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| Author(s): |
André Luís Bertani
Total Authors: 1
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| Document type: | Doctoral Thesis |
| Press: | Botucatu. 2017-04-12. |
| Institution: | Universidade Estadual Paulista (Unesp). Faculdade de Medicina. Botucatu |
| Defense date: | 2017-02-24 |
| Advisor: | Irma de Godoy; Suzana Erico Tanni Minamoto |
| Abstract | |
Objective: A randomized controlled clinical trial to evaluate the influence of brief intervention based on cognitive-behavioral therapy complemented by video and handbook, with content specifically developed for pregnant smokers in the rate of smoking cessation during pregnancy and after delivery. Individuals and Methods: We evaluated 127 pregnant women who underwent prenatal care at the Hospital das Clínicas, Botucatu Medical School, and at the Primary care of the city of Botucatu; Randomly divided into intervention group (n = 77) and control group (n = 50). All the pregnant women were evaluated by means of a questionnaire developed for the evaluation and follow-up of pregnant women with demographic, socioeconomic, gestational, smoking history and received a counseling session of 15 minutes at the beginning of the study. The intervention group could also participate in up to 7 additional counseling sessions. Both groups received a DVD containing video and printed handbook with educational material specifically developed for pregnant smokers at baseline. The two groups were followed up at subsequent prenatal consultations to assess the smoking status, confirmed by monoximetry and, in case of abstinence, to measure the level of craving by the QSU-B scale. In addition, all pregnant women were evaluated using standardized instruments for the evaluation of the smoker, such as: degree of dependence (Fargestrom test), motivational stage (Prochaska and Di Clemente), anxiety and depression hospital scale (HAD - Zigmond and Snaith) and perceived stress scale (EEP - Cohen). The pregnant women were also grouped into abstinent and smokers according to the smoking status at the time postpartum and the pregnant women in the intervention group were separated according to the participation in the counseling sessions. Information on delivery and postpartum was obtained from the patient's file. Results: The control group was older than the intervention (29.5 ± 6.1 years vs 24.3 ± 7.2 years, p <0.001). The Abstract 6 majority of pregnant women were in a stable union (66.9%), had only elementary education (57.4%) and belonged to economic classes D and C2 (58.1%), with no difference between groups. A higher proportion of pregnant women in the intervention group had a diagnosis of pulmonary diseases compared to control (31.1 vs 12%, p = 0.023). The proportion of pregnant women in the control group who consumed narghile (34% vs 7.7%, p <0.001) and bali cigarette (38% vs 5.2%, p <0.001) concomitantly with conventional cigarettes was higher than that found in group intervention. Among the pregnant women who reported secondhand smoke, the highest proportion was found in the intervention group (69% vs 36%, p <0.001). The highest proportion of pregnant women in the intervention group was in the contemplative stage (76.7% vs 32%, p <0.001). The smoking cessation rate was higher in the intervention group than in the control group (55.8% vs 34%, p = 0.026). Regarding the adherence of the pregnant women in the intervention group, 50.8% of them participated in 6 to 8 sessions. Smoking status after delivery showed a positive association with ≥ 10 pack/years of smoking, participation in only one counseling session, exposure to secondhand smoke and non-use of educational material. Abstinent pregnant women post-treatment who used the educational material showed significant and greater variations in mean anxiety, depression and stress scores throughout the treatment. For the current gestation, 15.7% of pregnant women had miscarriage, 2.3% presented placenta previa and 1.6% ectopic pregnancy, with no difference between abstinent and smokers. Conclusions: The smoking cessation rate was higher in the intervention group. Educational material positively influenced abstinence after treatment. The greater adherence to the counseling sessions showed favorable results for abstinence and the pregnant women with symptoms of depression at baseline were more likely to stop smoking after delivery. (AU) | |
| FAPESP's process: | 13/14910-9 - Effects of brief smoking cessation intervention directed to pregnant women during pregnancy period and postpartum |
| Grantee: | André Luís Bertani |
| Support Opportunities: | Scholarships in Brazil - Doctorate |