Discussion : Among women who quit smoking during pregnancy, a worsening of depressive and stress symptoms over 12 weeks postpartum was associated with an increased risk of smoking by 24 weeks.
IntroductionApproximately one third of female smokers quit once they learn that they are pregnant ( Fingerhut, Kleinman, & Kendrick, 1990 ;Floyd, Rimer, Giovino, Mullen, & Sullivan, 1993 ;LeClere & Wilson, 1997 ;Severson, Andrews, Lichtenstein, Wall, & Zoref, 1995 ), but up to two thirds of women who stop smoking during pregnancy relapse within 6 months after delivery ( Colman & Joyce, 2003 ;Fingerhut et al., 1990 ;Martin et al., 2008 ;McBride & Pirie, 1990 ;McBride, Pirie, & Curry, 1992 ;Ratner, Johnson, Bottorff, Dahinten, & Hall, 2000 ). Women who remain tobacco abstinent after delivery experience health benefi ts that include protection of infants from secondhand smoke exposure, lower risk of poor pregnancy outcomes in subsequent pregnancies, and decreased personal risk of tobacco-related health problems ( Mullen, 2004 ). To increase the proportion of women who maintain tobacco abstinence after delivery, it is necessary to understand the modifi able factors associated with postpartum relapse to smoking.In the general population, depression, anxiety, and stress are more common among smokers than nonsmokers; these factors are barriers to smoking cessation and triggers for relapse
AbstractIntroduction : The aim of this prospective repeated measures, mixed-methods observational study was to assess whether depressive, anxiety, and stress symptoms are associated with postpartum relapse to smoking.Methods : A total of 65 women who smoked prior to pregnancy and had not smoked during the last month of pregnancy were recruited at delivery and followed for 24 weeks. Surveys administered at baseline and at 2, 6, 12, and 24 weeks postpartum assessed smoking status and symptoms of depression (Beck Depression Inventory [BDI]), anxiety (Beck Anxiety Inventory [BAI]), and stress (Perceived Stress Scale [PSS]). In-depth interviews were conducted with women who reported smoking.Results : Although 92% of the participants reported a strong desire to stay quit, 47% resumed smoking by 24 weeks postpartum. Baseline factors associated with smoking at 24 weeks were having had a prior delivery, not being happy about the pregnancy, undergoing counseling for depression or anxiety during pregnancy, and ever having struggled with depression ( p < .05). In a repeated measures regression model, the slope of BDI scores from baseline to the 12-week follow-up differed between nonsmokers and smokers ( − 0.12 vs. +0.11 units/week, p = .03). The slope of PSS scores also differed between nonsmokers and smokers ( − 0.05 vs. +0.08 units/week, p = .04). In qualitative interviews, most women who relapsed attributed their relapse and continued smoking to negative emotions.