Kadın sağlığı hastanesinde sigara bırakma poliklinik hizmetleri ve gebelikte sigara içen kadınların gebelik sonuçları

Öz

Amaç: Gebelikte tütün ürünleri kullanımı hem anneyi hem de bebeğini olumsuz olarak etkilemektedir. Bu çalışmada sigara kullanan gebelerde saptanan medikal komplikasyonları, gebelerin doğum özelliklerini ve yenidoğan bulgularını tanımlamayı ve ikincil olarak, hastanemize başvuran gebelerdeki sigara kullanma oranını saptamayı amaçladık.Yöntem: Bu retrospektif kesitsel çalışmada, 1 Ocak 30 Mayıs 2018 tarihleri arasında Sigara Bırakma Birimine SBB gönüllü olarak başvuran postpartum hastalar sigaranın etkilerini değerlendirmek için, hastanemiz antenatal kliniklerine başvuran tüm gebe kadınlar ise sigara içme oranını saptamak için çalışmaya dahil edildi. Verilerin analizi SPSS 17 istatistik programı ile yapıldı. İçilen günlük sigara miktarının doğum haftası, bebeğin Apgar skoru, doğum ağırlığı ve boyu üzerine etkisi parametrik veriler için Pearson, nonparametrik değerler için Spearman korelasyon analizi ile değerlendirildi.Bulgular: Antenatal polikliniğine başvuran 50.140 gebenin 3181 %6,34 ’i sigara kullandığını beyan etti. Bu kadınların 41 %1,29 tanesi sigarayı bırakmak için gönüllü olarak SBB’ ye başvurdu. Doğum sonrası SBB’ den gönüllü olarak tedavi almayı kabul eden toplam 103 kadın vardı. Results: In total 50,140 pregnant women applied to our antenatal clinics. 3181 6.3% of them were cigarette smoker. 41 1.9% of smoker women applied to SCU volunteraly. Among postpartum cases, 103 women accepted smoking cessation theraphy and volunteraly applied to SCU. In these 103 cases we observed 9 8.70% intrauterine-ex, 11 9.67% abortus imminens, 7 6.79% anemia, 2 1.94% preeclampsia, 2 1.94% gestational diabetes, 2 1.94% placenta previa, 2 1.94% hyperemesis gravidarum, 1 0.97% oligohydramniosis. In multigravid cases, 95% 76/80 of cases declared that they smoked during previous pregnancies. In 94 livebirths, birth method was vaginal delivery in 28 29.8% cases and cesarean section in 66 70% of which 48% was primary. Preterm birth ratio was 9.96% n: 9 , low birth weight ratio was 11.8% n: 11 . We didn’t find any statistically significant correlation between number of cigarette smoked per day and birth week p = 0.39, rho = 0.09 , birth weight p = 0.96, r = 0.04 , 5th minute Apgar score p =0.49, rho = 0.07 and length of baby p = 0.97, rho = 0.01 .Conclusion: Intrauterine-ex ratio in our study was higher than the reported ratios in literature. Other pregnancy complication ratios detected in our study is compatible with the results of the reported studies in the literature. Smoking during pregnancy ratio in our hospital is higher than world avarage

Anahtar Kelimeler

• Sigara, tütün, gebelik, düşük doğum ağırlığı, sezaryen doğum

Smoking cessation unit services and pregnancy outcomes of smoking women during pregnancy in a maternal health hospital

Öz

Objective: The use of tobacco products during pregnancy has negative effects both on the mother and newborn. It is aimed to determine the ratios of medical complications, birth charaterictics and newborn findings in smoking pregnant women. Our second purpose was to detect the ratio of smoking in pregnant women who apply to our hospital.Methods: Between January 2018 and May 2018, smoking postpartum women who applied to Smoking Cessation Unit SCU of our hospital volunteraly were included into this retrospective cross sectional study to examine advers effects of smoking on both mother and newborn. All pregnant women who applied to antenatal clinics of our hospital were included into study for determination of smoking ratio. In postpartum cases we searched for daily smoked cigarette number, pregnancy complications, birth characteristics and newborn charaterictics. It was searched for any possible correlation between daily cigarette number and birth week, birth weight and newborn length and Apgar score of the baby. Data analysis was performed by SPSS 17. It was used for parametric values Pearson correlation analysis and for parametric values Srearman correlation analysis was used.abruptio placenta, ölü doğum gibi gebelik Gebelikte sigara kullanımının plasenta previa, GIRIŞ Results: In total 50,140 pregnant women applied to our antenatal clinics. 3181 6.3% of them were cigarette smoker. 41 1.9% of smoker women applied to SCU volunteraly. Among postpartum cases, 103 women accepted smoking cessation theraphy and volunteraly applied to SCU. In these 103 cases we observed 9 8.70% intrauterine-ex, 11 9.67% abortus imminens, 7 6.79% anemia, 2 1.94% preeclampsia, 2 1.94% gestational diabetes, 2 1.94% placenta previa, 2 1.94% hyperemesis gravidarum, 1 0.97% oligohydramniosis. In multigravid cases, 95% 76/80 of cases declared that they smoked during previous pregnancies. In 94 livebirths, birth method was vaginal delivery in 28 29.8% cases and cesarean section in 66 70% of which 48% was primary. Preterm birth ratio was 9.96% n: 9 , low birth weight ratio was 11.8% n: 11 . We didn’t find any statistically significant correlation between number of cigarette smoked per day and birth week p = 0.39, rho = 0.09 , birth weight p = 0.96, r = 0.04 , 5th minute Apgar score p =0.49, rho = 0.07 and length of baby p = 0.97, rho = 0.01 .Conclusion: Intrauterine-ex ratio in our study was higher than the reported ratios in literature. Other pregnancy complication ratios detected in our study is compatible with the results of the reported studies in the literature. Smoking during pregnancy ratio in our hospital is higher than world avarage

Anahtar Kelimeler

• smoking, tobacco, pregnancy, low birth weight, cesarean birth

Kaynakça

1. 1. Pineles BL, Park E, Samet JM. Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol 2014; 179: 807–23.
2. 2. Rogers JM. Tobacco and pregnancy. Reprod Toxicol 2009; 28: 152–60.
3. 3. Miyake Y, Tanaka K. Arakawa M. Active and passive maternal smoking during pregnancy and birth outcomes: the Kyushu Okinawa maternal and child health study. BMC Pregnancy and Childbirth 2013; 13:157-64.
4. 4. Kohta Suzuki, Taichiro Tanaka, Naoki Kondo, Junko Minai, Miri Sato, Zentaro Yamagata. Is Maternal Smoking during Early Pregnancy a Risk Factor for All Low Birth Weight Infants?. J Epidemiol 2008;18(3) 89-96.
5. 5. Qui J, He X, Cui H, Zhang C, et al. Passive Smoking and Preterm Birth in Urban China. Am J Epidemiol. 2014;180(1):94–102.
6. 6. Kelmanson IA, Erman LV, Litvina SV. Maternal smoking during pregnancy and behavioural characteristics in 2 - 4-month-old infants. Klin Padiatr. 2002;214(6):359-64.
7. 7. McEvoy CT, Spindel ER. Pulmonary effects of maternal smoking on the fetus and child: Effects on lung development, respiratory morbidities, and life long lung health. Paediatr Respir Rev. 2017;21:27-33.
8. 8. Behrooz L, Balekian DS, Faridi MK, Espinola JA, Townley LP, Camargo CA Jr. Prenatal and postnatal tobacco smoke exposure and risk of severe bronchiolitis during infancy. Respir Med. 2018;140:21-6.

9. 9. Bruner JP, Forouzan I. Smoking and buccally administered nicotine. Acute effect on uterine and umbilical artery Doppler flow velocity waveforms. J Reprod Med. 1991;36(6):435-40.
10. 10. Bahadori B1, Riediger ND, Farrell SM, Uitz E, Moghadasian MF. Hypothesis: smoking decreases breast feeding duration by suppressing prolactin secretion. Med Hypotheses. 2013;81(4):582-6.
11. 11. Primo CC, Ruela PB, Brotto LD, Garcia TR, Lima Ede F. Effects of maternal nicotine on breastfeeding infants. Rev Paul Pediatr. 2013;31(3):392-7.
12. 12. Jauinaux E, Burton GJ. Morphological and biological effects of maternal exposure to tobacco smoke on the feto-placental unit. Early Hum Dev 2007;83:609-706.
13. 13. Lange S, Probst C, Rehm J, Popova S. National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis. Lancet Glob Health 2018;6:e769-e776.
14. 14. Mutlu LC, Saraçoğlu GV. Prevalence of smoking and factors affecting smoking behaviour during pregnancy: A sample from Tekirdağ. Turk J Public Health, 2014;12(1):1-12.
15. 15. Ergin I, Hassoy H, Tanik F.A, Aslan G. Maternal age, educational level and migration: Socioeconomic determinants for smoking during pregnancy in a field study from Turkey. BMC Public Health 2010; 10:325.
16. 16. Mei-Dan E, Walfisch A, Weisz B, Hallak M, Brown R, Shrim A. The unborn smoker: association between smoking during pregnancy and adverse perinatal outcomes. J Perinat Med. 2015 Sep;43(5):553-8.
17. 17. Hyland A, Piazza KM, Hovey KM, Ockene JK, Andrews CA, Rivard C, Wactawski-Wende J. Associations of lifetime active and passive smoking with spontaneous abortion, stillbirth and tubal ectopic pregnancy: a cross-sectional analysis of historical data from the Women’s Health Initiative. Tob Control. 2015;24(4):328-35.
18. 18. Marakoğlu K, Sezer RE. Sivas’ta gebelikte sigara kullanımı. C.Ü. Tıp Fakültesi Dergisi, 2003; 25(4): 157-64.
19. 19. Moore E, Blatt K, Chen A, Van Hook J, DeFranco EA. Relationship of trimester-specific smoking patterns and risk of preterm birth. Am J Obstet Gynecol. 2016;215(1):109.e1-6
20. 20. Horta BL, Victora CG, Menezes AM, Halpern R, Barros FC. Low birthweight, preterm births and intrauterine growth retardation in relation to maternal smoking. Paediatr Perinat Epidemiol. 1997;11(2):140-51
21. 21. Ananth JV, Savitz DA, Luther ER. Am J Epidemiol. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. 1996;144(9):881-9
22. 22. Zang J ve Fried DB. Relationship of maternal smoking during pregnancy to placenta previa. Am J Prev Med. 1992;8(5):278-82
23. 23. Smedberg J, Lupattelli A, Mardby AC, Nordeng H. Characteristics of women who continue smoking during pregnancy: A cross-sectional study of pregnant women and new mothers in 15 European Countries. Biomed Central, 2014; 14: 213-29
24. 24. Cesur B. Sivas İl Merkezinde Sigara İçen ve İçmeyen Annelerin ve Bebeklerinin Bazı Özelliklerinin Karşılaştırılması. Yüksekli-sans Tezi. Erciyes Üniversitesi Sağlık Bilimleri Enstitüsü Halk Sağlığı Anabilim Dalı Kayseri, 2005
25. 25. E, Blatt K, Chen A, Van Hook J, DeFranco EA. Relationship of trimester specific smoking patterns and risk of preterm birth. Am J Obstet Gynecol. 2016; 215(1): 109.e1–109.e6