Stressful life events are associated with perinatal cigarette smoking

• Published in: Preventive medicine 2019-01, Vol.118, p.264-271
• Main Authors: Allen, Alicia M., Jung, Alesia M., Lemieux, Andrine M., Alexander, Adam C., Allen, Sharon S., Ward, Kenneth D., al'Absi, Mustafa
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cigarette smoking; Cigarette Smoking - adverse effects; Cross-Sectional Studies; Female; Humans; Life Change Events; Perinatal Care; Postpartum; PRAMS; Pregnancy; Recurrence; Smoking Cessation; Stress; Stress, Psychological - psychology; Surveys and Questionnaires; Young Adult
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2018.11.012

Perinatal smoking, including smoking during pregnancy and postpartum smoking relapse, is a persistent public health problem. While childhood trauma has been linked to perinatal smoking, less is known about the association with more proximal stressful life events (SLEs). The objective of this study was to examine the association between SLEs that occurred during the year prior to childbirth with perinatal smoking. Using the Pregnancy Risk Assessment Monitoring System 2009–2011, perinatal smoking was assessed at three time points: (1) three months prior to pregnancy, (2) the last three months of pregnancy, and (3) two to six months postpartum. Survey respondents endorsed up to 13 SLEs (i.e., death of someone close). SLEs were analyzed individually, as well as using a cumulative score (range 0–13). Weighted analyses included unadjusted and adjusted logistic regression. Among those who smoked prior to pregnancy (n = 15,316), 48% (n = 7308) reported quitting smoking during pregnancy. Of those, 44% (n = 3126) reported postpartum smoking relapse. A total of 11 SLEs were associated with smoking during pregnancy and 2 SLEs were associated with postpartum smoking relapse. The odds of continued smoking during pregnancy was 12% higher for each SLE endorsed (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI]: 1.09, 1.15) and this association was attenuated in relation to the odds of postpartum smoking relapse (aOR = 1.03, 95% CI: 0.99, 1.08). SLEs are associated with perinatal smoking. Additional research is needed to elucidate the mechanisms of action and to develop interventions specific to the needs of women who experience SLEs. •The prevalence of perinatal cigarette smoking (PCS) remains high despite known risks.•Stressful life events (SLEs) may increase the risk of PCS, but this is not yet known.•Continued smoking during pregnancy was significantly associated with 11 of 13 SLEs.•Postpartum smoking relapse was significantly associated with 2 of 13 SLEs.•SLEs are associated with PCS, especially continued smoking during pregnancy.