Characterizing Nicotine Withdrawal in Pregnant Smokers

描述（由申请人提供）：这是研究资助的第二次也是最后一次修订，旨在描述怀孕吸烟者尼古丁戒断的特征。在美国，母亲吸烟是导致妊娠结局不良和儿童发病率和死亡率的主要可预防原因，虽然80%的孕妇吸烟者报告说在怀孕期间认真考虑戒烟，但大多数人甚至无法戒烟一周。已经开发了有效的干预措施用于怀孕期间戒烟，但戒烟率很低，通常低于20%。尼古丁戒断被认为是早期吸烟复发的重要因素之一，并在非怀孕吸烟者中进行了广泛研究。据我们所知，只有两份关于妊娠期间尼古丁戒断的报告：Albrecht及其同事（1999年）对妊娠青少年的回顾性研究和我们小组最近的前瞻性初步研究（Heil et al.，2006年）。鉴于近30年来对怀孕期间戒烟的研究，这代表了这一文献中的一个惊人空白。我们最初的试点研究得出了两个开创性的发现。首先，我们观察到怀孕吸烟者在尝试戒烟前报告的戒断症状水平显著升高。其次，即使在戒烟前升高，我们也能够验证持续戒烟5天的怀孕吸烟者的一些戒断症状，并确定其发生率，程度和急性时程。虽然这是一个重要的进步，但我们的试点研究提出了关于怀孕吸烟者尼古丁戒断代谢的其他问题。构成拟议研究的两个目标旨在跟进和扩展该领域的文献。首先，我们建议对戒烟前戒断症状升高进行彻底检查，将妊娠吸烟者与妊娠非吸烟者和非妊娠女性吸烟者的水平进行比较，以阐明戒断症状升高的来源。其次，我们建议对妊娠期间尼古丁戒断进行更全面和更严格的表征，增加样本量并延长我们初步研究的时间进程。拟议的研究将与正在进行的临床试验合作，测试基于代金券的激励措施对促进怀孕期间戒烟的有效性。我们将分析从作为本试验一部分的戒烟孕妇中收集的尼古丁戒断数据，并将结果与戒烟的非妊娠女性吸烟者和妊娠非吸烟者的结果进行比较。公共卫生相关性：拟议的研究有可能为孕妇尼古丁戒断提供重要的新信息。这些新知识可能有助于开发更有效的治疗方法，以解决我国最令人生畏的药物滥用问题之一。

DESCRIPTION (provided by applicant): This is the second and final revision of a research grant to characterize nicotine withdrawal in pregnant smokers. Maternal cigarette smoking is the leading preventable cause of poor pregnancy outcomes and pediatric morbidity and mortality in the U.S. While 80% of pregnant cigarette smokers report seriously thinking about quitting while pregnant, most are unable to quit for even one week. Efficacious interventions have been developed for smoking cessation during pregnancy, but cessation rates are low, typically under 20%. One factor thought to play a substantial role in early smoking relapse and extensively investigated in non- pregnant smokers is nicotine withdrawal. To our knowledge, there are only two reports on nicotine withdrawal during pregnancy: a retrospective study in pregnant adolescents by Albrecht and colleagues (1999) and our group's recent prospective pilot study (Heil et al., 2006). Given nearly 30 years of research on smoking cessation during pregnancy, this represents a striking gap in this literature. Our initial pilot study resulted in two seminal findings. First, we observed that pregnant smokers report substantially elevated levels of withdrawal symptomatology prior to the cessation attempt. Second, even with this pre-cessation elevation, we were able to validate a number of withdrawal symptoms in pregnant smokers who sustained abstinence for five days and establish their incidence, magnitude, and acute time course. While a significant step forward, our pilot study raised additional questions about nicotine withdrawal symptomatology in pregnant smokers. The two aims that make up the proposed study are designed to follow up and extend the literature in this area. First, we propose performing a thorough examination of pre- cessation elevated withdrawal symptomatology, comparing levels in pregnant smokers to those in pregnant non-smokers and non-pregnant female smokers in an effort to elucidate the source of the increased symptomatology. Second, we propose performing a more comprehensive and rigorous characterization of nicotine withdrawal during pregnancy, increasing the sample size and lengthening the time course from our pilot study. The proposed study will partner with an ongoing clinical trial testing the efficacy of voucher-based incentives to promote smoking cessation during pregnancy. We will analyze nicotine withdrawal data collected from pregnant women who abstain as part of this trial and compare results to those of abstinent non-pregnant female smokers and pregnant non-smokers. PUBLIC HEALTH RELEVANCE: The proposed study has the potential to contribute important new information about nicotine withdrawal among pregnant women. Such new knowledge may contribute to the development of more effective treatments for one of our nation's most daunting drug abuse problems.