DURHAM, N.C. -- Many women stop smoking as soon as they find out they're pregnant. But shortly after giving birth, most of them will start lighting up again. That behavior is puzzling to health researchers who know that most other people who go nine months without a puff have become non-smokers.
As a consequence, a research study reported in the May issue of the American Journal of Public Health takes the first stab at trying to prevent pregnant women from resuming their smoking habits after their babies are born.
The researchers found that ongoing supportive counseling is needed to keep new moms off cigarettes because when the trial run of counseling ended, many of the women in the test program started smoking again.
"This is the first trial designed specifically to prevent smoking relapse in postpartum and to test different approaches to accomplish that," said one of the study leaders, Colleen McBride, associate professor at Duke University Medical Center. "It's important to try to help pregnant women stay off cigarettes in postpartum."
The trial included three groups of women who were patients at two managed care organizations in Seattle and Minneapolis. A booklet called Stop Now For Your Baby was given at the beginning of pregnancy to all three groups. A second group also got three telephone counseling calls before giving birth. The third group got telephone counseling before and after giving birth -- for a total of six calls -- along with parenting newsletters that included smoking information.
"Our primary question was whether intervention provided during pregnancy would be enough to prevent smoking relapse or if we had to extend into postpartum," explained McBride, interim director of Duke Comprehensive Cancer Center Cancer Control Program. "We got the best results by continuing intervention after the baby was born."
But while postpartum contact delayed relapse back to smoking habits, it didn't prevent relapse entirely. Six months after giving birth, the group of women who got the most attention were less likely to be smoking than the other two groups, but by a year all three groups had similar smoking rates.
"Cigarette smoking causes a lot of problems for mother and baby, and we need to find ways to encourage women to remain nonsmokers after the baby is born," McBride said.
Besides cigarettes' link to diseases like lung cancer and emphysema, there are known risks during pregnancy. Pregnant smokers are more likely to have low birth weight babies and complications during birth. Their babies are at higher risk for Sudden Infant Death Syndrome, and nicotine is passed to the baby in breast milk. Young children exposed to second-hand smoke have more upper respiratory infections.
"Some of these women have been non-smokers for seven to 10 months," McBride said. "Other groups of smokers who stay off cigarettes for 10 months are home free, but that's not true for pregnant women.
"We've been able to delay relapse in this study, but we need to do more," she said. "We need to build this type of support intervention into the women's social networks."
One of the major predictors of relapse is living with another smoker, so McBride is enlisting women's partners for help in a new study based at Ft. Bragg. She hopes this intervention will both prevent partners from smoking and give cessation support that will stick around. The final results are expected in a few years.
"Our first study relied on telephone counseling by a trained health educator, but someone the women didn't know. When that went away, the smoking came back," she said. "Partners have an equal investment in the child and could be a source of ongoing support."
Additionally, she said, it might be possible to train pediatricians to help prevent relapse through contact at well-baby visits.
McBride is also evaluating factors that influence pregnant women's return to smoking. Motivation for stopping is one of them. "It's likely if women stop just for the baby they'll resume as soon as they deliver," she said.
Another factor might be coping mechanisms. McBride said that during pregnancy a woman may simply avoid situations where she would normally want to smoke. When faced with them again, the woman may find that she hasn't developed skills to avoid temptation. Even if she hadn't wanted to smoke again, she could find herself with cigarette in hand.
Co-authors on the report are Susan Curry, with the Group Health Cooperative of Puget Sound and the University of Washington, Seattle; Harry Lando and Phyllis Pirie with the University of Minnesota at Minneapolis; and Lou Grothaus and Jennifer Nelson with the Center for Health Studies in Seattle. When the study began, McBride was at the Group Health Cooperative of Puget Sound and the University of Washington.
Journal
American Journal of Public Health