteria for validity efficacy ratio as well as cessation effectiveness outcome and places acceptance towards the evaluation research design, sample representativeness as well as measuring of quality and the reliability of smoking cessation as one ideal intervention.
Truly, research based studies have had sufficient methodological quality in producing research approach that is of reliable and valid domain, and that certain poor measurement of smoking status, as well as incorrect calculation of smoking quit rates places in a glimpse of methodological weakness. The study of O’Connor (1992) assumed in “comparisons from usual care nurse advice to quit and one formal class in self-help cessation methods with a 20 min one-to-one risk counseling and instruction in self-help methods among pregnant smokers in an Ottawa hospital. The study had multiple methodological strengths including an experimental design, sufficient sample size and a detailed description of a tailored intervention. Baseline equivalence on demographic, health and smoking characteristics was documented, comparable data were not presented on those patients who refused. Urinary cotinine was used to confirm self-reported cessation. Patients lost to follow-up were not included in the calculation of quit rates. Using patients lost to follow-up in a recalculation of quit rates did not change the study results”.
Furthermore, Hartmann (1996), presented in “experimental design and breath carbon monoxide measurements were applied to evaluate the effectiveness of brief delivered patient education methods to pregnant smokers. The intervention have produced large significant reduction rates and the truly the study is methodological evaluated from within efficacy of physician delivered behavior change methods to pregnant smokers, the duration of patient counseling sessions by residents was not reported and usual care methods were not presented”.
Another can be the study of Gielen (1997), as the proponent had “examined the efficacy of multi-component intervention of risk counseling, A Pregnant Woman’s Guide to Quit Smoking (1991), clinic reinforcement and social support delivered by educator in urban hospital: Johns Hopkins University Hospital. There can be methodological issues put into statistical power as well as measurement and replicable intervention as addressed”. The study does allow for a strong recording into the effectiveness of physician delivered behavior change. Henceforth, Lowe (1998), integrated an “experimental design and biochemical confirmation to document the effectiveness of tailored smoking cessation methods for pregnant smokers in Brisbane, Australia and the need to tailor methods into the population, a cessation booklet was developed for pregnant smokers in this setting as there can be efficacy of one on one motivational counseling cessation by the nurse from combining in a tailored self help booklet”.
Smoking cessation intervention: Conclusion and Recommendation
Smoking cessation intervention recommendation is for a positive note since, smoking cessation during pregnancy do minimize several risks of fetal death, as well as low birthweight and do prevent desirable complications during the pregnancy period (Boyd and Windsor, 1993, p. 240) also, encouraging that approximately 30 percent of women who smoke during their pregnancy quit smoking for the duration of the pregnancy (Boyd and Windsor, 1993; Butler, Goldstein and Ross, 1972; Cnattingius, Lindmark and Meirik, 1992; Ershoff, Mullen and Quinn, 1989). Furthermore, certain social and psychological changes like, motivation and social pressure can maintain abstinence, exposure to risky situations that are being avoided during pregnancy of women (Gielen, Windsor, Faden, O’Campo, Repke and Davis, 1997, p. 248). Thus, “smoking cessation and significant reduction during pregnancy can improve maternal and infant health” as noted by USDHHS (1990) and Healthy People (2000; 1992). Thus, certain health education methods provided during regular prenatal care have produced quit rates from 10 to 14% in public and from 22 to 25% in private prenatal care settings (Windsor et al., 1985, 1993; Windsor and Orleans, 1986; Ershoff, 1989; Mayer et al., 1990; Hjalmarson et al., 1991; Adams et al., 1992; O’Campo et al., 1992).
Smoking intervention addressing the factors during pregnancy may reduce also cases of postpartum relapse cases, within relapse prevention components of cessation interventions for pregnant smokers as being minimal and target from the prenatal period. Smoking cessation intervention for pregnant women because of a wide range evidence being put in research from within resources support serves as one criteria why the intervention is ideal for pregnant women having smoking issues and or problems as there can be several studies done by several proponents along with methodological dominance essential for a possible research assessment and critique to the focused topic respectively.
The need to develop and evaluate methods to achieve higher cessation and reduction rates and to prevent relapse persists (Windsor et al., 1993). Effective cessation intervention is needed for educationally and economically disadvantaged pregnant women who experience added risk if they smoke during pregnancy (Adams et al., 1992; O’Campo et al., 1992). Smoking cessation interventions, particularly in the health care settings, must be neither labor intensive nor expensive to provide routinely (Windsor et al., 1988). Research evidence have found that “maternal smoking had the strongest effect on birthweight inthe 8 factor regression and births less 2500 gm increased directlywith smoking level from 20 percent to 340 percent in 37 data subgroups” (Meyer, Jonas and Tonascia, 1976, p. 463).
Moreover, the prevalence of smoking during pregnancy vary across countries and that, prevalence rates appear to have peaked and begun to decline, whereas in other countries smoking is becoming increasingly common among young women. According to information, “randomized controlled trials have shown that smoking interventions during pregnancy have had limited success” (Cnattingius, 2004, p. 125). There has to be application of brief cessation counseling session with the provision of pregnancy specific materials upon increasing rates ofcessation among pregnant smokers. The recommended evidence based procedures have to be adopted by every prenatal health care providers and the utilization of the research evidence based on interventionwill bring in feasibility stance in hospital care settings offering prenatalcare and thus implemented with or without inhibiting some of the importantaspects of prenatal flow. If implementedwidely, the smoking cessation approach have to be potential designed and planned in order to achieve reduction of the adverse pregnancyoutcomes and limited health carecosts (Melvin, Dolan-Mullen, Windsor, Whiteside and Goldenberg, 2000, p. 80).
Aside, “prevalence of pregnant women who stopped smoking was higherin the intervention than in the control group and a positive effectof cessation intervention has been observed for a manner.There is potential for women to become non-smokers duringtheir pregnancy and embrace motherhood at their best shape and effective and affordable smoking intervention is realistic and it is a must for research study to be explored” (Haug et al., 1994, p. 112).
Therefore, smoking during pregnancy is being recognized as the most important preventable risk factor for incidence of unsuccessful pregnancy outcome. Smoking is ideally associated with fetal growth restriction and the research evidence suggests that smoking may cause such preterm birth as well as placental abruption and other problems there is that is why it is imperative for pregnant women to undergo extensive smoking cessation intervention in order to terminate those above realities mention and if smoking still happens worst case can incur to the sudden infant death during pregnancy period as the fact that, smoking during pregnancy is being associated with increased risks of possible abortion, ectopic pregnancies and the increase risks of behavioral disorders of the affected child and amiably, smoking during pregnancy will continue as one major risk towards negative maternal and fetal outcomes during and after pregnancy. For those who do not quit, interventions during the childbearing year could provide additional incentive and support for complete cessation. Successful smoking interventions share similar characteristics and tailoring cessation messages to client populations may enhance the effectiveness of interventions. Assessing certain smoker’s degree of addiction and tailoring counseling for cessation according to the patient’s readiness might enhance current clinical practices. Even with the most effective individual counseling, it is increasingly evident that additional strategies are needed to achieve population-wide reductions in smoking and its related health conditions and health professionals might take an active role in supporting the broad range of legislative, advocacy efforts. As clinicians face significant barriers to providing smoking cessation treatment such as lack of training resulting in negative attitudes and weak counseling skills so, the healthcare systems can address these problems and provide the support clinicians need for treating smokers and the need to execute cessation strategies accordingly. Lastly, there has to be ample need to creating smoking cessation among pregnant women as one better priority in the society of concern, as well as integrate smoking cessation services from within maternal and child services and the putting in of recognized policies in support of smoking cessation from within clinical research and development and the need for continuum care for smokers esp. pregnant women and provides treatment to mothers before and after giving birth also proper progress in establishing health care quality.
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