Investigating N-3 Fatty Acids to prevent Neonatal Tobacco-related outcomeS (INFANTS)

项目摘要 吸烟是不良妊娠结局（包括早产）最重要的可改变风险因素， 新生儿死亡和产妇并发症。怀孕期间的吸烟率仍然高得令人无法接受。率 怀孕期间戒烟率很低，特别是在服务不足的人群中，目前已获得批准 戒烟的药物治疗要么被认为是不安全的怀孕或有不确定的 有效性确定安全有效的干预措施，以减轻吸烟的不利影响 对母婴结局的影响是一个主要的公共卫生优先事项。我们的研究小组发现，吸烟者， 和非孕妇，在n-3长链多不饱和脂肪酸（LCPUFA）相对缺乏。我们 假设吸烟引起n-3 LCPUFA相对缺乏可能是一个重要机制 导致与烟草相关的不良妊娠结局， 专门针对怀孕吸烟者可以减少这些并发症。支持这一假设 来自最近对补充欧米茄-3脂肪酸预防早产的二次分析 一项出生试验发现，只有吸烟者服用n-3 LCPUFA， 不吸烟者。虽然令人信服，但这项研究是一项事后分析，仅包括一小部分样本， 吸烟者，并且在随访期间没有收集吸烟行为的数据。然而，确定纵向 吸烟行为是至关重要的，因为一些临床研究发现，补充n-3 LCPUFA也可能 减少对尼古丁的渴望，减少每日吸烟。因此，吸烟者可以从补充N- 3 LCPUFA通过降低早产风险和/或增加戒烟。为了解决这些知识 空白，我们建议进行一项n-3 LCPUFA的多中心、随机、安慰剂对照、双盲研究 400名孕妇吸烟者我们将收集有关吸烟行为的详细信息， 香烟暴露的生物标志物（尿可替宁、呼气末一氧化碳）和 n-3 LCPUFA状态（红细胞磷脂膜脂肪酸）。我们提出这项建议的具体目的是 1）确定补充n-3 LCPUFA对分娩时胎龄和早产的影响， 2）确定补充n-3 LCPUFA对孕妇吸烟的影响 吸烟者。通过我们最近完成的试点研究，我们优化了招聘和留住员工的工作 策略，并确定我们干预的耐受性。我们的研究团队包括经验丰富的 先前成功招募孕妇进行临床研究并进行 戒烟的干预性研究。我们将从八个产科诊所招募潜在的参与者 穿越田纳西中部地区这将是第一次对补充n-3 LCPUFA进行研究 只在怀孕的吸烟者中。我们的研究可能会对有害的烟草- 相关的生育结果和戒烟努力。

Project Summary Smoking is the most important modifiable risk factor for adverse pregnancy outcomes including preterm birth, neonatal death, and maternal complications. Smoking rates in pregnancy remain unacceptably high. Rates of smoking cessation during pregnancy are low, particularly in underserved populations, and currently approved pharmacotherapies for smoking cessation either are considered unsafe in pregnancy or have uncertain effectiveness. Identifying safe and effective interventions, which might mitigate the adverse effects of smoking on maternal-fetal outcomes, is a major public health priority. Our group has found that smokers, both pregnant and non-pregnant, have a relative deficiency in n-3 long-chain polyunsaturated fatty acids (LCPUFAs). We hypothesize that smoking-induced n-3 LCPUFA relative deficiencies may be an important mechanism contributing to tobacco-related adverse pregnancy outcomes and that n-3 LCPUFA supplementation specifically targeted to pregnant smokers may reduce these complications. Support for this hypothesis comes from a recent secondary analysis of the Omega-3 Fatty Acids Supplementation to Prevent Preterm Birth trial that found that only smokers taking n-3 LCPUFAs had a reduction in preterm labor risk as compared to non-smokers. While compelling, this study was a post hoc analysis that included only a small sample of smokers and did not collect data on smoking behaviors during follow up. Yet the ascertainment of longitudinal smoking behavior is critical, as some clinical studies have found that supplemental n-3 LCPUFAs might also reduce nicotine cravings, and lower daily cigarette use. Thus, smokers may doubly benefit from replenishing n- 3 LCPUFAs via lower risk of preterm labor and/or increased smoking cessation. To address these knowledge gaps, we are proposing a multi-center, randomized, placebo-controlled, double-blinded study of n-3 LCPUFA supplementation in 400 pregnant smokers. We will collect detailed information on smoking behavior, validated biological markers of cigarette exposure (urinary cotinine, end-expiratory carbon monoxide) and biomarkers of n-3 LCPUFA status (red blood cell phospholipid membrane fatty acids). Our specific aims of this proposal are to 1) determine the effect of supplemental n-3 LCPUFAs on gestational age at delivery and preterm labor in pregnant smokers and 2) determine the effect of n-3 LCPUFA supplementation on tobacco use in pregnant smokers. Through our recently completed pilot study, we have optimized our recruitment and retention strategies and determined the tolerability of our intervention. Our research team includes experienced researchers with prior successes in recruiting pregnant women for clinical studies and performing interventional studies for smoking cessation. We will recruit potential participants from eight obstetrics clinics across the Middle-Tennessee area. This will be the first study of supplemental n-3 LCPUFAs conducted exclusively in pregnant smokers. Our study could have a major translational impact on both adverse tobacco- related birth outcomes and smoking cessation efforts.