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      Influence of smoking and socioeconomic status on labor analgesia: a nationwide register-based study in Finland

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          Abstract

          Purpose

          Labor pain can be treated by medical and non-medical analgesia. Smoking during pregnancy has been shown to increase the incidence of several complications and may influence analgesic effectiveness. Previous studies have linked socioeconomic status to the use of epidurals for labor analgesia. We aimed to determine whether smoking and socioeconomic status influence the use of labor analgesia in Finland.

          Methods

          From January 1, 2004 to December 31, 2018, we collected data from the national Finnish Medical Birth Register on smoking status, labor analgesia, and socioeconomic status during pregnancy. These categorized variables were presented as absolute numbers and percentages. We included data on singleton pregnancies and excluded any data on pregnancies that missed smoking or socioeconomic status.

          Results

          71,603 women smoked during the first trimester, 42,079 women continued to smoke after the first trimester, and 641,449 were non-smokers. The four most used labor analgesia were nitrous oxide, epidural, other medical analgesia, and non-medical analgesia. The most frequently used analgesia was nitrous oxide, which was used by 60.8% of the group of smokers after the first trimester, 58.8% of smokers during the first trimester, and 54.5% of non-smokers. There were no substantial differences between socioeconomic status classes and labor analgesia used.

          Conclusion

          Women who continued smoking after the first trimester used labor analgesia more often than non-smokers. There were no clear differences between socioeconomic status classes and labor analgesia used. These findings highlight the need to reduce maternal smoking during pregnancy, and universal social healthcare systems should promote equality in labor analgesia.

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          Most cited references29

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          Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

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            • Abstract: found
            • Article: not found

            The association between smoking and low back pain: a meta-analysis.

            To assess the association between smoking and low back pain with meta-analysis. We conducted a systematic search of the MEDLINE and EMBASE databases until February 2009. Eighty-one studies were reviewed and 40 (27 cross-sectional and 13 cohort) studies were included in the meta-analyses. In cross-sectional studies, current smoking was associated with increased prevalence of low back pain in the past month (pooled odds ratio [OR] 1.30, 95% confidence interval [CI], 1.16-1.45), low back pain in the past 12 months (OR 1.33, 95% CI, 1.26-1.41), seeking care for low back pain (OR 1.49, 95% CI, 1.38-1.60), chronic low back pain (OR 1.79, 95% CI, 1.27-2.50) and disabling low back pain (OR 2.14, 95% CI, 1.11-4.13). Former smokers had a higher prevalence of low back pain compared with never smokers, but a lower prevalence of low back pain than current smokers. In cohort studies, both former (OR 1.32, 95% CI, 0.99-1.77) and current (OR 1.31, 95% CI, 1.11-1.55) smokers had an increased incidence of low back pain compared with never smokers. The association between current smoking and the incidence of low back pain was stronger in adolescents (OR 1.82, 95% CI, 1.42-2.33) than in adults (OR 1.16, 95% CI, 1.02-1.32). Our findings indicate that both current and former smokers have a higher prevalence and incidence of low back pain than never smokers, but the association is fairly modest. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults. Copyright 2010 Elsevier Inc. All rights reserved.
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              Data quality after restructuring a national medical registry.

              The validity of the 1991 Finnish Medical Birth Registry data was assessed, with special emphasis on the effects of changes made to the data collection form in 1990. Data abstracted from medical records for all births occurring in 49 hospitals during a five-day sample period (n = 865) were compared to the register information. Good or satisfactory validity was found for 32 of 33 variables, when minor error was tolerated in variables with continuous scales. For diagnoses and procedures, recorded in check-box format, satisfactory validity was found for 10 of 45 variables. Validity could not be assessed for 18 variables because of insufficient number of cases (13 items) or definition problems (5 items). When the results were compared to a 1987 data quality study, many of the variables that had been changed to the check-box format showed improvement in validity. In addition, in some cases a small change in question alternatives or instructions caused a noticeable change in validity.

                Author and article information

                Contributors
                haapmarjut@gmail.com
                Journal
                Arch Gynecol Obstet
                Arch Gynecol Obstet
                Archives of Gynecology and Obstetrics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0932-0067
                1432-0711
                19 July 2024
                19 July 2024
                2024
                : 310
                : 4
                : 1989-1996
                Affiliations
                [1 ]GRID grid.414325.5, ISNI 0000 0004 0639 5197, Department of Gynecology and Obstetrics, , Mikkeli Central Hospital, ; Porrassalmenkatu 35-37, 50100 Mikkeli, Finland
                [2 ]Kuopio Pediatric Research Unit (KUPRU), Institute of Clinical Medicine, University of Eastern Finland, ( https://ror.org/00cyydd11) Kuopio, Finland
                [3 ]Department of Pediatrics and Neonatology, Kuopio University Hospital, ( https://ror.org/00fqdfs68) Kuopio, Finland
                [4 ]GRID grid.502801.e, ISNI 0000 0001 2314 6254, Faculty of Medicine and Life Sciences, , University of Tampere, ; Tampere, Finland
                Author information
                http://orcid.org/0000-0003-3357-3756
                Article
                7647
                10.1007/s00404-024-07647-3
                11393191
                39028434
                908a5287-36ff-4d96-9a19-8a546c60ae83
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 5 May 2024
                : 9 July 2024
                Funding
                Funded by: University of Eastern Finland (including Kuopio University Hospital)
                Categories
                Maternal-Fetal Medicine
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2024

                Obstetrics & Gynecology
                labor analgesia,register study,smoking,socioeconomic status
                Obstetrics & Gynecology
                labor analgesia, register study, smoking, socioeconomic status

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