Smokers Quit in Study on Pregnant Smoking and Childhood Obesity

Wen’s maternal smoking-cessation program is an example of how Western New Yorkers are benefiting from the growth of clinical research at the Jacobs School of Medicine and Biomedical Sciences.

When people participate in clinical trials, they typically enjoy better health outcomes. “Similar to other researchers, we do care about data,” says Wen, assistant professor of pediatrics in the Division of Behavioral Medicine, “but what’s most rewarding is when you get out into the community, meet people and see firsthand how your research is actually helping them lead healthier lives.

“The big reward for me is we can make a difference in the mother’s health and also the health of the next generation.”

Although children born to women who smoke during pregnancy often have low birth weight, paradoxically, maternal smoking during pregnancy is one of the best predictors of pediatric obesity later in life.

In the months following birth, babies born to mothers who smoke often undergo a period of rapid infant weight gain, surpassing their peers and setting a pattern of weight gain that may persist into childhood.

“If you look at the evidence, it’s very consistent across countries, across decades,” says Wen, the principal investigator. “That’s why we are trying to use smoking cessation during pregnancy to prevent childhood obesity.”

For now, Wen’s team is monitoring the growth of the babies in his program up to 2 years of age. Using data gathered in this clinical study, he is now in the process of applying for federal funding to continue the program and expand it.

“Child obesity is epidemic in this country, and many other countries, and it can cause a lot of health issues,” Wen says. “We know that obese kids are much more likely to be obese adults. And adult obesity is tied to a host of health problems, from diabetes to cardiovascular disease to cancer.”

“So far, we can get about 63 percent of mothers to quit smoking completely during pregnancy,” explains Wen. “That’s not just based on self-reporting; it’s based on our two biochemical tests. Our data show that those babies are born normal at birth and have normal growth.”

“We are so glad to see that our intervention really works,” he says. 

Patients in Wen’s program learn adaptive techniques to deal with cravings, such as finding a distraction or focusing on breathing. Patients have reported that the methods have helped them cope with stressors that previously drove them to smoke cigarettes.

In addition to education and counseling, one of the important components of Wen’s treatment program is monitoring and feedback. 

Patients are tested for two harmful chemicals during pregnancy: breath carbon monoxide and urine cotinine, a byproduct of nicotine. While checking for compliance, Wen shows mothers the benefits of quitting smoking in real time as they watch levels of these two toxins in their bodies drop the longer they stay off tobacco — which means their growing children are also receiving less exposure to these toxins.

Wen’s study population reflects the demographics of the group most at risk for maternal smoking.

Seventy-two percent of the women were recruited from two of Buffalo’s chronically underserved neighborhoods: 14 percent from the West Side and 58 percent from the East Side. About 70 percent of the women in Wen’s group were African-American, Hispanic or Native American. More than 60 percent were single and more than 70 percent unemployed. About 80 percent had a high school or lower level of education.

The study is a prototype for recruiting and serving Buffalo’s traditionally underserved neighborhoods; Wen’s study has showed how UB research helps reduce health disparities in the region while enhancing the relevance of the research findings.

UB’s Clinical and Translational Science Institute (CTSI) Translational Pilot Studies Program, which funded this initial phase of Wen’s research program, provides seed money to advance promising new therapies. Top priority is given to projects, such as Wen’s, that address health care disparities in underserved or underrepresented populations in Western New York.

“Dr. Wen’s study is exactly the kind of study on which the CTSI places a high priority,” says CTSI director Timothy F. Murphy, MD, senior associate dean for clinical and translational research and SUNY Distinguished Professor of medicine. “This innovative study included members of our community who are traditionally excluded from the benefits of participating in clinical research.”

Underrepresented minorities account for less than 10 percent of people enrolled in clinical trials nationally, according to Murphy, yet the population of the city of Buffalo is 50 percent minority.

Recruiting volunteers in underserved and underrepresented neighborhoods continues to be a challenge for clinical researchers seeking a more representative population for their studies.

Teresa Quattrin, MD, UB Distinguished Professor and chair of pediatrics, heads up the CTSI’s special populations core. She was instrumental in helping to enlist this diverse group of volunteers. “I am extremely proud of Dr. Wen’s effort to include women with social disparities and move his research to the community,” she says.