Preventing Postpartum Smoking Relapse

Abstract

IMPORTANCE Most women who quit smoking during pregnancy will relapse postpartum. Previous efforts to prevent postpartum relapse have been unsuccessful at increasing rates of sustained abstinence. OBJECTIVE To evaluate the relative efficacy of 2 different approaches to prevent postpartum smoking relapse. DESIGN, SETTING, AND PARTICIPANTS Pregnant women who recently had quit smoking were recruited before the end of pregnancy. Intervention sessions were conducted through a combination of telephone calls and in-person visits beginning at delivery and continuing through 24 weeks postpartum. Participants completed assessments at the prenatal baseline and at 12, 24, and 52 weeks postpartum. Participants were recruited between March 2008 and December 2012. The dates of the analysis were April 2014 to February 2015. INTERVENTIONS Women received postpartum-adapted, behavioral smoking relapse prevention intervention and were randomly assigned to an enhanced cognitive behavioral intervention that included additional specialized strategies and content focused on women's postpartum concerns about mood, stress, and weight (Strategies to Avoid Returning to Smoking [STARTS]) or a supportive, time and attention-controlled comparison (SUPPORT). Intervention began before delivery and continued through 24 weeks postpartum. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically confirmed sustained tobacco abstinence at 52 weeks postpartum. Secondary outcomes were self-reported mood, levels of perceived stress, and degree of concern about smoking-related weight gain. RESULTS The study cohort comprised 300 participants (150 randomly assigned to each group). Their mean (SD) age was 24.99 (5.65) years. Overall, 38.0% (114 of 300), 33.7% (101 of 300), and 24.0% (72 of 300) of the sample maintained abstinence at 12, 24, and 52 weeks' postpartum, respectively. There were no differences between the intervention groups in abstinence or time to relapse. Self-reported depressive symptoms and perceived stress significantly improved over time, and improvements were similar for both intervention groups. Women with more depressive symptoms and higher levels of perceived stress were more likely to relapse (hazard ratio, 1.

Do Psychiatric Disorders or Measures of Distress Moderate Response to Postpartum Relapse Prevention Interventions?

“…In our recent trial of two cognitive-behavioral relapse prevention interventions delivered 6 months postpartum, we found high rates (24%) of biochemically-validated abstinence at 1 year postpartum, although no differences between the intervention conditions. 21 Our finding was similar to results from a recent trial comparing intensive smoking abstinence intervention to an information-only control condition. 22 In that trial, intervention and control content were delivered in the third trimester and throughout the first postpartum year, and no difference was found between conditions.…”

“…One possible explanation for the better abstinence rates in women with low distress in SUPPORT is that there was less effort involved with engaging in treatment (eg, less emphasis on and homework related to addressing psychosocial concerns). Although attendance rates were the same for each intervention (see Levine et al 21 ), it is possible that women were better able to engage in the less intensive, supportive behavioral intervention in the context of the postpartum period. Future studies that include qualitative data to better understand the treatment process and women's reactions to postpartum behavioral relapse prevention intervention are warranted.…”

“…Although treatments to address perinatal smoking have not consistently been successful in preventing relapse postpartum, 44 results of our recent trial 21 suggest interventions adapted to the specific demands on women during the postpartum period increase rates of sustained abstinence. In that trial, two behavioral smoking relapse prevention interventions were evaluated.…”

“…To maximize participation, and in light of our interest in lifetime psychiatric disorders, women who had already delivered (n = 66) were contacted postpartum to complete the SCID-I/NP within 55 weeks of delivery. However, the majority of women completed the interview, prenatally, at study enrollment (n = 215; see Levine et al 21 ). Diagnostic interviews that occurred during pregnancy were completed between 33 and 41 weeks gestation.…”

The Influence of Smoking on Breast feeding Among Women Who Quit Smoking During Pregnancy

“…Participants were enrolled in a relapse prevention trial among women who had quit smoking as a result of their pregnancy. 23 Pregnant women who smoked daily for at least 1 month during the 3 months prior to becoming pregnant, at least five cigarettes per day before quitting, had not smoked during the past 2 weeks, and were motivated to stay quit were recruited. At enrollment, smoking cessation was documented using the timeline follow-back methodology 24 and an expired-air carbon monoxide (CO) level less than or equal to 8 parts per million (ppm).…”