Postpartum Smoking Relapse Prevention by Breastfeeding Promotion

通过促进母乳喂养预防产后吸烟复吸

• 批准号: 9753319
• 负责人: Xiaozhong Wen
• 金额: $ 20.24万
• 依托单位: STATE UNIVERSITY OF NEW YORK AT BUFFALO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9753319
• 关键词: Address; Adrenal Glands; Air; Amygdaloid structure; Anger; Anxiety; Applications Grants; Attention; Behavioral; Brain; Breast Feeding; Child; Child Care; Child Development; Child Health; Conceptions; Control Groups; Cotinine; Counseling; Data; Dopamine; Education; Emotional; Enrollment; Etiology; Family; Financial compensation; Fostering; Frequencies; Fright; Future; Hand; Hormonal; Hormones; Human Milk; Hypothalamic structure; Infant; Infant Behavior; Infant Development; Infant Health; Infant formula; Intervention; Investments; Lactation; Late pregnancy; Life; Massage; Maternal Behavior; Maternal and Child Health; Mediating; Mediation; Mental Depression; Milk; Milk Ejection; Monitor; Mothers; Neurosecretory Systems; Oxytocin; Pamphlets; Pharmacology; Pilot Projects; Pituitary Gland; Plasma; Postpartum Period; Pregnancy; Pregnant Women; Prenatal care; Prolactin; Public Health; Randomized; Randomized Controlled Trials; Relapse; Reporting; Research; Rewards; Risk; Role; Skin; Smoke; Smoker; Smoking; Stimulus; Stress; Syringes; System; Testing; Time; Tobacco; Uncertainty; United States National Institutes of Health; Urine; Visit; Woman; biological adaptation to stress; clinical practice; craving; disorder later incidence prevention; environmental tobacco smoke exposure; feeding; feeding plan; financial incentive; follow-up; group intervention; incentive-based intervention; innovation; intervention program; maternal stress; milk production; multi-component intervention; negative affect; novel strategies; offspring; peer; postnatal; prenatal; prevent; primary outcome; protective effect; psychologic; response; smoking abstinence; smoking cessation; smoking during pregnancy; smoking relapse; stressor; success; successful intervention; suckling

PROJECT SUMMARY/ABSTRACT About 23% of U.S. women smoke at conception, and 54% of them report quitting spontaneously during pregnancy. However, large numbers of women who quit during pregnancy return to smoking (“relapse”) after delivery, e.g., 45% and 81% relapse by 6 and 12 months postpartum, respectively. Postpartum smoking relapse not only limits benefits of smoking abstinence to the mother, but also has serious negative consequences for child health and development through tobacco metabolites in breast milk and ambient air. There is little success in preventing long-term (9 months or longer) postpartum smoking relapse by existing interventions. Breastfeeding mothers tend to have lower risk of postpartum smoking relapse than formula- feeding mothers, although the causality of this association is unclear. It is possible that ex-smoking mothers who are less likely to relapse choose to breastfeed longer. But the reverse may also be true, i.e., mothers who breastfeed may be less likely to relapse, partly due to the hormonal (high oxytocin and prolactin), emotional, and mother-infant relationship benefits resulting from breastfeeding. A randomized controlled trial to reduce postpartum smoking relapse by promoting breastfeeding may not only move the field forward by addressing the uncertainty of causality, but also yield a new approach to reducing the large public health problem of postpartum smoking relapse that has long lasting benefits for mothers and infants. We propose the first randomized controlled trial to reduce postpartum smoking relapse by breastfeeding promotion from late pregnancy to 6 months postpartum. We will enroll 60 pregnant women who successfully quit smoking within 3 months before or during this pregnancy (<28 weeks) and randomize them into either the breastfeeding intervention group (N=30) or the control group (N=30). The intervention group will receive multicomponent interventions consisting of prenatal breastfeeding education, postnatal lactation counseling, family/peer/employer support, contingent financial incentives, and early limited formula milk via syringe (optional for at-risk infants). The control group will receive only a brief pamphlet on breastfeeding education. The primary outcome is timing of postpartum smoking relapse verified by urine cotinine test. Specific Aim 1 is to examine the efficacy of breastfeeding promotion intervention on postpartum smoking relapse. Specific Aim 2 is to collect preliminary data regarding potential mediating mechanisms: increases in lactation hormones (plasma oxytocin and prolactin), enhancing mother-infant relationship (bonding and positive maternal and infant behaviors during interactions), and reductions in stress and negative affect. This innovative and feasible pilot study can yield promising preliminary data to strongly support our future application of a NIH R01 grant proposal that has the potential to reduce smoking-related harms to both the mother and the infant, and maximize the protective effects of breastfeeding on infant health and development.

项目总结/摘要 大约23%的美国女性在怀孕时吸烟，其中54%的人在怀孕期间自发戒烟。 怀孕然而，大量在怀孕期间戒烟的妇女在怀孕后又重新吸烟（“复吸”）。 递送，例如，产后6个月和12个月复发率分别为45%和81%。产后吸烟 复吸不仅限制了母亲戒烟的益处，而且对母亲的健康也有严重的负面影响。 母乳和环境空气中的烟草代谢物对儿童健康和发育的影响。 通过现有的预防措施来预防长期（9个月或更长时间）产后吸烟复发的成功率很低。 干预措施。母乳喂养的母亲产后吸烟复发的风险往往低于配方奶粉- 喂养母亲，虽然这种关联的因果关系尚不清楚。有可能戒烟的母亲 那些不太可能复发的人选择母乳喂养更长的时间。但反过来也可能是真的，即，的母亲 母乳喂养可能不太可能复发，部分原因是荷尔蒙（高催产素和催乳素），情绪， 和母乳喂养对母婴关系的好处。一项随机对照试验， 通过促进母乳喂养来预防产后吸烟复发不仅可以通过解决 因果关系的不确定性，而且还产生了一种新的方法，以减少大的公共卫生问题， 产后吸烟复发对母亲和婴儿有持久的好处。 我们提出了第一个随机对照试验，以减少产后吸烟复发， 从怀孕后期到产后6个月提倡母乳喂养。我们将招募60名孕妇， 在怀孕前3个月内或怀孕期间（<28周）成功戒烟，并将其随机分组 随机分为母乳喂养干预组（N=30）和对照组（N=30）。干预组将 接受由产前母乳喂养教育、产后哺乳 咨询、家庭/同伴/雇主支持、应急经济激励和早期限制配方奶， 注射器（高危婴儿可选）。对照组只会收到一份有关母乳喂哺的简介小册子 教育主要结果是通过尿可替宁试验验证产后吸烟复发的时间。 具体目的一是探讨母乳喂养促进干预对产后妇女的影响， 复吸具体目标2是收集关于潜在介导机制的初步数据： 增加泌乳激素（血浆催产素和催乳素），增强母婴关系（结合 和积极的母婴行为在互动），并减少压力和负面影响。 这项创新和可行的试点研究可以产生有希望的初步数据，以有力地支持我们的未来 应用NIH R 01拨款提案，该提案有可能减少吸烟相关的危害， 母乳喂养是母亲和婴儿的最佳选择，最大限度地发挥母乳喂养对婴儿健康和发育的保护作用。