Correlates of postpartum smoking relapse: Results from the pregnancy risk assessment monitoring system (PRAMS)

doi:10.1016/S0749-3797(00)00198-7

American Journal of Preventive Medicine

Volume 19, Issue 3, October 2000, Pages 193-196

https://doi.org/10.1016/S0749-3797(00)00198-7 Get rights and content

Abstract

Background: Using population-based data from the Pregnancy Risk Assessment Monitoring System (PRAMS), this study examines the prevalence and intensity of smoking before, during, and after pregnancy, and identifies correlates of postpartum smoking relapse.

Methods: Women who delivered live births in 1996 responded to a mailed questionnaire approximately 2 to 6 months after delivery (N =17,378). Data from 10 states participating in PRAMS were included in the study, and the overall participation rate was 75%. Analyses were adjusted for survey design and sampling strategy. Logistic regression analysis identified independent correlates of smoking relapse.

Results: Overall, 25.6% of women reported cigarette smoking before pregnancy. Among women who smoked before pregnancy, 44.5% quit during pregnancy. Among women who quit during pregnancy, half relapsed by the time of the survey. Independent correlates associated with increased risk of postpartum relapse included African American race/ethnicity, multiparity, high maternal weight gain, late or no prenatal care, and stressful life events.

Conclusions: Correlates of postpartum smoking relapse identified by this study may contribute to the development of effective and targeted interventions to maintain long-term smoking cessation.

Introduction

W omen often quit smoking during pregnancy (20% to 40%),1, 2, 3 but relapse to smoking after pregnancy is high (50% to 80% within 6 months).3, 4, 5, 6, 7 Many studies have examined predictors of quitting during pregnancy,1, 2, 5, 6, 8, 9, 10 but our understanding of predictors of return to smoking postpartum is limited.2, 3, 5, 11 A clearer understanding of correlates of postpartum relapse could assist in the design of effective interventions and contribute to long-term smoking cessation. This study examines the prevalence and intensity of smoking before, during, and after pregnancy, and identifies correlates of postpartum smoking relapse in a population-based sample of recent live births.

Section snippets

Methods

The Pregnancy Risk Assessment Monitoring System (PRAMS) collects data from women who recently delivered a live-born infant, using stratified, systematic samples (ranging from 100 to 250 per state per month) derived from birth certificates.12, 13 Questionnaires are mailed 2 to 6 months postpartum, and responses are linked with birth certificates. We examined data on births delivered in 1996 in the ten participating states with response rates of >70% (Arkansas, Alabama, Florida, Georgia, Maine,

Results

Most women in the study sample were aged 20 to 34 years (88.3%), Caucasian (76.8%), married (68.2%), and had at least a high school education (80.4%), and most entered prenatal care during the first trimester (87.2%). Most infants (99%) were 2 to 6 months old at the time of the survey; median age was 3.4 months.

Overall, 25.6% of women reported cigarette smoking before pregnancy (Table 1). Among women who smoked before pregnancy, 44.5% reported quitting during pregnancy

Discussion

Among women who reported quitting smoking during pregnancy, almost half relapsed to smoking within several months after delivery, which is in general agreement with previous studies.5, 7, 10, 15, 16 From a behavioral perspective, high rates of postpartum relapse are surprising because most women quit early in pregnancy and maintain quitting until delivery; therefore, they have maintained quit status for a significant length of time.15 Susceptibility to relapse after delivery appears to be more

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Breastfeeding duration is positively associated with decreased smoking relapse in the postpartum period
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A significant proportion of women quit smoking during pregnancy, creating a unique window of opportunity to encourage long-term smoking cessation. Efforts to prevent smoking relapse in the postpartum period, however, have largely been ineffective. We investigated the association between breastfeeding duration and smoking relapse to help inform postpartum smoking cessation strategies.
The Ulm SPATZ Health Study consists of 1006 newborns and their 970 mothers recruited from April 2012 to May 2013 in Ulm, Germany. For this analysis, only mothers who quit smoking during pregnancy, for whom breastfeeding and smoking data were available, were included. Kaplan-Meier plots were used to investigate the relationship between breastfeeding duration and postpartum smoking relapse within 2 years. Cox proportional hazards regression models were used to estimate hazard ratios, adjusted for factors reported to influence postpartum smoking outcomes.
A total of 115 mothers were included. They had a mean age of 32.0 (SD: 5.0) years and breastfed for 5.6 (SD: 4.4) months. Of those who remained in the study, 14 (12.2%) experienced smoking relapse by 6 weeks and 48 (51.1%) relapsed by 2 years. In an adjusted analysis which accounted for age, educational attainment, postpartum weight retention, and gestational weight gain, breastfeeding for at least 6 months was significantly associated with decreased smoking relapse within 2 years (HR: 0.18; 95% CI: 0.07 - 0.45).
Breastfeeding for at least 6 months was associated with decreased postpartum smoking relapse. Breastfeeding promotion should be considered to enhance smoking cessation strategies in the postpartum period.
Factors associated with post-partum smoking relapse in Taiwan: A trial of Smoker's helpline
2019, Taiwanese Journal of Obstetrics and Gynecology
Many women quit smoking during pregnancy resume in postpartum period and difficult to prevent. No studies had focused on their psychosocial response in Taiwan. We analyzed data from a trial of Taiwan Smoker's Helpline (TSH) to determine factors associated with smoking relapse after delivery.
A prospective cohort was conducted at Taipei City Hospital during Sep. 2014 and Nov. 2015 period. We collected data by self-developed questionnaire combining theory of planned behavior (TPB), Fagerstrom test for nicotine dependence (FTND) and Edinburgh Postnatal Depression Scale (EPDS) from 68 women immediately after delivery, 2 months later and followed up until 6 months. Multivariable logistic models for relapse of smoking at the end of 3rd month and 6th month were created.
At 6th month, 42.6% participants relapsed with odds lower among first parity (OR = 0.04, 95% CI = <0.01–0.54, p = 0.015), having quitting experience in past (OR = 0.09, 95% CI = 0.01–0.84, p = 0.019) and higher perceived behavior control (PBC) (OR = 0.99, 95% CI = 0.98–1.00, p = 0.035), but greater for those with longer smoking duration in past (OR = 1.29, 95% CI = 1.04–1.58, p = 0.018).
Protective and precipitating factors to post-partum's smoking relapse were identified in our study.
Using time-to-event analysis to identify preconception and prenatal predictors of child protective services contact
2018, Child Abuse and Neglect
We examined preconception and prenatal predictors of time to first child protective services (CPS) contact among Alaska children. Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a population-representative data source linking 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) data with administrative data sources through 2015. We examined the incidence CPS contact using the Kaplan-Meier method and predictors of CPS contact using Cox proportional hazards regression. Using data from the Alaska Permanent Fund Dividend and Child Death Review, we censored children who emigrated out-of-state or died during the study period. Significant predictors included low socioeconomic status (HR = 2.23, 95% CI 1.68, 2.96), maternal smoking during pregnancy (HR = 1.87, 95% CI 1.55, 2.24), unmarried maternal marital status (HR = 1.62, 95% CI 1.31, 1.99), urban residence (HR = 1.59, 95% CI 1.32, 1.92), lower maternal education (HR = 1.54, 95% CI 1.24, 1.92), maternal experience of intimate partner violence in the 12 months before childbirth(HR = 1.32, 95% CI 1.01, 1.74), Alaska Native/American Indian race (HR = 1.40, 95% CI 1.15, 1.71), a greater number of living children (HR = 1.20, 95% CI 1.13, 1.29), a greater number of stressful life eventsin the 12 months before childbirth (HR = 1.16, 95% CI 1.11, 1.21), and younger maternal age at childbirth (HR = 0.95, 95% CI 0.93, 0.97). Use of multiple linked data sources and time-to-event analysis methods adds to the growing literature regarding predictors of CPS contact. Results suggest that assessing for and addressing clinical, social, and environmental indicators during the prenatal period may aid prevention efforts in mitigating family need for involvement with CPS.
Moderators and mediators of the relationship between receiving versus being denied a pregnancy termination and subsequent binge drinking
2016, Drug and Alcohol Dependence
Citation Excerpt :
This paper also presents findings from mediation analyses that test two hypothesized pathways through which terminating versus continuing an unwanted pregnancy relates to subsequent binge alcohol use: stress/coping and social roles. Stressful events have been linked to alcohol use in general (Hasin et al., 2007), heavy drinking in pregnancy (May et al., 2000), and postpartum tobacco relapse (Carmichael and Ahluwalia, 2000). Pregnancy termination has been hypothesized as a stressful or traumatic event resulting in alcohol and drug disorders (Coleman, 2005; Coleman et al., 2005, 2002; Pedersen, 2007).
Women who terminate pregnancies drink more subsequent to the pregnancy than women who give birth, including women who give birth after seeking to terminate a pregnancy.
Data are from the Turnaway Study, a prospective, longitudinal study of 956 women who sought to terminate pregnancies at 30 U.S. facilities. This paper focuses on the 452 women who received terminations just below facility gestational limits and 231 who were denied terminations because they presented just beyond facility gestational limits. This study examined whether baseline characteristics moderate the relationship between termination and subsequent binge drinking and whether stress, feelings about the pregnancy, and number of social roles mediate the relationship.
Only having had a previous live birth modified the termination–binge drinking relationship. Among women with previous live births, binge drinking was reduced among women carrying to term compared to terminating the pregnancy. Among women who had not had a previous live birth, however, the reduction in binge drinking among those denied termination was not sustained over time, and binge drinking of those who had and had not had terminations converged by 2.5 years. Neither stress, negative emotions, nor social roles mediated effects on binge drinking. Positive emotions at one week mediated effects on binge drinking at six months, although positive emotions at two years did not mediate effects on binge drinking at 2.5 years.
Higher levels of binge drinking among those who terminate pregnancies do not appear due to stress or to negative emotions. Only parous women – and not nulliparous women – denied terminations experienced sustained reductions in binge drinking over time.
The Relationship Between Postpartum Depression and Perinatal Cigarette Smoking: An Analysis of PRAMS Data
2015, Journal of Substance Abuse Treatment
This study examines the relationship between postpartum depression (PPD) and cigarette smoking from prior to pregnancy to postpartum.
The study sample consisted of 29,654 U.S. women who reported smoking in the 3 months prior to pregnancy and for whom data on PPD were available from the Pregnancy Risk Assessment Monitoring System (PRAMS). Two sets of analyses were conducted. The first compared smoking at 2 time points (prior to pregnancy and postpartum) and the second at 3 time points (prior to pregnancy, during pregnancy, and postpartum). PPD was defined as responses of “often” or “always” to 2 questions: "Since your baby was born, how often have you felt down, depressed, or sad?" and “Since your new baby was born, how often have you had little interest or little pleasure in doing things?”
Overall, 22% of the sample endorsed PPD symptoms. In the 2 time-point analysis, controlling for known confounders, participants whose smoking was reduced or unchanged postpartum were about 30% more likely to have PPD compared to those who quit (OR: 1.34; 95% CI = 1.10–1.60, p = 0.001; OR:1.32; 95% CI: 1.10–1.50, p < 0.001 respectively). Participants who increased smoking postpartum were 80% more likely to have PPD compared those who quit (OR: 1.80; 95% CI: 1.50–2.30, p < 0.001). In the 3 time-point analysis, participants who continued smoking at any level during pregnancy and postpartum had 1.48 times the odds of reporting PPD (95% CI: 1.26, 1.73) compared to those who quit during pregnancy and remained quit postpartum. Participants who quit during pregnancy but resumed postpartum had 1.28 times the odds of reporting PPD (95% CI: 1.06, 1.53) compared to those who quit during pregnancy and remained quit postpartum.
Results suggest an association among women who smoke cigarettes prior to pregnancy between PPD and continued smoking during pregnancy and postpartum.
Smoking Cessation During Pregnancy and Relapse After Childbirth in Canada
2015, Journal of Obstetrics and Gynaecology Canada
This analysis was undertaken to determine the rates and determinants of smoking cessation during pregnancy and smoking relapse after childbirth in Canada.
We used data from the Maternity Experiences Survey, a cross-sectional study of mothers who gave birth to a singleton baby in Canada in 2006. A total of 1586 mothers who smoked occasionally or daily before pregnancy were included in the analysis.
The rate of smoking cessation during pregnancy was 53.0% (95% CI 50.3% to 55.7%). Higher pre-pregnancy smoking frequency, Inuit origin, being aged ≥ 35 years, lower education, not attending prenatal classes, lack of social support, stress before or during pregnancy, and living with a smoker were independently associated with higher risk of continued smoking, while First Nations (off-reserve) origin was associated with a lower risk. Among those who had quit smoking, 47.1% (95% CI 43.5% to 50.6%) relapsed postpartum. Living with a smoker, not having breastfed, and having stopped breastfeeding were independently associated with a higher risk of relapse.
This study highlights the need to tailor smoking cessation and prevention interventions for some high-risk groups of women.
Cette analyse a été menée pour déterminer les taux et les déterminants de l’arrêt tabagique pendant la grossesse et de la rechute post-partum au Canada.
Nous avons utilisé les données de l’Enquête sur l’expérience de la maternité, soit une étude transversale sur des mères ayant accouché à la suite d’une grossesse simple au Canada en 2006. En tout, 1 586 mères ayant fumé occasionnellement ou quotidiennement avant la grossesse ont été incluses dans l’analyse.
Le taux d’arrêt tabagique pendant la grossesse était de 53,0 % (IC à 95 %, 50,3 % - 55,7 %). Une consommation de cigarettes plus élevée avant la grossesse, être d’origine inuite, être âgée de 35 ans ou plus, être moins scolarisée, la non-participation à des cours prénataux, le manque de soutien social, le stress avant ou pendant la grossesse et la cohabitation avec un fumeur étaient associés de façon indépendante à un risque accru de poursuite du tabagisme, tandis que le fait d’être issue des Premières Nations (hors-réserve) était associé à un risque moindre. Parmi les mères qui avaient cessé de fumer, 47,1 % (IC à 95 %, 43,5 % - 50,6 %) ont recommencé à fumer après l’accouchement. La cohabitation avec un fumeur, ne pas avoir allaité et avoir cessé d’allaiter étaient associés de façon indépendante à un risque accru de rechute.
Cette étude souligne la nécessité d’adapter les interventions d’abandon et de prévention du tabagisme aux groupes de femmes exposées à des risques élevés.

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¹: The PRAMS Working Group is composed of the following individuals from states with PRAMS programs: Alabama, Albert Woolbright; Alaska, Kathy Perham-Hester; Arkansas, Gina Redford; Colorado, Marilyn Leff; Florida, Richard Hopkins; Georgia, Tonya Johnson; Illinois, Bruce Steiner; Louisiana, Danielle Broussard; Maine, Martha Henson; New Mexico, Susan Nalder; New York, Michael Medvesky; North Carolina, Paul Buescher; Ohio, Jo Bouchard; Oklahoma, Richard Lorenz; South Carolina, Alexandra Connelly; Utah, Nan Streeter; Washington, Sherilyn Casey; and West Virginia, Melissa Baker.

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Brief reportCorrelates of postpartum smoking relapse: Results from the pregnancy risk assessment monitoring system (PRAMS)

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Addict Behav

Prev Med

Prev Med

Prev Med

Am J Prev Med

Semin Perinatol

Addict Behav

Addict Behav

Smoking before, during, and after pregnancy

Am J Public Health

Smoking during pregnancyprevalence, effects, and intervention strategies

Birth

Smoking among low-income, pregnant womenprevalence rates, cessation interventions, and clinical implications

Birth

Smoking reduction during pregnancy by a program of self-help and clinical support

Obstet Gynecol

Brief report
Correlates of postpartum smoking relapse: Results from the pregnancy risk assessment monitoring system (PRAMS)