Smoking Trajectories during the Perinatal Period and Their Risk Factors: The Nationally Representative French ELFE (Etude Longitudinale Française Depuis l'Enfance) Birth Cohort Study

Abstract

Background: In France, rates of perinatal smoking are among the highest worldwide; however, perinatal smoking trajectories and associated factors have still not been adequately researched. Methods: Among women participating in the French nationally representative etude longitudinale française depuis l'enfance birth cohort (n = 15,540), perinatal smoking trajectories were estimated using group-based modelling. Associated characteristics were studied using multinomial logistic regression. Results: Four trajectories were identified: non-smokers (59%), quitters (20%), persistent moderate (12%) and persistent heavy (9%) smokers. Older age, being native French, low socioeconomic position, persistent psychological difficulties and alcohol use in pregnancy, lack of social support, partner's smoking, mistimed pregnancy, and child formula feeding at birth were associated with persistent heavy smoking. Most of these factors were also associated, but to a lesser extent, with persistent moderate smoking, except for age and migrant status, which had opposite effects. Women who successfully lost weight prior to pregnancy had higher levels of quitting smoking. Conclusion: Women's long-term smoking trajectories vary in terms of initial tobacco consumption level but also in relation to socio-demographic, psychological, behavioral and partner characteristics. Health professionals in contact with pregnant smokers should address perceived risks and benefits of smoking, including partner's smoking and weight-gain concerns.

Maternal smoking trajectory during pregnancy predicts offspring’s smoking and substance use – The Northern Finland birth cohort 1966 study

“…In this study we found four trajectories of maternal smoking during pregnancy which is in line with previous studies ( Eiden et al, 2013 , El-Khoury et al, 2017 ). Each trajectory represented a distinct phenomenon of maternal smoking during pregnancy, however, all trajectories represented either continuous behavior or smoking cessation.…”

“…Among this population we did not identify any trajectories in which smoking was initiated or increased during pregnancy. However, the lack of such a trajectory is in line with previous studies ( Eiden et al, 2013 , El-Khoury et al, 2017 , Dukes et al, 2017 ). Notably, the clear majority (i.e.…”

“…The prevalence on pregnancy smoking is around 2% worldwide and 8% in Europe ( Lange et al, 2018 ). Previous studies have found four to seven different trajectories of maternal smoking during pregnancy ( Eiden et al, 2013 , El-Khoury et al, 2017 , Dukes et al, 2017 , De Genna et al, 2016 ). These trajectories represent different pathways and timings of smoking changes during pregnancy.…”

Socio-demographic and motivational correlates of smoking status at term and postpartum

“…In 54 studies reviewed, including 505 584 women, they were able to identify that predictors of cessation are: older maternal age, higher socio-economic status, overseas maternal birth, living with partner or married, lower exposure to passive smoking, low cigarette dependence, low exposure to second-hand smoking, not drinking alcohol before and/or during pregnancy, primiparity, perceived adequate prenatal care, planned breastfeeding, good mental health during pregnancy and higher levels of self-efficacy for quitting. This is consistent with another report based on a cohort study (El-Khoury et al, 2017).…”

Evolution of smoking rates among immigrants in France in the context of comprehensive tobacco control measures, and a decrease in the overall prevalence.

“…This categorization was motivated by previous research we conducted, where we showed that rst and second-generation immigrants to France from Africa and/or the Middle East have different smoking patterns individuals born elsewhere. [17,18] Due to French regulations, we were unable to ask more direct questions about perceived ethnicity, ethnic origin, or the country of birth. Due to their small effect size, rst and second generation immigrants were grouped together.…”