Counselling for smoking cessation during pregnancy reduces tobacco-specific nitrosamine (NNAL) concentrations: A randomized controlled trial
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General Oncology Hospital of Kifissia “Agioi Anargyroi”
George D Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
Institute of Public Health, American College of Greece, Athens, Greece
General Maternity Hospital Helena Venizelou, Athens, Greece
School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Maternity Unit, Attikon Hospital, Athens, Greece
Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, Greece
Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom
Publish date: 2018-11-14
Submission date: 2018-08-21
Acceptance date: 2018-11-03
Eur J Midwifery 2018;2(November):14
Smoking cessation during pregnancy is beneficial to both the mother and child. Our objective was to assess if an intensive smoking cessation intervention for pregnant women increases: a) rates of smoking cessation, and b) reduces exposure to tobacco-specific carcinogens during pregnancy.

A two-group single-blinded parallel randomized controlled trial (RCT) was conducted involving 84 pregnant smokers in either a high intensity (n=42) or minimal contact control group (n=42). Women assigned to the high intensity smoking cessation intervention group received a single 30-minute behavioural counselling session and a tailored self-help booklet. The primary outcome measures were: 7-day point prevalence abstinence measured by selfreport and urine cotinine levels, and maternal tobacco specific carcinogens nitrosamine (NNAL) urine concentrations assessed at 32 weeks of gestation.

A significantly greater percentage of pregnant smokers quit smoking in the high intensity group compared to the low intensity control group (45.2% vs 21.4%; p=0.001). A significant decrease in urine cotinine concentrations was documented in the experimental group (-140.74 ± 361.70 ng/mL; p=0.004), with no significant decrease documented in the control group. A significant decrease in NNAL levels was also documented in the experimental group (158.17 ± 145.03 pg/mL before, 86.43 ± 112.54 pg/mL after; p=0.032) with no significant changes in the control group.

The high intensity intervention tested resulted in significantly greater cessation rates. Intensive smoking cessation interventions can be effective in reducing fetal exposure to NNAL. This is the first trial to report on NNAL tobacco-specific carcinogen concentrations before and after an intervention for smoking cessation during pregnancy.

Andriani N. Loukopoulou   
George D. Behrakis Research Lab, Hellenic Cancer Society, 17b Ipitou street, Athens 105 57, Greece
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