The association of depressive, anxiety, and stress symptoms and postpartum relapse to smoking: A longitudinal study

Abstract

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.

Perinatal substance use: A prospective evaluation of abstinence and relapse

“…The high rates of relapse following delivery in this study are consistent with the smoking literature (Gyllstrom et al, 2012;Park et al, 2009;Tran et al, 2013;Yasuda et al, 2013) and the limited literature on postpartum relapse to alcohol and illicit substances (Ebrahim and Gfroerer, 2003;Gilchrist et al, 1996;Howell et al, 1999). However, the longitudinal nature of this study is unique and allows us to estimate the reduction of substance use over the course of pregnancy and the pattern of relapse in the first two years following delivery.…”

“…The majority of research has focused on smoking relapse postpartum (Colman and Joyce, 2003;Gyllstrom et al, 2012;Kaneko et al, 2008;Park et al, 2009;Ruger et al, 2008;Tong et al, 2008;Tran et al, 2013;Yasuda et al, 2013), with only a handful of studies looking at postpartum alcohol relapse (Ebrahim et al, 1998;Fleming, 2007a, 2007b;Nayak and Kaskutas, 2004). One of these studies found that at six to 12 weeks postpartum 37.8% of women who were frequent drinkers before pregnancy reported postpartum risky drinking, with 18% reporting heavy episodic drinking, 5% frequent drinking only and 15% reporting both behaviors (Jagodzinski and Fleming, 2007a).…”

Antenatal physical activity: Investigating the effects on postpartum depression

“…Moreover, women who reported smoking during pregnancy were more likely to report PPD symptomatology than their non-smoking counterparts [50,55,56]. Smoking during pregnancy has been previously established as associated with being multiparous, pregnancy unwantedness and current or previous diagnoses of depression [57]. In a recent study, smoking relapse 24 weeks postpartum was attributed to negative emotions [57], however the relationship between antenatal sedentary behavior and smoking on PPD is understudied and remains unclear.…”

Preventing postpartum smoking relapse among diverse low-income women: A randomized clinical trial

“…Treatment efficacy among low-income pregnant/postpartum women might be further enhanced by addressing the myriad of stressors common among such populations, including high levels of stress, negative affect and depression, and low levels of social support (Allen, Prince, & Dietz, 2009;Park et al, 2009;Reitzel et al, 2007). These, and other stressors (e.g., partner relational problems, financial difficulty), often derail women's attempts to maintain smoking abstinence (Ripley-Moffitt et al, 2008) and clearly warrant attention within a broader based treatment program.…”