Smoking Reduction In Gravid Substance Use Disorders

NCT ID: NCT04132232

Last Updated: 2024-08-05

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

View full results

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

74 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-02-15

Study Completion Date

2023-12-01

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The aim of this study is to encourage smoking cessation in women with substance use disorders by providing knowledge of expired carbon monoxide. We hypothesize that women who are provided knowledge of their expired carbon monoxide and the associated percent fetal carboxyhemoglobin will have a greater success at quitting smoking during pregnancy than women who are not provided this information.

A secondary aim of the study is to correlate expired carbon monoxide throughout pregnancy with infant birth weight.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

This is a randomized controlled trial. Pregnant smokers who are substances users who meet inclusion criteria will be offered participation in the study at their first obstetrical appointment. Patients who consent to participate will be randomized.

At the enrollment/randomization visit, women will be randomized to either the intervention (knowledge of and interpretation carbon monoxide levels and associated percent fetal carboxyhemoglobin) or control group (no information on carbon monoxide and associated percent fetal carboxyhemoglobin). Allocation will be computer generated. This will be done after the patient meets all inclusion criteria. If randomization to the intervention arm, the patient will be notified of carbon monoxide and associated fetal carboxyhemoglobin levels at each obstetrical visit and counseled on how it affects maternal and fetal health.

If randomized to the control arm, the patient will have expired carbon monoxide and associated fetal carboxyhemoglobin levels measured at each obstetrical visit but blinded to these results. These patients will not be notified of the levels, nor counseled on what levels mean for maternal or fetal health.

See below for intervention and control protocols.

Maternal demographic (age, race, socioeconomic status), medical history (other medical problems, medications, height, weight) and obstetric history (parity, gestational age) data will be abstracted from the patient's chart and supplemented with a patient questionnaire at the enrollment/randomization visit. The primary outcome is the expired maternal carbon monoxide level at the last obstetric visit or at delivery. This will be determined by the Smokerlyzer device used to measure this. Secondary aims of the study will be to evaluate how maternal carbon monoxide levels correlate with fetal growth, cigarette use per day, patient satisfaction and neonatal birth weight.

All patients will have the following performed at the enrollment/randomization visit and subsequent prenatal visits:

a. The order of events for all patients will be as follows: i. Blood pressure evaluation ii. Weight iii. Fundal height iv. Patient will be asked the number of cigarettes used per day v. Patient will exhale into Smokerlyzer device to obtain expired carbon monoxide and associated percent fetal carboxyhemoglobin vi. Patients will be provided smoking cessation resources and counseling on smoking cessation in pregnancy

Intervention Protocol

1. Intervention group will undergo Smokerlyzer ® exhaled carbon monoxide measurements at enrollment, each prenatal visit, and at their last (\>36 week) prenatal visit or at delivery if not captured in clinic.
2. Women will be informed of their exhaled carbon monoxide measurement at each visit as well as the correlation to fetal carboxyhemoglobin.
3. At each visit, the intervention group will receive counseling on fetal impact of smoking based on fetal carboxyhemoglobin level and institutional and state information on smoking cessation will be provided.
4. The patient will then proceed to the remainder of the obstetrical visit.

Control Protocol

1. Women in the control group will undergo Smokerlyzer ® exhaled carbon monoxide measurements at enrollment, each prenatal visit and at their final (\>36 week) prenatal visit or at delivery if not captured in clinic.
2. Both levels (maternal carbon monoxide and fetal carboxyhemoglobin) will be recorded by the co-investigatory, but NOT disclosed to the patient
3. At each visit, control group will be provided institutional and state information on smoking cessation if they report continued smoking.
4. The patient will then proceed to remainder of the obstetrical visit.

For both groups:

At the time of delivery, maternal and neonatal outcome data will be recorded from the chart, including gestational age at delivery, mode of delivery, indications for delivery, birth weight, Apgar score, cord blood gas, length of stay, and neonatal complications, if any. A survey will be completed for both intervention and standard care groups after delivery.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Tobacco Smoking in Mother Complicating Pregnancy Tobacco Use Disorder Tobacco Smoking

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
Will not discuss percent fetal carboxyhemoglobin to control group versus disclosing percent fetal carboxyhemoglobin to intervention group.

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Treatment Group

1. The patient will exhaled into the Smokerlyzer® device will at each visit
2. Exhaled carbon monoxide and fetal carboxyhemoglobin levels will be disclosed to the patient
3. Risks of adverse perinatal outcomes related to maternal carboxyhemoglobin and fetal carboxyhemoglobin level will be provided.

Group Type EXPERIMENTAL

knowledge of expired maternal carbon monoxide and fetal carboxyhemoglobin levels

Intervention Type DIAGNOSTIC_TEST

Will use the Smokerlyzer® device at each visit and be provided information on exhaled carbon monoxide and fetal carboxyhemoglobin. Risks of adverse perinatal outcomes related to maternal carbon monoxide and fetal carboxyhemoglobin level will be provided.

Control Group

1. The patient will exhale into the Smokerlyzer® device at each visit.
2. Exhaled carbon monoxide and fetal carboxyhemoglobin level will NOT be disclosed to the patient
3. No risks of adverse perinatal outcomes related to maternal carbon monoxide and fetal carboxyhemoglobin levels will be provided

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

knowledge of expired maternal carbon monoxide and fetal carboxyhemoglobin levels

Will use the Smokerlyzer® device at each visit and be provided information on exhaled carbon monoxide and fetal carboxyhemoglobin. Risks of adverse perinatal outcomes related to maternal carbon monoxide and fetal carboxyhemoglobin level will be provided.

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

adverse outcomes related to expired maternal carbon monoxide and fetal carboxyhemoglobin levels

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

i. Age 16-45

ii. Singleton gestation

iii. Gestational age at enrollment \<24 weeks

iv. Substance use disorder defined as modified National Institute on Drug Abuse ASSIST ≥4

v. Cigarette smoker using ≥10 cigarettes/day interested in quitting

Exclusion Criteria

i. Known or suspected fetal growth restriction at enrollment

ii. Known fetal anomaly, aneuploidy, or demise

iii. Not interested in smoking cessation or reduction during pregnancy

iv. E-cigarette use
Minimum Eligible Age

16 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

University of Alabama at Birmingham

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Rubymel J Knupp

Maternal-Fetal Medicine Fellow

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Rachel G Sinkey, MD

Role: PRINCIPAL_INVESTIGATOR

University of Alabama at Birmingham

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

University of Alabama

Birmingham, Alabama, United States

Site Status

Countries

Review the countries where the study has at least one active or historical site.

United States

References

Explore related publications, articles, or registry entries linked to this study.

Sandberg A, Skold CM, Grunewald J, Eklund A, Wheelock AM. Assessing recent smoking status by measuring exhaled carbon monoxide levels. PLoS One. 2011;6(12):e28864. doi: 10.1371/journal.pone.0028864. Epub 2011 Dec 16.

Reference Type BACKGROUND
PMID: 22194931 (View on PubMed)

Bedfont. Smokerlyzer range user manual. http://www.bedfont.com/file.php?f=ZmlsZSMjMTgxMg. Updated 2019. Accessed Sept 16, 2016.

Reference Type BACKGROUND

Gomez C, Berlin I, Marquis P, Delcroix M. Expired air carbon monoxide concentration in mothers and their spouses above 5 ppm is associated with decreased fetal growth. Prev Med. 2005 Jan;40(1):10-5. doi: 10.1016/j.ypmed.2004.04.049.

Reference Type BACKGROUND
PMID: 15530575 (View on PubMed)

Goldstein AO, Gans SP, Ripley-Moffitt C, Kotsen C, Bars M. Use of Expired Air Carbon Monoxide Testing in Clinical Tobacco Treatment Settings. Chest. 2018 Feb;153(2):554-562. doi: 10.1016/j.chest.2017.11.002. Epub 2017 Nov 11.

Reference Type BACKGROUND
PMID: 29137909 (View on PubMed)

Riaz M, Lewis S, Coleman T, Aveyard P, West R, Naughton F, Ussher M. Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomized controlled trial. Addiction. 2016 Sep;111(9):1656-65. doi: 10.1111/add.13395. Epub 2016 May 6.

Reference Type BACKGROUND
PMID: 26997495 (View on PubMed)

Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med. 2013 Jan 24;368(4):341-50. doi: 10.1056/NEJMsa1211128.

Reference Type BACKGROUND
PMID: 23343063 (View on PubMed)

QuickStats: Number of Deaths from 10 Leading Causes,* by Sex - National Vital Statistics System, United States, 2015. MMWR Morb Mortal Wkly Rep. 2017 Apr 21;66(15):413. doi: 10.15585/mmwr.mm6615a8.

Reference Type BACKGROUND
PMID: 28426642 (View on PubMed)

Middleton ET, Morice AH. Breath carbon monoxide as an indication of smoking habit. Chest. 2000 Mar;117(3):758-63. doi: 10.1378/chest.117.3.758.

Reference Type BACKGROUND
PMID: 10713003 (View on PubMed)

McClure JB. Are biomarkers a useful aid in smoking cessation? A review and analysis of the literature. Behav Med. 2001 Spring;27(1):37-47. doi: 10.1080/08964280109595770.

Reference Type BACKGROUND
PMID: 11575171 (View on PubMed)

11. Bedfont. Smokerlyzer range user manual. http://www.bedfont.com/file.php?f=ZmlsZSMjMTgxMg. Updated 2019. Accessed Sept 16, 2019.

Reference Type BACKGROUND

Shahab L, West R, McNeill A. A randomized, controlled trial of adding expired carbon monoxide feedback to brief stop smoking advice: evaluation of cognitive and behavioral effects. Health Psychol. 2011 Jan;30(1):49-57. doi: 10.1037/a0021821.

Reference Type BACKGROUND
PMID: 21299294 (View on PubMed)

Bize R, Burnand B, Mueller Y, Rege-Walther M, Camain JY, Cornuz J. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database Syst Rev. 2012 Dec 12;12:CD004705. doi: 10.1002/14651858.CD004705.pub4.

Reference Type BACKGROUND
PMID: 23235615 (View on PubMed)

Reynolds CME, Egan B, Kennedy RA, O'Malley E, Sheehan SR, Turner MJ. The implications of high carbon monoxide levels in early pregnancy for neonatal outcomes. Eur J Obstet Gynecol Reprod Biol. 2019 Feb;233:6-11. doi: 10.1016/j.ejogrb.2018.11.020. Epub 2018 Nov 30.

Reference Type BACKGROUND
PMID: 30529257 (View on PubMed)

Ecker J, Abuhamad A, Hill W, Bailit J, Bateman BT, Berghella V, Blake-Lamb T, Guille C, Landau R, Minkoff H, Prabhu M, Rosenthal E, Terplan M, Wright TE, Yonkers KA. Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. Am J Obstet Gynecol. 2019 Jul;221(1):B5-B28. doi: 10.1016/j.ajog.2019.03.022. Epub 2019 Mar 27. No abstract available.

Reference Type BACKGROUND
PMID: 30928567 (View on PubMed)

Provided Documents

Download supplemental materials such as informed consent forms, study protocols, or participant manuals.

Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form

View Document

Related Links

Access external resources that provide additional context or updates about the study.

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

JCHF

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

UAB

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

SIGS

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Telephone Counseling for Pregnant Smokers
NCT02144883 COMPLETED PHASE3
Helping Moms Quit Pilot Trial
NCT05041413 COMPLETED NA
Affect Regulation Training for Pregnant Smokers
NCT01163864 COMPLETED PHASE1/PHASE2