Smoking cessation in pregnant women with mental disorders: a cohort and nested qualitative study

Abstract

ObjectiveTo investigate whether 1) pregnant smokers with mental disorders are less likely to accept referrals to smoking cessation services compared with pregnant smokers without disorders; 2) they experience specific barriers to smoking cessation.DesignCohort study supplemented by cross-sectional survey and nested qualitative study.SettingThree maternity services, London, UK.PopulationPregnant smokers with and without mental disorders.MethodsCase notes were examined on a cohort of 400 consecutive pregnant smokers; data were triangulated with routinely collected data on 845 pregnant smokers at two other sites; 27 pregnant smokers were interviewed using qualitative methods.Main outcome measuresAcceptance of referral to smoking cessation services; perceived barriers to quitting.ResultsPregnant smokers with a mental disorder recorded by midwives were one-quarter of the cohort (97, 23%), were more likely to accept referral to smoking cessation services (69% versus 56%, adjusted odds ratio 1.70, 95% confidence interval 1.03–2.79), but more likely to still smoke at delivery (69% versus 56%, adjusted odds ratio 2.63, 95% confidence interval 1.41–4.92). Discussion about smoking was documented in 7.7% of subsequent antenatal visits in women with or without mental disorders. Pregnant smokers with diagnosed mental disorders reported that they and health practitioners did not prioritise smoking advice because of concern about adversely impacting mental health.ConclusionsPregnant women with mental disorders appear more motivated, yet find it more difficult, to stop smoking. Prioritisation of mental health over smoking may therefore lead to increasing health inequality for this group. Research into effective smoking cessation interventions is required for those with mental disorders.

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

“…[110][111][112][113][114][115][116][117][118][119][120] This is a consistent finding in the literature that has been described since members of our team first conducted research with disadvantaged women in the 1970s. 151 The importance of smoking to reduce stress was also described by partners and HPs.…”

Fatores associados ao uso nocivo do tabaco durante a gestação

“…(17) Therefore, actions to assist pregnant women with mental disorders to quit smoking since the beginning of pregnancy should be considered for the promotion of mother and fetus health, as well as the interaction of health care teams of women and those dedicated to tobacco control, since the strategies usually applied to the general population in the cessation of smoking should be modified for pregnant women with mental disorders. (8) Successful and strongly indicated experiences are brief interventions, led by cognitive therapy framework. (6) A survey raised the difficulties of a pregnant woman with mental disorder, construction and training for specific coping.…”

“…(6) A survey raised the difficulties of a pregnant woman with mental disorder, construction and training for specific coping. (8) A previous study of pregnant women was conducted in the USA and revealed that alcohol provides an increase in both use of tobacco and in its dependency on the gestational period. (18) During pregnancy, the prevalence of the alcohol was lower (15%) than that of tobacco (46%) increasing with the multiuse (44%) of drugs such as alcohol, tobacco and cannabis.…”

“…Presence of depressive symptoms and no help in mental disease or smoking cessation makes the cessation of its use more complex, with predictable consequences to the fetus. (8) It is also noteworthy that in Latin America one third of pregnant women manifests depressive symptoms during prenatal care in the first weeks of pregnancy. Protective factors for depressive symptoms during pregnancy are associated with a higher socioeconomic status and…”

“…(2) On a personal level, the routinely use of other psychoactive substances, both licit and illicit, was significantly associated with tobacco use during pregnancy. (8) The quality of mental health of pregnant women and recidive of mental illnesses were also described as smoking predictor during that period. (9) Some women abandon tobacco use when they discover the pregnancy, but there are a significant number of women who continue to use it.…”