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Background: Disability is a global phenomenon counting more than one billion people reaching the percentage of 15% of the population worldwide and it will be rising constantly in the coming years. Women with disabilities are getting pregnant more and more. Although perinatal care has been extensively researched and is constantly being improved for women without disabilities, health care professionals are not adequately educated and fully experienced for caring for pregnant women with disabilities. As a result of that they are negatively inclined towards disabled women. Objective: The purpose of this review is to investigate health care providers’ behaviors and attitudes towards women with disabilities whilst providing perinatal care. Conclusion: Overall, it seems that health care providers feeling insecure and not confident in providing perinatal care to women with disabilities which results in them having negative attitudes and behaviors. This stems from the inadequate knowledge they have about disability conditions and pregnancy. Upgrading their training and education from undergraduate level is an urgent need. Constant contact with disabled patients seems to be a beneficial factor for better treatment.

Objective:Maternal healthcare providers are usually unfamiliar and not adequately educated to cover the special needs of women with vision impairment during the perinatal period. Moreover, maternity clinics and hospitals may not be able to provide appropriate support based on the distinct needs of women with vision disorders. A systematic review was conducted with the aim to investigate the gap between those women’s particular needs and the health services provided to them as well as the overall barriers that arise during perinatal care of women with vision disorder. Material and methods:We searched for peer-reviewed articles published in any language in two online databases, Medline and Scopus, using the following keywords: "perinatal care", "perinata*", "wom*", “vision disabilit*”, “vision disorder*”, “visual disorder*”, “visual impairment”, “blindness”. Articles were selected based on four inclusion criteria: (a) studies published over the last ten years, (b) primary researches and conference papers, (c) studies in English language, and (d) adult patient population. Results:A total of 33 studies via Medline and 177 studies via Scopus were initially identified as relevant, but eventually, only three articles were found to meet all inclusion criteria. A systematic analysis of these three studies mainly showed that (a) pregnant women with vision disorders expressed lack of satisfaction for the quality of perinatal care that they received; (b) both hospital facilities and healthcare staff approaches were found incompatible with the specific functional needs of these women; (c) maternity care professionals’ training and attitudes need to be modified in order to meet those needs. Conclusion:It is crucial to note that the limited number of relevant studies found by us, which demonstrates by itself the need to conduct more studies in order to draw clearer and safer conclusions. Consequently, more research is required to evaluate how compatible with the functional needs of women with vision disorder the employed maternal healthcare interventions during the perinatal period really are. This would in turn improve perinatal outcomes for both the women and their families.

Εισαγωγή Το ενεργητικό και το παθητικό κάπνισμα κατά τη διάρκεια της εγκυμοσύνης προκαλούν πλήθος επιπλοκών τόσο στην ίδια τη γυναίκα όσο και στο έμβρυο. Οι επιδράσεις τους έχουν επιπτώσεις και στη μετέπειτα ζωή του παιδιού, καθώς και πλήθος αυτών εκδηλώνονται στην ενήλική του ζωή. Η εγκυμοσύνη παρόλο που είναι μια περίοδος με μεγάλα ποσοστά διακοπής του καπνίσματος - συγκριτικά με τις άλλες περιόδους της ζωής μίας γυναίκας - και παρόλο που υπάρχει αρκετά ισχυρό κίνητρο για τις γυναίκες να διακόψουν το κάπνισμα κατά την περίοδο αυτή, μεγάλο ποσοστό των εγκύων συνεχίζει να καπνίζει σε όλη την διάρκεια της εγκυμοσύνης. Είναι λοιπόν προφανές ότι υπάρχουν αρκετοί επιβαρυντικοί παράγοντες και εμπόδια για τη μη διακοπή του καπνίσματος κατά τη διάρκεια της εγκυμοσύνης. Η πρώιμη ανίχνευση των παραγόντων κινδύνου που συνδέονται με τη μη διακοπή του καπνίσματος κατά την εγκυμοσύνη - παράγοντες όπως κοινωνικοί, οικονομικοί, δημογραφικοί, ψυχολογικοί όπως η καταθλιπτική διάθεση (με την κλίμακα Beck Inventory I-A), βιολογικοί όπως η εξάρτηση από τη νικοτίνη (με την κλίμακα του Fagerstrom), η εξάρτηση από το αλκοόλ (με την κλίμακα AUDIT-C) - συμβάλει στην πρόληψη και μείωση των επιπλοκών και όλων των δυσμενών επιπτώσεων που έχει το κάπνισμα στην εγκυμοσύνη, καθώς και στην υγεία του εμβρύου και του νεογνού. Σκοπός Ο σκοπός της παρούσας διδακτορικής διατριβής ήταν να μελετήσει εκείνους τους ψυχοκοινωνικούς παράγοντες που επιδρούν στην καπνιστική κατάσταση της γυναίκας, κατά την περίοδο της εγκυμοσύνης. Στόχοι της μελέτης ήταν: 1. Να διερευνήσει την επίδραση του βαθμού της εξάρτησης από τη νικοτίνη και την κατανάλωση αλκοόλ στην καπνιστική κατάσταση των γυναικών κατά την εγκυμοσύνη. 2. Να διερευνήσει την επίδραση του βαθμού της εξάρτησης από τη νικοτίνη στην επιτυχία της διακοπής του καπνίσματος στην εγκυμοσύνη. 3. Να διερευνήσει την επίδραση της καταθλιπτικής διάθεσης στην καπνιστική κατάσταση των γυναικών κατά την εγκυμοσύνη. 4. Να διερευνηθούν οι παράγοντες, οι οποίοι σχετίζονται με τη νόσο του καπνίσματος και την καπνιστική κατάσταση κατά τη διάρκεια της εγκυμοσύνης. 5. Να διερευνηθούν οι παράγοντες οι οποίοι επηρεάζουν τις γνώσεις και τις απόψεις των εγκύων γυναικών σχετικά με τη νόσο του καπνίσματος. Μεθοδολογία Ο πληθυσμός του δείγματος αποτελούνταν από 1100 έγκυες γυναίκες. Οι γυναίκες αυτές, είτε παρακολουθούνταν, είτε νοσηλεύονταν, είτε πραγματοποιούσαν κάποια εξέταση σχετικά με την εγκυμοσύνη τους ή στο πλαίσιο του προγεννητικό έλεγχου, στα τρία νοσοκομεία/μαιευτήρια των Αθηνών που επιλέχθησαν. Δόθηκε ειδική άδεια από την επιτροπή ηθικής για τη διεξαγωγή της έρευνας και από τα τρία νοσοκομεία/μαιευτήρια. Η έρευνα βασίστηκε στη συμπλήρωση ενός ερωτηματολογίου, το οποίο διανεμήθηκε τυχαία και το οποίο δημιουργήθηκε και χρησιμοποιήθηκε για πρώτη φορά για τη συγκεκριμένη μελέτη. Στο συγκεκριμένο ερωτηματολόγιο ενσωματώθηκαν επίσης τρεις αυτοσυμπληρούμενες κλίμακες με σκοπό να αξιολογηθεί η εξάρτηση από τη νικοτίνη, η χρήση αλκοόλ και η καταθλιπτική συμπτωματολογία κατά τη διάρκεια της εγκυμοσύνης. Οι εν λόγω τρεις κλίμακες είναι οι ακόλουθες: 1. Το ερωτηματολόγιο AUDIT-C. Κλίμακα εκτίμησης της κατανάλωσης αλκοόλ κατά την εγκυμοσύνη. 2. Το ερωτηματολόγιο Beck (B.D.I) I-A. Κλίμακα μέτρησης της καταθλιπτικής συμπτωματολογίας Beck. Χρησιμοποιήθηκε το ερωτηματολόγιο τύπου Α, γυναικεία μορφή. 3. Το ερωτηματολόγιο Fagerstrom (FTND). Κλίμακα εξάρτησης από τη νικοτίνη. Προκειμένου για τη διασφάλιση της εγκυρότητας του περιεχομένου του ερωτηματολογίου μελετήθηκαν οι σχετικές έρευνες και προέκυψε με βάση τη διεθνή βιβλιογραφία μια τράπεζα ερωτήσεων. Η στατιστική ανάλυση των δεδομένων έγινε με το στατιστικό πρόγραμμα για τις κοινωνικές επιστήμες IBM-SPSS 24 (Statistical Package for Social Sciences). Οι στατιστικές δοκιμασίες που επιλέχθηκαν για τον έλεγχο της στατιστικής σημαντικότητας των μεταβλητών της έρευνας είναι οι ακόλουθες: η δοκιμασία x2, η δοκιμασία student’s t-test, η δοκιμασία ANOVA, η ανάλυση γραμμικής παλινδρόμησης, η ανάλυση συσχετίσεων μεταξύ δυο μεταβλητών και η διερευνητική παραγοντική ανάλυση κυρίων συνιστωσών. Παράλληλα, για τον έλεγχο της κανονικότητας διεξήχθη η δοκιμασία των Kolmogorov-Smirnov, όπως επίσης χρησιμοποιήθηκε και ο συντελεστής Cronbach’s alpha. Αποτελέσματα Τα αποτελέσματα καταδεικνύουν υψηλή συσχέτιση μεταξύ της καταθλιπτικής διάθεσης, της εξάρτησης από τη νικοτίνη και της καπνιστικής κατάστασης κατά την εγκυμοσύνη μετά την μελέτη της κλίμακας Beck Inventory I-A και της κλίμακας εξάρτησης από τη νικοτίνη του Fagerstrom. Η λογιστική γραμμική παλινδρόμηση ανέδειξε επίσης ένα μοντέλο πρόβλεψης της καπνιστικής κατάστασης κατά την εγκυμοσύνη που εξηγεί παράλληλα και το υψηλό ποσοστό (17,55%) των εγκύων καπνιστριών που συνέχισαν να καπνίζουν καθ’ όλη την εγκυμοσύνη. Οι κυριότεροι προβλεπτικοί παράγοντες για την καπνιστική κατάσταση προέκυψε πως είναι οι εξής ψυχοκοινωνικοί παράγοντες: η καταθλιπτική διάθεση, η εξάρτηση από τη νικοτίνη, η στήριξη από το σύντροφο και την οικογένεια στην προσπάθεια διακοπής του καπνίσματος, το κάπνισμα προ εγκυμοσύνης καθώς και παράγοντες όπως το μέρος που καταναλώνει η έγκυος τα περισσότερα τσιγάρα, η επιθυμία της να επισκεφθεί ένα κέντρο διακοπής του καπνίσματος, το ωράριο εργασίας της, ο τρόπος με τον οποίο παίρνει πληροφορίες σχετικά με το κάπνισμα και τέλος η εμφάνιση άμεσων επιπτώσεων στην εγκυμοσύνη λόγω του καπνίσματος. Επίσης παρατηρήθηκε ότι το 46,73% των γυναικών δήλωσαν καπνίστριες στην αρχή της εγκυμοσύνης, ενώ το 17,55% συνέχισε να καπνίζει σε όλη την εγκυμοσύνη. Οι κυριότερες πηγές παθητικού καπνίσματος αναφέρουν οι συμμετέχουσες ότι είναι οι χώροι εστίασης (79,5%), ο κοινωνικός τους περίγυρος (39,8%), ο σύντροφος (28,8%), καθώς και το εργασιακό περιβάλλον (21%). Υπήρξε στατιστικά σημαντική διαφορά (p=0,015) στα ποσοστά μεταβολής της καπνιστικής κατάστασης στην εγκυμοσύνη μεταξύ των ηλικιακών ομάδων των γυναικών. Συγκεκριμένα οι γυναίκες οι οποίες ανήκαν στη ηλικιακή ομάδα 16-20, φάνηκε πως συνέχισαν να καπνίζουν σε όλη τη διάρκεια της εγκυμοσύνης σε ποσοστό 45,5%. Το x2 test έδειξε ότι όσο περισσότερες ήταν οι κυήσεις των γυναικών, τόσο μικρότερο ήταν το ποσοστό διακοπής του καπνίσματος (p

Introduction African refugee women constitute a growing group of maternity service users in Greece. Being a refugee is considered a risk factor in itself for poorer maternal and neonatal health outcomes. These women additionally, are at high risk of perinatal complications, often due to misconceptions or absence of interpretation between providers and patients through different cultural concepts. Consequently, midwives may feel uncertainly experienced when provide perinatal care for a culturally diverse patient population. Aim The aim of the study was to investigate perinatal cultural aspects and practices of African refugee pregnant women in Greece, in order to increase cultural awareness and improve midwifery care in a culturally-sensitive way. Methods Forty-two (n=42) African pregnant women who lived in a "Reception and Identification Center" on a greek island named "Samos", were included in the study. Women were selected by "simple random sampling" and asked to complete anonymously, with assistance of interpreters, a questionnaire that was devised by the authors with open-ended and closed-ended questions. Results Women were aged between 19-38 years old. The 50% (n=21) of them were from the Democratic Republic of the Congo, 28.6% (n=12) from Ghana and 21.4% (n=9) from Cameroon. Major themes emerging from the data analysis were: presence of antenatal care in African countries, potentiality of abortions, complications in previous pregnancy, supplement receipt in previous pregnancy after healthcarers' consultation, decision of birth place, support of traditional birth attendants' during pregnancy and birth, consumption of culturally acceptable food during pregnancy and birth, culturally accepted disposal of placenta, postpartum ceremonies for the baby and newborn's navel care. Conclusion Increased understanding of the pluralistic African perinatal cultural aspects is essential. Inclusion of cultural insight and/or family members in decision making and implementation of training programmes culturally-oriented for midwives, can fulfil women's health, social needs and expectations.

Background. The aim of this study was to develop and assess the psychometric properties of the Electronic Fetal Monitoring Knowledge Scale (EFMKS), a self-report and short instrument measuring knowledge concerning Electronic Fetal Monitoring (EFM). Additionally, it was aimed to use the EFMKS for briefly assessing EFM knowledge in midwives and doctors working in labour ward. Methods. The EFMKS was developed in a three-phase process by using an integrated mixed-methods approach that included literature reviews, professional focus groups, expert consultations and a psychometric survey evaluation. The psychometric evaluation was conducted by recruiting a sample of 128 professionals (midwives and doctors). Data were collected between April and July of 2016 in two public hospitals of Athens, Greece. Content validity, exploratory factor analysis, discriminant and construct validity, test-retest reliability and internal consistency were explored. Results. The expert panel determined that the content validity was satisfactory. The final 10-item scale consisted of three factors explaining 73% of the total variance in the data. Discriminant validity was satisfactory. Internal consistency reliability (α = 0.89) and test-retest reliability (0.85) were satisfactory. The majority of the midwives and the obstetricians had a good level of knowledge while approximately one third of them had a low level of knowledge in EFM. Midwives and doctors having a lower level of knowledge related to EFM, were more frequently professionals with less than five years of clinical experience in the labor ward and reported low confidence for cardiotocography (CTG) interpretation and inadequate preparation for CTG usage.Conclusion. The EFMK demonstrated good content validity, an easily interpretable three-factor structure, high internal consistency, high test-retest reliability, and satisfactory discriminant and construct validity with sample characteristics. The EFMKS may be used for evaluating the EFM knowledge of health professionals and for identifying the areas of their knowledge gap. Based on study findings, an annual multi-professional CTG training is necessary for all intrapartum staff and in particular for the midwives and doctors with shorter clinical experience in the labor ward.

Background: Individuals with disabilities remain one of the most socially excluded segments of the population, constantly fighting for equal rights and social inclusion. Disability is not an easy subject for health professionals to deal with, in part because it crosses many professional and cultural boundaries. Objective : The aim of this research is to analyze and understand the various attitudes toward people with disabilities, amongst the final year medical, midwifery and nursing students and to compare the three health departments on their students’ attitudes. Methods: A questionnaire-based electronic survey was directed to all medical, midwifery and nursing students registered at two big universities in Athens, Greece (n=190). The time frame was decided to encompass a month window (from 2 nd May to 2 nd June 2021). Results: The Nursing students in the study showed overall a better attitude towards disabled people. Our research mainly indicates the fact that in general, there is need to prioritize training in both theoretical and practical fields through alterations in all three university departments’ curricula. Conclusions: Undergraduates Health Students (of Nursing, Midwifery and Medicine) generally present a lack of awareness, familiarity and experience towards disabled people. Numerous reasons seemed to influence health professional’s attitudes to people with a disability including their age, gender, nationality, education, years of experience, general knowledge regarding a disability and the level and nature of their training. This research clearly illustrates the importance of improving how universities’ undergraduate curricula address disabilities in an effort to inspire upcoming health professionals.

There is evidence that social media offer a great field for successful health interventions through enhancement of commitment and social support. FΒ was shown to be a feasible and acceptable environment to achieve smoking cessation interventions. We present the case of 12 smokers attending the SC outpatient clinic that additionally created a FB closed-group, in a self-motivated attempt to support each other. All smokers (characteristics shown at table 1), attended 4 behavioral counseling sessions and 91% used pharmaceutical treatment and followed for additionally 3 months. They all consider themselves to be skilled FB users with 66% reporting daily use of social media. 53% of the participants mentioned that they attended the closed-group daily, while the rest around 3 times a week, all of them both sharing posts and “liking” others’ posts. 83% succeeded in quitting in 4 months and still are participating at the group. All of the members reported that participation in such a group can play a supplemental role to the outpatient clinic, but all rejected replacement of in person visits. 58% believe that this could substitute some visits saving time, though not at the beginning of their attempt. All of them believe that their engagement to this group reinforced their attempts for smoking cessation. This case further supports evidence that FB-group based interventions enhance engagement to smoking cessation.

In this article, early career members and experienced members of the Epidemiology and Environment Assembly of the European Respiratory Society highlight and summarise a selection of six sessions from the Society's annual congress, which in 2018 was held in Paris, France. The topics covered in these sessions span from cutting-edge molecular epidemiology of lung function to clinical, occupational and environmental epidemiology of respiratory disease, and from emergent tobacco products to tobacco control., Highlights of #ERSCongress 2018 from @ERStalk Assembly 6 http://ow.ly/O03v30nEHhJ

Introduction: Smoking during pregnancy is the most considerable risk factor leading to a variety of unfavorable pregnancy outcomes. Aim: To study the smoking status of pregnant women. - To assess their knowledge and attitude towards smoking cessation. Methods: We conducted a survey (May 2016- January 2018) in two public Maternity hospitals in Athens, Greece. Results: 50,4% were smokers at the beginning of their pregnancy despite 56,3% of them having planned their pregnancy meaning that they had not even tried to quit smoking during the family planning phase. - 19% continued to smoke during pregnancy. - 73% considered quitting and 77,7% of them did in fact tried to quit, however 57,9% of them actually failed. - Only 3,5% had reached out to a health professional specially trained in smoking cessation in order to receive help, despite 79,3% of them declaring having been knowledgeable of the existence of smoking cessation clinics inside public hospitals. - 19,4% wanted to visit such clinics. - 92% believe that smoking during pregnancy is harmful for them and for their babies. - 50,3% avoid visiting places where they were exposed to second hand smoke. - 79% have not been actively supported in their attempt to quit smoking, by their partner and family. - Finally, 83,3% want to breast feed, regardless of whether they smoked or not. Conclusion: A significant percentage of pregnant smokers continue to smoke throughout their pregnancy as a result of not having been informed or helped adequately in order to quit. Smoking cessation clinics should be created inside maternity hospitals in Greece and should be manned with specially trained health professionals. Midwives and gynecologists, should actively inform and refer pregnant smokers to these clinics.

Introduction Despite the fact that the association between smoking and Gestation Diabetes Mellitus (GDM) is not clear, it is evident that pregnant smokers have 2h lower plasma glucose after an Oral glucose tolerance test and a higher HbA1c. Active maternal tobacco smoking and second hand smoke exposure during pregnancy is certainly the most important preventable cause for a variety of unfavorable pregnancy outcomes. Aim: Our study aimed at exploring potential new strategies in performing smoking cessation on pregnant women with GDM. Methods Our study was a review of the international bibliography on Smoking Cessation on Pregnant women with GDM. Results Smoking cessation programs in pregnancy are effective and should be implemented as part of routine care for every pregnant smoker. Especially on pregnant smokers with GDM, emphasis should be laid on the fact that provided they quit, there is a good possibility that they might also benefit from needing fewer insulin doses or a less strict diet to follow. It is therefore considered essential for Maternity clinics to have a health professional specially trained in smoking cessation who can provide behavioral support on women who want to quit. Since quitting smoking may be incredibly difficult for a considerable amount of pregnant smokers and since relapses are frequent, the support provided to women in their effort to quit should be continuous throughout pregnancy. The classical 5A’s approach could be shortened into just 3A’s: Ask, Advice, Act. Cognitive behavioral support, motivational interviewing and structured self-help represent for pregnant women their best chance for quitting. Also, from the pharmaceutical treatment perspective, only NRTs could be used in pregnancy. Conclusions Pregnant smokers with GDM have more complicated pregnancies because of both smoking and gestational diabetes risks. Regardless, all pregnant smokers should be encouraged by knowing that help is always available and that quitting is always feasible.

Introduction Maternal smoking is responsible for a number of adverse pregnancy outcomes. Even among women who do quit smoking, many will continue to be exposed to second hand smoke. Aim: The smoking status of pregnant women. Their knowledge and the way they were informed about the risks of smoking. Methods The research was conducted between May and November 2016 in a public Maternity hospital in Athens, Greece. A structured questionnaire was filled in by 195 pregnant women. Results 24,6% of pregnant women reported that they continued to smoke during pregnancy. 58.5 % of pregnant women had been smokers before their pregnancy. 82,8% reported that they had thought about quitting smoking and 71,1 % of them had tried to quit. 50% of them failed quitting. There was no statistically significant difference (p=0.727) in the mean Fagerstrom score between those women who have tried to quit smoking (2±1.91) and those who have not (1.81±2.07) 72.6% of pregnant smokers reported that they were not adequately supported from their partner and family in their attempt to quit smoking. 67,2% of pregnant smokers smoke the majority of their cigarettes in public places and only 11.8% reported also smoking at home. 41% reported that the main source of passive smoking exposure was at public places like restaurant and cafeterias. Finally 92,6% reported having been informed about the risks of active and passive smoking during pregnancy. The main source of information however was reported to be the internet, instead of the health care professionals. Conclusions Despite the fact that most women eventually chose to quit smoking during pregnancy, a significant percentage continued to smoke because they had not been helped or informed properly. Smoking cessation programs and clinics with specially trained staff should therefore be introduced to maternity hospitals in Greece.

Introduction It is observed that delivery does not completely eliminate the risk of developing symptoms of preeclampsia, as well as its impending complications. The postpartum period is often associated with a high risk of developing preeclampsia, eclampsia and HELLP syndrome. Yet, there is neither an established standard, nor specific guidelines for peripartum fluid management. Our purpose is to study during the first four days of the postpartum period the differences in fluid balance on: normal pregnancies, pregnancies with preeclampsia and pregnancies with oedema and proteinuria. Methods The setting was the Gaia private maternity clinic in Athens, where 100 women in the postpartum period took part in the study and were requested to fill in a data collection-sheet, specially developed for the study. They were recruited between January 2014 and November 2014 and were divided into three groups. Group I consisted of all normal pregnancies, Group II those with oedema and proteinuria, and Group III those with preeclampsia. The demographic and clinical characteristics of the women and fetuses were initially recorded. Subsequently, daily records of fluid balance, as well as body weight, were kept for four days after labor. Descriptive statistics were used to analyze the demographic data of the sampled women. We compared the fluid balances among the three groups using t-test association and one-way Anova. Results The mean age of the women was 32.48±4.38 years. Out of a total of 100 women, 59 of them had a normal pregnancy (Group I), 24 developed oedema and proteinuria (Group II) and 17 developed preeclampsia (Group III). All three groups had a positive fluid balance on the first day postpartum and only the first group had a negative cumulative fluid balance from the second day postpartum and onwards. The second group despite having started to discard a small volume of fluid, from the second day postpartum, the balance remained positive throughout the next two days. The third group however, had a negative fluid balance only during the fourth day after labor. Conclusions ur results indicate a difference in the kinetics of fluids in women with preeclampsia, compared to those that had a normal pregnancy and postpartum period. Consequently, there appears to be a need for more rational management and follow up on fluid balance throughout labor.

Introduction The aim of the study was to evaluate the smoking status of pregnant women and their knowledge and attitude towards smoking cessation, in Greece. Material and Methods The research was conducted between May and December 2016 in two public Maternity hospitals in Athens, Greece. A structured questionnaire was filled in by 246 pregnant women. Results 17.07% of pregnant women reported that they continued to smoke during pregnancy. Almost all pregnant smokers (81,3%) reported that they had considered quitting smoking and 69,9% of them had actually tried to quit. 50% of them failed quitting. 69.9% of pregnant smokers reported that they were not adequately supported by their partner and family in their attempt to quit smoking. 66.2% of pregnant smokers smoke the majority of their cigarettes in public places (cafeterias and restaurants) and only 10.8% reported also smoking at home. 22.5% of pregnant women have tried an e-cigarette. 7.8% of women reported been exposed to passive smoking by their partner, 40.3% reported that the main source of passive smoking exposure was in public places. Finally 91.2% reported having been informed about the risks of active and passive smoking during pregnancy. The main source of information was reported to be the internet (17.1%), instead of the health care professionals (14.9%). Conclusions Having not being informed and helped adequately, a significant percentage of pregnant women continued to smoke throughout their pregnancy. The failure in imposing the clean indoor air law in public places in Greece has also contributed to the increased passive smoking exposure.

Active and passive smoking during the perinatal period is one of the most important preventable causes of a variety of unfavorable pregnancy outcomes. Despite being informed about the risks at least one third of women still smoke during pregnancy. Greece has a smoking prevalence of 38%. It is essential for midwives to be trained in smoking cessation in order to help pregnant effectively to quit. Most women who quit smoking during pregnancy without following a smoking cessation program usually resume smoking within 6 months after delivery. We surveyed 294 midwives in Athens (professionals & students) in 2015 using a questionnaire to ascertain their perception and knowledge on: · the risks of active and passive smoking in pregnancy · smoking cessation in general · smoking cessation as part of their duty · the kind of information and help they should provide to pregnant smokers. Results: 1. Almost all participants reported that they routinely inform pregnant smokers about the risks of active and passive smoking. 2. The vast majority (97%) believe that smoking cessation is an important part of their role. 3. Only 51.7% reported feeling comfortable in offering quitting support. 4. 87.4% reported that pregnant women were not well informed about the risks of active and passive smoking. 5. Both professional and student midwives have insufficient knowledge on the effects of smoking during pregnancy and lactation (only 1% answered correctly all relevant questions). We conclude that midwives want to efficiently advise pregnant and breastfeeding smokers to quit. In order to be effective in this role they should be adequately educated on the effects of smoking during pregnancy and lactation and trained in smoking cessation strategies.

Active and passive smoking during pregnancy is the most important preventable cause of unfavorable pregnancy outcomes. We evaluated exposure to tobacco smoke (active/passive) and quitting methods using a questionnaire and depression using EPDS (Greek validated version of Edinburgh Postnatal Depression Scale questionnaire) of pregnant. 300 women were recruited from the perinatal care registers of 2 Public Maternity Departments in Athens during 2014. The questionnaires were administered on the 3rd postnatal day. 48% of mothers were smokers beginning their pregnancy.Among them 83,3% tried to quit but less than half (21,7%) managed to. Thus, finally 73.7% reported being non-smokers during pregnancy, but none in a smoke-free environment. The ones that failed to quit (26.3%) mostly (55.8%) felt unable. There were statistically significant differences between smokers and non smokers in pregnancy and fetal problems (χ2=11.41; df=5; p The mean EPDS score for smokers was 9.72 (SD=6.28;Std Error Mean 0.52) and for quitters 8.04 (SD=5.17;Std Error Mean:0.41). Smokers had significantly more depressive symptoms than quitters [Levene9s Test for equality of variances and homogeneity (F=43.059, P=0.0005) (t=2.403 df=298 Sig.(2-tailed)=0.0005]. Information about risks of active/passive smoking were given from internet/books (37.1%), midwives/doctors (32,1%) and family/friends (30,7%). We conclude that it is essential both pregnant and their partners/families are informed on the health risks of active and passive smoking. Only smoke-free environments will sufficiently promote optimal perinatal health for the woman and her fetus/newborn.