The relationship between maternal depression and smoking cessation during pregnancy—a cross-sectional study of pregnant women from 15 European countries

Abstract

Epidemiologic studies have reported an association between depression and continuing smoking during pregnancy. However, differences in study design and methodology challenge study comparability. The purpose of this study was to examine the relationship between maternal depression and continuing smoking among pregnant European women while adjusting for maternal characteristics. This multinational, web-based study evaluated pregnant women in 15 European countries recruited from October 2011 to February 2012. Data on depression status, smoking habits, maternal socio-demographic characteristics, and life-style factors were collected via an anonymous online questionnaire. Associations were estimated with logistic regression. Of 4,295 women included, 1,481 (34.5 %) reported smoking before pregnancy, and 391 (26.4 %) continued smoking during pregnancy whereof 127 (32.5 %) were depressed. The association between depression and continuing smoking during pregnancy were uniform across the European countries (OR 2.02, 95 % CI 1.50-2.71), with about twice the prevalence of continuing smoking among the depressed. There was a strong relationship between continuing smoking in pregnancy and low education level (OR 4.46, 95 % CI 2.72-7.32), which coincided with risky pregnancy behavior such as failure to attend pregnancy/birth preparation courses (OR 1.80, 95 % CI 1.19-2.72) and follow recommended use of folic acid (OR 1.81, 95 % CI 1.23-2.65). Women who perceived the risk for the fetus of continued smoking during pregnancy as higher were the least likely to continue smoking during pregnancy (OR 0.72, 95 % CI 0.68-0.77). This underlines the clustering of risk in some pregnant women, and the results should guide antenatal care of depressed women struggling to quit smoking during pregnancy.

Smoking during pregnancy in the United States, 2005–2014: The role of depression

“…More research is needed to determine racial disparities related to reasons for smoking during pregnancy in this group, to inform the development of more effective and targeted prevention and intervention efforts. In addition, we found that the relation between depression and smoking during pregnancy was significant among all education levels and strongest among women with a college degree or higher; this is contrary to findings relating maternal depression and continued smoking to be highest among women in the lowest educational stratum (Smedberg et al, 2015). We do note, however, that these educational differences are most likely related to the small number of smokers in the higher education group as reflected in the wide confidence intervals.…”

Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy – A Review

“…It was particularly difficult for the pregnant woman to stop smoking if her partner smoked [35]. In addition to social characteristics there was repeated evidence for the existence of mental health problems or stress among pregnant women who smoked, usually in the form of increased depression and anxiety scores [51,53,54,59,68]. Women who continued to smoke during pregnancy were almost twice as likely to be depressed compared to women who had stopped smoking [68].…”

“…In addition to social characteristics there was repeated evidence for the existence of mental health problems or stress among pregnant women who smoked, usually in the form of increased depression and anxiety scores [51,53,54,59,68]. Women who continued to smoke during pregnancy were almost twice as likely to be depressed compared to women who had stopped smoking [68]. Critical life events and high levels of perceived stress could also make it more difficult to quit smoking during pregnancy [54].…”

Serious Psychological Distress and Smoking During Pregnancy in the United States: 2008–2014

“…First, current information on the relationship between mental health problems and smoking among pregnant women is needed, as the most recent data on the link between mental health problems and prenatal smoking in the United States are nearly a decade old, 25 though recent data from various countries suggest a persistent problem. 43 Second, in previous research, the timeframes used for the assessment of mental health problems in terms of the proximity to cigarette use during pregnancy were approximate. 25,43 It remains unclear whether the positive associations are limited to pregnant women whose mental health problems are current, or if those with a recent history of mental health problems are also at risk for prenatal smoking.…”