Prevalencia de tabaquismo durante el embarazo y factores asociados en Andalucía 2007-2012 (*)

• Autores: Pedro Mateos Vílchez, José Manuel Aranda Regules, Gema Díaz Alonso, Pilar Mesa Cruz, Begoña Gil Barcenilla, María José Ramos Monserrat, Patricia Moreno Peral, Josefina Castro Barea, Juan de Dios Luna del Castillo
• Localización: Revista española de salud pública, ISSN 1135-5727, ISSN-e 2173-9110, Vol. 88, Nº. 3, 2014, págs. 369-381
• Idioma: español
• DOI: 10.4321/S1135-57272014000300007
• Títulos paralelos:
  • Smoking Prevalence and Associated Factors During Pregnancy in Andalucía 2007-2012
• Enlaces
  • Texto completo (pdf)
• Dialnet Métricas: 2 Citas
• Resumen
  • español

    Fundamentos: El tabaquismo durante la gestación constituye el principal problema prevenible de salud perinatal. El objetivo es establecer la prevalencia de tabaquismo de las mujeres gestantes en distintos momentos del embarazo así como explorar factores asociados al mismo. Métodos: Estudio transversal. La población diana fueron las mujeres cuyo control de embarazo se realizaba en centros de salud públicos. Muestra aleatoria representativa de 40 centros estratificados según número de embarazos. Participaron 1.813 mujeres seleccionadas en 3 muestras independientes (inicio y final del embarazo y posparto). La exposición se midió mediante cotinina en orina, autodeclaración y monóxido de carbono. Se registraron variables sociodemográficas, de tabaquismo y clínico-obstétricas. Se realizó una regresión logística para identificar los factores asociados al tabaquismo. Resultados: La prevalencia media fue 21,6%, menor al final del embarazo (15,6%) y en el puerperio (16,7%) y mayor en el principio del embarazo (30,3%). Las mujeres fumadoras diarias pasaron del 56,3% antes del embarazo al 14% al final (autodeclaración). El 21,8% de los abandonos se produjo antes del embarazo y el 23,6% cuando las mujeres supieron que estaban embarazadas. La ocultación del consumo fue 19,6% . Fueron factores asociados ser joven (OR: 0,956; IC: 0,92-0,99), estar expuesta al tabaco en el hogar (OR: 3,48; IC: 2,6-4,7), consumo pregestacional alto (6-10 OR: 13,1 IC: 3-56,9; >10 OR: 25,1 IC: 5,8-109,6), mayor edad gestacional en la medición (al final OR: 0,5 IC: 0,4-0,8; posparto inmediato OR: 0,4 IC: 0,3-0,6) y menor nivel de estudios (sin estudios y primer grado comparadas con universitarias OR: 1,98; IC: 1,22-3,22). Conclusiones: El perfil de la mujer gestante fumadora es el de una mujer joven con bajo nivel educativo, expuesta al humo de tabaco en el hogar y con alto consumo pregestacional.

  • English

    Background: Smoking during pregnancy is the most important preventable perinatal health problem. The aim of this research is to determine smoking prevalence in pregnant women at different times of pregnancy in Andalucía, using biochemical validation methods and to explore factors associated with it. Methods: Cross-sectional study. The study population was pregnant women followed in andalusian public health centers. A random sample of 40 health centers, stratified by number of pregnancies was collected, with 1813 pregnant enrolled in 3 independent samples (beginning and end of pregnancy, postpartum). The smoke exposure was measured by urinary cotinine, self-report and carbon monoxide in exhaled air. Control variables were socio-demographic, obstetric and related to smoking habit. A logistic regression was performed to explore factors associated with pregnancy smoking. Results: The mean prevalence in the whole sample was 21.6%, which was lower at the end of pregnancy (15.6%) and postpartum (16.7%) than at the beginning (30.3%). Daily smokers fell from 56.3% before pregnancy to 14% at the end (according to selfreport). Most of the quitters gave up before pregnancy (21.8%) or when they noticed they were pregnant (23.6%). Deception rate was 19.6%, varying according to gestational age and the amount of tobacco consumed. Younger age (OR: 0.956, CI 0.92-0.99), be exposed to second hand smoke at home (OR: 3.48, CI 2.6 to 4.7), a higher level of consumption before pregnancy (6-10 OR 13.1 CI 3 to 56.9,> 10 OR 25.1 CI 5.8 to 109.6), greater gestational age at measurement (end OR: 0.5 CI: 0.4-0.8; immediate postpartum OR 0.4 CI 0.3-0.6) and lower educational level (no education and first grade compared to university OR: 1.98, CI 1.22 to 3.22) were identified as factors associated. Conclusion: Consumption variations with gestational age compel to indicate the time of measurement in prevalence studies. The profile of the pregnant smoker was being young, poorly educated, exposed to tobacco smoke at home and with a previous history of heavy smoking.

• Referencias bibliográficas
  • Di Franza, JR, Lew, RA. (1995). Effect of maternal cigarette smoking on pregnancy complications and sudden infant death syndrome. J Fam Pract.....
  • (2001). Women and smoking: a report of the surgeon general. US Department of Health and Human Services. Public Health Service. Office of Surgeon...
  • Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics and pregnancy outcomes....
  • Pichini, S, García-Algar, O. (2014). Consumo de tabaco durante la gestación. Med Clin. Barc.
  • Encuesta Nacional de Salud. 2011/12.
  • (2013). Encuesta Andaluza de Salud 2011. Consejería de Salud y Bienestar Social. Sevilla.
  • Moussa, KM, Ostergren, PO, Eek, F. (2010). Are time-trends of smoking among pregnant immigrant women in Sweden determined by cultural or socioeconomic...
  • Vardavas, CI, Patelarou, E, Chatzi, L. (2010). Factors associated with active smoking, quitting and secondhand smoke exposure among pregnant...
  • Tappin, DM, MacAskill, S, Bauld, L. (2010). Smoking prevalence and smoking cessation services for pregnant women in Scotland. Subst Abuse...
  • Aranda, JM. Índices de Riesgo Obstétrico para Andalucía.
  • Martínez-Frías, ML, Rodríguez-Pinilla, E, Bermejo, E. (2005). Consumo de tabaco durante el embarazo en España: análisis por años, comunidades...
  • Villalbí, JR, Salvador, J, Cano-Serral, G. (2007). Maternal smoking, social class and outcomes of pregnancy. Paediatr Perinat Epidemiol.....
  • Jiménez-Muro, A, Samper, MP, Marqueta, A. (2011). Prevalencia de tabaquismo y exposición al humo ambiental de tabaco en las mujeres embarazadas:...
  • Iñiguez, C, Ballester, F, Amorós, R. (2011). Active and passive smoking during pregnancy and ultrasound measures of fetal growth in a cohort...
  • Rojas-Villegas, J, Soto-Campos, JG, Peña-González, P. (2011). Hábito tabáquico en embarazadas en el distrito Jerez Costa Noroeste. Aten Primaria....
  • Puig, C, Vall, O, García-Algar, O, Papaseit, E. (2012). Assessment of prenatal exposure to tobacco smoke by cotinine in cord blood for the...
  • Mateos, PM, Aranda, JM. (2005). Posibles sesgos metodológicos en estudios de prevalencia del hábito de fumar durante el embarazo en España....
  • García-Algar, O, Puig, C, Pallas, K. (2012). Umbilical cord blood cotinine and smoking during pregnancy. J Perinatol.. 32. 156
  • Llaquet, H, Pichini, S, Joya, X. (2010). Biological matrices for the evaluation of exposure to environmental tobacco smoke during pregnancy...
  • Solomon, LJ, Quinn, VP. (2004). Spontaneous quitting: self-initiated smoking cessation in early pregnancy. Nicotine Tob Res.. 6. 203-216
  • DiClemente, CC, Dolan-Mullen, P, Windsor, RA. The process of pregnancy smoking cessation: implications for interventions. Tob Control. 9....
  • Dossier Técnico del método INMULITE 2000 Nicotine Metabolite (PIL2KNM-10 2006-12-29).
  • (1994). Clasificación Nacional de Ocupaciones 1994 (CON-94). INE. Madrid.
  • Royston, P. (2005). Multiple imputation of missing values: update of ice. Stata Journal. 5. 527-36
  • White, IR, Royston, P, Wood, AM. (2011). Multiple imputation using chained equations: Issues and guidance for practice. Statistics in Medicine....
  • Little, RJA, Rubin, DB. (2002). Statistical analysis with missing data. 2. New YorkWiley.
  • Palma, S, Pérez-Iglesias, R, Pardo-Crespo, R. (2007). Smoking among pregnant women in Cantabria (Spain): trend and determinants of smoking...
  • Severson, HH, Andrews, JA, Lichtenstein, E. (1995). Predictors of smoking during and after pregnancy: a survey of mothers of newborns. Prev...
  • Mohsin, M, Bauman, AE. (2005). Socio-demografic factors associated with smoking and smoking cessation among 426,344 pregnant women in New...
  • Mateos, PM. Consumo de tabaco en mujeres gestantes: propuesta de un modelo de intervención psicológica en el Sistema Sanitario Público de...
  • Aranda, JM, Mateos, PM, González, A. (2008). Validez de distintas medidas de consumo de tabaco durante el embarazo: especificidad, sensibilidad...
  • Castellanos, ME, Muñoz, MI, Nebot, M. (2000). Validez del consumo declarado de tabaco en el embarazo. Aten Primaria. 9. 629-32
  • Russell, T, Crawford, M, Woodby, L. (2004). Measurements for active cigarette smoke exposure in prevalence and cessation studies: why simple...
  • Dempsey, D, Jacob, P, Benowitz, N. (2002). Accelerated metabolism of nicotine and cotinine in pregnant smokers. J Pharmacol Exp Ther.. 301....
  • Higgins, ST, Heil, SH, Badger, GJ. (2007). Biochemical verification of smoking status in pregnant and recently postpartum women. Exp Clin...
  • Greaves, R, Trotter, L, Brennecke, S. (2000). A simple high-pressure liquid chromatography cotinine assay: validation of smoking status in...
  • Stragierowicz, J, MikoBajewska, K, Zawadzka-Stolarz, M. (2013). Estimation of cutoff values of cotinine in urine and saliva for pregnant women...
  • Secker-Walker, R, Vacek, P, Flynn, B. (1997). Exhaled carbon monoxide and urinary cotinine as measures of smoking in pregnancy. Addict Behav.....
  • Benowitz, R. (1983). Measurement in the analysis and treatment of smoking behaviour. National Institute of Drug Abuse. Rockville^eMD MD. 6-26
  • (2005). Ley 28/2005 de 26 de Dic. de medidas sanitarias frente al tabaquismo y reguladora de la venta, el suministro, el consumo y la publicidad...
  • (2013). Plan Integral de Tabaquismo de Andalucía: Balance diciembre 2012. Junta de Andalucía. Sevilla.