A recent study examines the relationship between postpartum depression (PPD) and cigarette smoking.  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).

Overall 22% of the sample reported PPD symptoms.  Women 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 did not resume smoking during the postpartum period. Controlling for known confounding variables, women whose smoking was reduced or unchanged during the postpartum were about 30% more likely to report PPD compared to those who quit.  Women 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).

These results suggest an association between PPD and continued smoking during pregnancy and the  postpartum period.  While we do not yet fully understand the nature of this association, we observe clinically that women with depression are less likely to quit smoking.  We also know that women with depressive symptoms are more likely to smoke during pregnancy and the postpartum period.

While there are many strategies targeted to decrease smoking in pregnant and postpartum women, this study argues that these interventions, in order to be maximally successful, must also take into consideration perinatal depression and its impact on smoking.

Ruta Nonacs, MD PhD

Salimi S, Terplan M, Cheng D, et al.  The Relationship Between Postpartum Depression and Perinatal Cigarette Smoking: An Analysis of PRAMS Data. J Subst Abuse Treat 2015.