Avoiding environmental tobacco smoke during pregnancy

Environmental Tobacco Smoke (ETS) commonly called secondhand smoke or passive smoking, can harm a developing fetus and may account for complications during pregnancy and birth. It is now known that non-whites experience more adverse pregnancy effects than do whites from smoking and ETS exposure.

In an article published in the March 2009 issue of the American Journal of Preventive Medicine, researchers examined whether black, non-smoking women were able to avoid ETS exposure early in pregnancy and the social contextual factors that affected their success in avoiding secondhand smoke.

This study was conducted by investigators from The George Washington University Medical Center School of Public Health & Health Services, Children's National Medical Center, RTI International, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Data were collected from 1044 women as part of a randomized, multiple–risk behavior intervention trial that addressed four risks for adverse pregnancy outcomes: cigarette smoking, ETS exposure, depression and intimate partner violence (IPV). In this study, the investigators analyzed data from 450 non-smokers who reported having partners, friends, household or family members who smoked. Demographic factors such as age, education, marital status and household income were collected, as was reproductive history information. Attitudes about being pregnant were assessed, as were mental health-related items such as depression symptoms and alcohol or illicit drug use. Interpersonal factors included having a current partner, the father's desire to have the baby and the incidence of IPV either before or during pregnancy.

Direct ETS exposure factors such as smoking by others in the household, household smoking bans, perceived support from significant others to avoid secondhand smoke and perceived harmfulness of ETS exposure to the baby's health were also measured. To accurately determine ETS exposure, cotinine levels in the mother's saliva were measured. Cotinine is a widely accepted biomarker for tobacco exposure.

Twenty-seven percent of pregnant nonsmokers were confirmed as ETS avoiders. The odds of ETS avoidance were increased among women who reported household smoking bans, reported the father wanted the baby and where no/few family members/friends smoked. The odds were decreased among women who had a current partner, reported any intimate partner violence during pregnancy and reported little social support to prevent ETS exposure.

Writing in the article, Susan Michele Blake, PhD, The George Washington University Medical Center, School of Public Health and Health Services, states, "Results highlight the importance of comprehensive prenatal screening to identify a woman's psychosocial and behavioral risks. Before addressing ETS exposure, it is important to gain a complete understanding of the social context of a woman's pregnancy. While providing behavioral counseling and skills-based interventions, it is important to consider other factors that could exacerbate risks for IPV and poor pregnancy outcomes."