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Armed service Usage of Reason for Care Ultrasound examination (POCUS).
Regarding the evaluation of tobacco addiction, the most commonly used questionnaires are the Fagerström tests (FTCD, HSI...), which are well correlated with cotinine concentration. However, there is insufficient evidence of their usefulness in reducing tobacco consumption during pregnancy to recommend them in current practice.DSM-V diagnostic criteria for addiction should be known as they can also be used to characterize the intensity of this addiction. INTRODUCTION The consequences of smoking have been studied more during pregnancy than during breastfeeding. There is a passage of nicotine and other substances in breast milk and some modifications of milk composition. The objectives of this chapter are to study the benefits of breastfeeding in women who smoke, and the adaptation of smoking, medication and behavioral habits in case of incomplete withdrawal to better guide women. METHODS The MedLine database, the Cochrane Library and foreign guidelines from 1999 to 2019 have been consulted. RESULTS The conservation of the benefit of breastfeeding in smokers with regard to the prevention of respiratory infections, infantile colic, cognitive deficits, obesity, sudden infant death, is not known to date. It is therefore not recommended to include smoking status in the choice of feeding mode for the newborn (Professional Agreement). However, since breastfeeding is a factor associated with a reduction in smoking and / or withdrawal (NP2), it is recommended to promote breastfeeding in non-weaned women in order to limit smoking (grade B). The use of nicotine replacement therapy is possible during breastfeeding (Professional Agreement). In the absence of data, bupropion (Zyban®) and varenicline (Champix®) are not recommended for women who are breast-feeding (Professional Agreement). A free interval between smoking and breastfeeding reduces the concentration of nicotine in milk (NP4). For non-weaned women who are breastfeeding, it is therefore recommended not to smoke just before breast-feeding (Professional Agreement). CONCLUSION The results indicate that breastfeeding is possible in smokers, although less often initiated by them. If the conservation of its benefits for the child is not demonstrated to date, breastfeeding allows the mother to limit smoking. OBJECTIVE The objective of this chapter is to evaluate the risks of second-hand-smoke during pregnancy and to assess the benefits of antenatal care. METHODS Bibliographical research in French and English using the Medline and Cochrane databases and the recommendations of international societies. RESULTS Exposure to second-hand smoke appears to be higher at home and in the car, with potential consequences for pregnancy, especially prematurity (NP3). Complete avoidance of smoking at home significantly reduces exposure to passive smoking compared to incomplete avoidance (NP4). The more numerous the sources, the higher the intoxication is (NP4). The major risk factor associated with passive smoking is the presence of a spouse who smokes. Other associated factors are the presence of a smoker at home or in the car, young population ( less then 25 years), low level of education, old smoking (NP4). Passive smoking is associated with an increased risk of fetal death in utero, fetal malformations, prematurity and birth weight under 2500g (NP 2). 7-Ketocholesterol in vivo No specific management is recommended for all pregnant women. Nevertheless, in a specific population of pregnant women with vulnerabilities, a behavioral approach aimed at teaching them to negotiate with their entourage may be beneficial in order to reduce the effects of passive smoking on pregnancy (NP2). CONCLUSION It is recommended to advise women and their family (especially spouses) to create a smoke-free environment, especially at home and in the car (Professional consensus). It is recommended to provide a minimum amount of smoking cessation advice to pregnant women's entourage (Professional consensus). Other methods of cigarette consumption include a variety of electronic products, as well as heated tobacco, snus and shisha. The questions in this chapter are What other methods of consumption are used during pregnancy (either electronic or containing tobacco) and what is their prevalence? What is their benefit/risk balance? Can their use during pregnancy be proposed?.Although the fetus is not exposed to the combustible toxins of tobacco, e-cigarette products may contain nicotine, which maintains the exposure of the fetus. Further research is needed on the other components of the electronic cigarette, such as flavorings and propylene glycol and/or glycerol, in order to assess the benefit/risk balance. In addition, some solvents contain ethanol. In the current state of knowledge, the precautionary principle should be respected and not recommend the initiation or continuation of the electronic cigarette during pregnancy (professional agreement). For smoking cessation or electronic cigarette cessation, it is recommended to provide the same advice and to use methods that have already been evaluated (professional agreement). For the JUUL, there are currently no data on obstetrical outcome when used.The use of shisha during pregnancy is associated with decreased fetal growth. It is recommended not to use shisha during pregnancy (Grade C). There are currently no data on the use of heated tobacco and obstetrical outcome. World tobacco consumption during pregnancy is estimated to be 1.7% (95% CI 0.0 - 4.5%). Among the 50 European countries evaluated, France ranks 7th among the countries most affected by active smoking during pregnancy. In the 2016 National Perinatal Survey, 30.0% of women reported active smoking before they started their pregnancy and 16.6% still smoked in the 3rd trimester of pregnancy. There are also disparities in consumption between regions in France (24.0% of pregnant women with active smoking in the 3rd trimester of pregnancy in Bretagne against 9.4% in the Paris region and 5.2% in the French departments and overseas regions). A young age, a low level of education, a low socioeconomic level, primiparity, a geographical origin of mainland France, unemployment, a smoking partner, no partner or a depression are risk factors for smoking during pregnancy. Multiparity is a risk factor for failure of smoking cessation during pregnancy. For health professionals in contact with women of childbearing age, it is recommended to identify a tobacco consumption in women or their partners before pregnancy or as early as possible during pregnancy.
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