Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort

Abstract

ObjectivesPregnancy motivates women to try stopping smoking, but little is known about timing of their quit attempts and how quitting intentions change during pregnancy and postpartum. Using longitudinal data, this study aimed to document women’s smoking and quitting behaviour throughout pregnancy and after delivery.DesignLongitudinal cohort survey with questionnaires at baseline (8–26 weeks’ gestation), late pregnancy (34–36 weeks) and 3 months after delivery.SettingTwo maternity hospitals in one National Health Service hospital trust, Nottingham, England.Participants850 pregnant women, aged 16 years or over, who were current smokers or had smoked in the 3 months before pregnancy, were recruited between August 2011 and August 2012.Outcome measuresSelf-reported smoking behaviour, quit attempts and quitting intentions.ResultsSmoking rates, adjusting for non-response at follow-up, were 57.4% (95% CI 54.1 to 60.7) at baseline, 59.1% (95% CI 54.9 to 63.4) in late pregnancy and 67.1% (95% CI 62.7 to 71.5) 3 months postpartum. At baseline, 272 of 488 current smokers had tried to quit since becoming pregnant (55.7%, 95% CI 51.3 to 60.1); 51.3% (95% CI 44.7 to 58.0) tried quitting between baseline and late pregnancy and 27.4% (95% CI 21.7 to 33.2) after childbirth. The percentage who intended to quit within the next month fell as pregnancy progressed, from 40.4% (95% CI 36.1 to 44.8) at baseline to 29.7% (95% CI 23.8 to 35.6) in late pregnancy and 14.2% (95% CI 10.0 to 18.3) postpartum. Postpartum relapse was lower among women who quit in the 3 months before pregnancy (17.8%, 95% CI 6.1 to 29.4) than those who stopped between baseline and late pregnancy (42.9%, 95% CI 24.6 to 61.3).ConclusionsMany pregnant smokers make quit attempts throughout pregnancy and postpartum, but intention to quit decreases over time; there is no evidence that smoking rates fall during gestation.

Electronic cigarettes and obstetric outcomes: a prospective observational study

“…There are no longitudinal data on changes in electronic cigarette use in pregnancy. However, previous studies have shown that antenatal tobacco smoking status generally remains stable …”

“…However, previous studies have shown that antenatal tobacco smoking status generally remains stable. 33,34 Secondly, we recorded self-reported smoking status and self-reported EC use. A previous study in our hospital suggests that a further 10% of smokers would be identified if breath carbon monoxide testing was used in conjunction with self-reporting.…”

Smoking in pregnancy: pathophysiology of harm and current evidence for monitoring and cessation

“…Many women report quitting spontaneously when pregnancy is confirmed, often within the first few days . Factors associated with spontaneous cessation include living in a household with a non‐smoking partner, smoking fewer cigarettes per day, a previously successful quit attempt and more awareness of the negative consequences of smoking . Women who quit in early pregnancy are more likely to maintain cessation than are those who quit later …”

“…Prospective longitudinal data suggest there is little change in smoking status from the second trimester onwards, and in fact intention to quit falls as the pregnancy progresses and in the postpartum period . Nonetheless, women may be planning to quit at any time during pregnancy and therefore smoking status and motivation to quit should be re‐addressed at each visit.…”

“…Unfortunately, there is a high rate of relapse, with many women smoking again before the end of pregnancy and in the early postnatal period . Less than a third of spontaneous quitters in pregnancy remain abstinent 1 year postpartum .…”