Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Apr 18, 2021
Open Peer Review Period: Apr 18, 2021 - Apr 29, 2021
Date Accepted: Sep 19, 2021
(closed for review but you can still tweet)
Health-Related Quality of Life Among Pregnant Women with Pre-pregnancy Smoking and Smoking Cessation during Pregnancy in China: A National Cross-sectional Study
ABSTRACT
Background:
Previous researches hardly explored the influence of pre-pregnancy smoking and smoking cessation during pregnancy on the health-related quality of life (HRQoL) of pregnant women, which is a topic that need to be addressed. And pregnant women in China is a big population in the largest developing country in the world and cannot be neglected.
Objective:
To evaluate the HRQoL of pregnant women in China with different smoking status and further estimate the association between pre-pregnancy smoking, smoking cessation and HRQoL.
Methods:
A nationwide-based cross-sectional study was conducted to determine the association between different smoking status (smoking currently, quit smoking, never smoking) and HRQoL in pregnant women across mainland China. A web-based questionnaire was delivered through the Banmi Online Maternity School platform, including questions about demographics, smoking status and HRQoL. EuroQoL Group’s five-dimension five-level (EQ-5D-5L) scale with EuroQoL Group’s visual analog (EQ-VAS) scale were used for measuring HRQoL.
Results:
Ethical approval was granted by the Institutional Review Board of the First Affiliated Hospital of Sun Yat-sen University (ICE-2017-296). From August, 2019 to September, 2019, a total of 16,483 participants from 31 provinces were included, among which 93 were smokers, 731 were ex-smokers and 15,659 were non-smokers. Non-smokers had the highest EQ-VAS score (84.49±14.84), smokers had the lowest EQ-VAS (77.38±21.99), and the EQ-VAS for ex-smokers lied between (81.04±17.68). Significant difference in EQ-VAS was detected between non-smokers and ex-smokers (P<.001), which indicated that pre-pregnancy smoking does have a negative impact on the HRQoL (EQ-VAS) of pregnant women. Compared with non-smokers, ex-smokers suffered from more anxiety/depression problems (P=.001, OR:1.29, 95% CI: [1.12, 1.50]). Among ex-smokers, the increased cigarette consumption is associated with lower EuroQol five-dimension (EQ-5D index) (P=.007) and EQ-VAS (P=.01) of pregnant women in mainland China. Compared to smoker, no significant difference was found in ex-smoker’s EQ-5D index and EQ-VAS (P=.33).
Conclusions:
Smoking history is associated with lower HRQoL in Chinese pregnant women. Pre-pregnancy smoking is related to lower HRQoL (EQ-VAS) and higher incidence of depression/anxiety problems. Smoking cessation during pregnancy does not significantly improve the HRQoL of Chinese pregnant women. Among ex-smokers, the more cigarettes they smoke, the lower HRQoL they have during pregnancy. We suggest that the Chinese government should strengthen the education of quitting smoking and avoiding second-hand smoke for women who have pregnancy plan and their family members.
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