High rate of smoking relapse after pregnancy
Smoking during pregnancy is associated with miscarriage, stillbirth and low birth weight, so helping pregnant women to quit is a major priority. Successful quitting, if maintained, also reduces the risk of cot death, protects future pregnancies and lessens the chance that the child will grow up to become a smoker.
The only problem is that many women who successfully quit smoking during pregnancy relapse soon after the baby is born. A study from the United States has looked in detail at the circumstances surrounding this first postpartum cigarette, so that recommendations may be made to health professionals on measures likely to prevent relapse in the postnatal period.
The researchers examined predictors of postpartum relapse in 87 women who quit smoking during pregnancy. The demographic, smoking history and psychosocial characteristics of those who relapsed were compared with those remaining abstinent, and the circumstances surrounding the first cigarette were investigated.
At six months after the birth, 48% of the women had relapsed. Of these women, 31% did so within the first 30 days after delivery, 39% between one and three months, and 30% between three and six months after delivery. Relapse was most likely to occur among women who smoked more heavily before pregnancy, had friends or relatives who smoked, and who had higher depression scores at the end of their pregnancy.
Almost two-thirds of relapses occurred when the women were around someone else who was smoking. At the time of lighting their first cigarette, two-thirds of the women were experiencing a high-energy negative emotion (such as stress, anxiety, anger or frustration). Almost one quarter were drinking alcohol when they relapsed.
This study reinforces the message that the postpartum period is a high-risk time for women who have quit smoking during pregnancy to relapse. Given the added stress of caring for a newborn baby this is perhaps no surprise, but it does remind us that pregnant women who quit smoking require support in the postnatal period as well as during pregnancy.
It is clear that the risk of relapse is greatly increased by coming into contact with other smokers, so wherever possible partners, family and friends should be involved in the attempt to quit, and social events where the patient could be exposed to smoking should be avoided.
Solomon LJ, Higgins ST, Heil SH et al. Predictors of postpartum relapse to smoking. Drug Alcohol Depend 2007; doi:10.1016/j.drugalcdep.2007.03.012author Reviewer
Dr Kevin Lewis
Former GP, Clinical Director of Smoking Cessation, Shropshire County Primary Care Trust