While many women who smoke successfully quit smoking during pregnancy, most of these women return to smoking within 12 months of delivery.  Several studies have suggested that certain factors may increase the risk of postpartum relapse, including unwanted pregnancy, multiparity, and stressful life events.  Two recent studies indicate that postpartum depressive symptoms may also increase the risk of smoking relapse after delivery.

The first study utilized data from the 2004 Pregnancy Risk Assessment Monitoring System (PRAMS) and included a total of 2566 women who reported smoking 3 months before pregnancy and reported abstinence from smoking during the last 3 months of pregnancy.  Women who experienced postpartum depressive symptoms were almost twice as likely to resume smoking as women who did not experience any depressive symptoms (OR= 1.86).  This finding persisted, even after controlling for a number of demographic characteristics, including intensity of smoking before pregnancy and time since delivery.

In the second study, 65 women who smoked prior to pregnancy and had not smoked during the last month of pregnancy were recruited and followed for six months after delivery. The following variables were assessed at delivery and at 2, 6, 12, and 24 weeks postpartum: smoking status, symptoms of depression or anxiety, and perceived levels of stress.

While 92% of the participants expressed a strong desire to abstain from cigarette smoking, 47% resumed smoking by six months postpartum.  Baseline factors associated with postpartum smoking relapse included multiparity, unwanted pregnancy, and history of depression prior to pregnancy.  Those women who experienced a worsening of depressive and/or stress symptoms during the first 12 weeks postpartum were at an increased risk of smoking relapse by 24 weeks.  Most women who relapsed attributed their relapse and continued smoking to negative emotions.

Both studies indicate that women who quit smoking during pregnancy may be more likely to relapse after delivery if they experience depressive symptoms.  Although women are highly motivated to quit smoking during pregnancy, they are at high risk for smoking relapse after delivery.  Anti-smoking interventions administered during pregnancy may help to reduce the risk of relapse after delivery.  Further research is needed to determine whether interventions that reduce the risk of postpartum depression may also reduce risk of smoking relapse.

Ruta Nonacs, MD PhD

Allen AM, Prince CB, Dietz PM. Postpartum depressive symptoms and smoking relapse. Am J Prev Med. 2009 Jan;36(1):9-12.

Park ER, Chang Y, Quinn V, Regan S, Cohen L, Viguera A, Psaros C, Ross K, Rigotti N. The association of depressive, anxiety, and stress symptoms and postpartum relapse to smoking: A longitudinal study. Nicotine Tob Res. 2009 May 12.