Postpartum Smoking Relapse Prevention by Breastfeeding Promotion -

大约23%的美国女性在怀孕时吸烟，其中54%的人报告说在怀孕期间自发戒烟 怀孕了。然而，大量在怀孕期间戒烟的妇女在怀孕后又重新吸烟(“旧病复发”) 分娩，例如，产后6个月和12个月的复发率分别为45%和81%。产后吸烟 旧病复发不仅限制了戒烟对母亲的好处，而且还带来了严重的负面影响 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。 在预防产后长期(9个月或更长时间)吸烟复发方面收效甚微 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喂养 母亲，尽管这种联系的因果关系尚不清楚。有可能以前吸烟的母亲 不太可能复发的人选择母乳喂养的时间更长。但反过来也可能是真的，即 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， 母婴关系受益于母乳喂养。一项随机对照试验以减少 通过促进母乳喂养来促进产后吸烟复发可能不仅通过解决 因果关系的不确定性，也产生了一种减少大规模公共卫生问题的新方法 产后吸烟复发，对母亲和婴儿有长期的好处。 我们提出了第一项随机对照试验，通过以下方式减少产后吸烟复发 从妊娠晚期到产后6个月促进母乳喂养。我们将招收60名孕妇 在怀孕前3个月内或怀孕期间(28周)成功戒烟，并将他们随机分组 母乳喂养干预组(N=30)或对照组(N=30)。干预组将 接受多项干预措施，包括产前母乳喂养教育、产后哺乳 咨询、家庭/同行/雇主支持、临时经济奖励和早期限量配方奶 注射器(高危婴儿可选)。对照组将只收到一本关于母乳喂养的简短小册子 教育。主要结果是通过尿可替宁试验证实产后吸烟复发的时间。 具体目标1是检查母乳喂养促进干预对产后的效果 又开始吸烟了。具体目标2是收集关于潜在调解机制的初步数据： 增加哺乳激素(血浆催产素和催乳素)，加强母婴关系(凝聚力 以及在互动过程中的积极母婴行为)，以及减少压力和负面影响。 这项创新和可行的初步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 NIH R01拨款提案的应用，该提案有可能减少吸烟对 最大限度地发挥母乳喂养对婴儿健康和发育的保护作用。

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.