Smoking during pregnancy among primary health care clients in Argentina. Identification of resources and stressors

Abstract

Background: Cigarette smoking increases the risk of perinatal disorders like premature rupture of membranes, placenta previa, abruptio placenta, stillbirth, preterm delivery, and low‐birth weight. Rates of smoking during pregnancy (SDP) vary, from 9.9% in Japan to 17% in Australia and 30‐35% in Spain. To determine variations in the risk of SDP and tailor interventions, understanding predictors is crucial. Methods: This study was conducted in 2014, among participants of free maternal‐child health services in four cities of Northwest Argentina. Mothers of children from birth to 5 years of age responded to a questionnaire (N=1107) in 16 randomly selected clinics. We conducted bi‐ and multivariate analysis of SDP by psychosocial risk factors. Results: A 10.3% of respondents reported SDP, with lower rates among Indigenous vs. non‐Indigenous women (4.7% vs. 11%). A greater percentage of mothers who did not report SDP had full term babies, and reported that the child's health was excellent or very good, but no significant differences were reported regarding child's health problems at birth. In bivariate analysis, educational level, occupational status, concern about household income, externalizing behavior, number of smokers in the household and the number of cigarettes smoked in the previous month, were significant risks. In multivariate analysis, Indigenous women were less likely to report SDP (OR 0.2); complete elementary or incomplete high school education were protective factors (OR 0.3) but higher educational status was not significant, compared with having less than elementary education. Students (OR 2.8), the unemployed or those with informal work (OR 9.6) were at risk compared with the formally employed. Conclusions: Understanding social norms, resources and stressors among women of different ethnic groups or educational and occupational status, could increase the efficacy of prevention strategies. We propose that close to zero exposure to cigarette smoke in utero is achievable and should be a Tobacco Free Generations primordial objective.