Andrea McCubbin

Perceptions and use of electronic cigarettes in pregnancy

Use of electronic cigarettes (e-cigs) is quickly growing in the United States, despite the unknown health implications and unregulated device contents. Although research is emerging around e-cigs in general, there continues to be a lack of scientific evidence regarding the safety and risks of e-cig use on maternal and fetal health, even though adverse health effects of nicotine on maternal and fetal outcomes are documented. This review summarizes existing perceptions of e-cig use in pregnancy, based on the limited number of publications available, and highlights the necessity of conducting additional research in this field of public health. Authors conducted a literature search of scientific peer-reviewed articles published from January 2006 to October 2016, comprising more than a decade of research. Search keywords include ‘tobacco use’, ‘electronic cigarette(s)’ and ‘pregnancy’. Fifty-seven publications were identified, narrowed to fifteen by screening title/abstract for potential relevance, with seven articles chosen for final inclusion. Of these seven studies, most participants not only believed e-cigs pose risks to maternal and child health but also perceived e-cigs as a safer and potentially healthier alternative to traditional cigarettes, and may assist with smoking cessation. Further research is needed to determine health implications and provide clinical guidelines for e-cig use in pregnancy.

Pilot Tobacco Treatment Intervention for Women in Residential Treatment for Substance Use Disorder

Objective: To test the feasibility, acceptability, and efficacy of Get Fit and Quit (GFAQ), a community‐engaged, holistic tobacco treatment program for women of childbearing age in a residential substance use disorder treatment facility. Design: A quasi‐experimental, one‐group, longitudinal design. Setting: A local Young Mens Christian Association (YMCA) location. Participants: Twenty‐three women of childbearing age were enrolled in the study. Nearly all (21/23) participants were White, and most were nonpartnered and unemployed. More than one third of participants had more than high school educations, and five (22%) were pregnant at enrollment. Methods: The program was conducted in 10 sessions over 6 months. For each 90‐minute session, approximately 45 minutes were dedicated to smoking cessation, and 45 minutes were dedicated to group physical activity. Means and 95% confidence intervals were used to summarize nicotine dependence, expired carbon monoxide, urine cotinine, and exercise self‐efficacy at baseline and 5‐week, 8‐week, and 6‐month assessments. Cigarettes smoked per day were summarized using medians and interquartile ranges over time. Program satisfaction and regular exercise were presented as percentages with 95% confidence intervals. Results: Of the 23 women who enrolled in GFAQ, 7 (30%) completed the program. Compared with baseline results, participants who completed GFAQ had lower nicotine dependence and smoked fewer cigarettes per day. Additionally, at 5 weeks, more GFAQ participants exercised regularly (64%) compared with baseline (14%). Most participants viewed the program favorably. Conclusion: Smoking in women of childbearing age with substance use disorders is an important public health issue. GFAQ is a promising intervention for tobacco treatment for this high‐risk population, although the number of initial participants who completed the program was low.

Comparison of Serum and Cervical Cytokine Levels throughout Pregnancy between Preterm and Term Births

Objective  To assess differences in cytokine levels in cervicovaginal fluid (CVF) and serum across trimesters between women with preterm births (PTBs) and full-term births. Study Design  This multicenter study enrolled 302 women with a singleton gestation. CVF and serum cytokines, interleukin 1α (IL-1α), IL-1β, IL-6, IL-8, IL-10, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and matrix metalloproteinase (MMP)-8, were measured. Women with at least one cytokine assessment and noted PTB status in their medical record were retained in the study ( N  = 272). Data were analyzed using mixed modeling (main effects of PTBs and time/trimester). Results  For the CVF values of IL-6, IL-8, IL-10, TNF-α, and CRP, and serum MMP-8, those who delivered preterm had significantly higher values than the full-term group regardless of trimester. For the serum values of IL-1β, IL-6, and TNF-α, those delivering preterm had significantly lower values than those delivering full-term regardless of trimester. For IL-1β in CVF, the cytokine was significantly higher in the PTB group for second and third trimesters only, relative to the full-term group. Conclusion  For each CVF cytokine that differed by birth status, values were higher for PTB than term, averaged over trimester. Numerous cytokine profiles varied across trimesters in women delivering term versus preterm in both CVF and serum.

Patterns of Systemic and Cervicovaginal Fluid Inflammatory Cytokines throughout Pregnancy

Objective This study describes the normal variations in serum and cervicovaginal fluid (CVF) cytokine levels throughout pregnancy. Study Design This multicenter, prospective study examined trimester‐specific maternal serum and CVF cytokines (interleukin [IL]‐1&agr;, IL‐1&bgr;, IL‐6, IL‐8, IL‐10, tumor necrosis factor‐&agr;, and C‐reactive protein [CRP]). A two‐factor linear mixed modeling approach compared cytokine distribution, while pairwise comparisons evaluated differences over time. Results Trimester‐specific serum cytokine data were available for 288, 243, and 221 patients, whereas CVF cytokine data were available for 273, 229, and 198 patients. CVF had significantly higher concentrations of IL‐1&agr;, IL‐1&bgr;, IL‐6, IL‐8, and matrix metalloproteinase‐8 (p < 0.001), irrespective of the trimester. At all time points, IL‐10 and CRP concentrations were higher in serum than CVF (p < 0.001). Serum IL‐10 increased significantly throughout pregnancy (p < 0.001). Conclusion Differences in cytokine distribution across different biological fluids are evident throughout pregnancy. These findings provide a framework for examining patterns of changes in cytokines throughout pregnancy.

Prenatal Systemic Immune Response in Smoking and Nonsmoking Women

Paper Presentation Objective To determine whether prenatal smoking affects systemic cytokine distribution. Design Planned secondary analysis of a prospective, longitudinal multicenter trial. Setting Regional prenatal clinics. Sample Smoking and nonsmoking pregnant women (81) with singleton gestation. Methods Cytokine biomarkers (IL‐1α, IL‐1β, IL‐2, IL‐6, IL‐8, IL‐10, TNFa) and C‐reactive protein (CRP) were measured using a multiplex bead lyte assay on a Luminexx IS‐100. At each time point, smoking status was collected via self‐report (survey) and validated by preset urine cotinine limits. Cytokine data were log transformed. Statistical analysis included descriptive statistics, analysis of variance, t ‐tests, and Spearmans rank correlation coefficient using Statistical Analysis Software (SAS) version 9.3. Results Eighty‐one women underwent evaluation in the first trimester, 76 in the second, and 69 in the third. Thirty‐nine of the participants (48%) were smokers and self‐report smoking status was strongly correlated with urine cotinine (ρ = .68). Less than 10% of women who stated they were nonsmokers were classified as smokers based on urine cotinine limits. First trimester serum CRP was significantly higher in women who smoked ( p = .04). Furthermore, proinflammatory cytokines in the second and trimester (IL‐6 and IL‐1α) were also significantly different between women who smoke and do not smoke during pregnancy ( p = .04; p = .02, respectively). No significant differences were observed in other serum cytokine concentrations, including anti‐inflammatory IL‐10. Conclusion/Implications for Nursing Practice Maternal tobacco use and systemic immune responsiveness are individually associated with preterm birth (PTB), and the interaction of tobacco use on systemic cytokines requires further study. Currently, there is limited evidence on the impact of prenatal smoking status on serum cytokines and stress. Prenatal tobacco may affect the critical balance between pro‐ and anti‐inflammatory cytokines/molecules. Both elevated CRP and proinflammatory mediators can trigger oxidative stress, potentially impacting endothelial/endocervical structure. Furthermore, upregulation of proinflammatory cytokines in the second and third trimesters may stimulate an unnecessary inflammatory response and increase the risk for PTB. Nurses and other healthcare professionals need to consistently screen for prenatal tobacco use and offer evidenced‐based smoking cessation interventions to reduce PTB risk. Further research is needed to investigate the role of maternal tobacco use on local and systemic immune response during pregnancy.