Maternal-fetal attachment differentiates patterns of prenatal smoking and exposure

Smoking cessation during pregnancy may reflect altruistic motives on behalf of the unborn baby. We test the hypothesis that pregnancy quitters have higher maternal-fetal attachment than persistent smokers, and secondarily explore how maternal-fetal attachment differs among non-smokers, pregnancy quitters, and persistent smokers.

Participants were 156 women in the Behavior and Mood in Babies and Mothers study who provided report of smoking throughout pregnancy via timeline follow back interviews, with salivary cotinine confirmation of reported cessation at 30 and 35 week gestation, and postpartum day one. Maternal Fetal Attachment Scale total and subscale scores (role-taking, differentiation of self from fetus, interaction with fetus, attributing characteristics to fetus, giving of self) were examined among non-smokers, pregnancy quitters, and persistent smokers.

At 30 weeks, pregnancy quitters scored higher on the 'giving of self' subscale compared to persistent smokers (21.6±2.4 versus 19.9±2.9; p=.004). Maternal 'giving of self' also differentiated pregnancies exposed to cigarette smoking from those without exposure from 30 weeks through delivery (19.9±2.9 versus 21.2±2.2; p=.002). Controlling for age, income, unemployment, gravida, and father's smoking status, 'giving of self' differentiated pregnancy quitters from persistent smokers [OR=5.144; 95% C.I. 1.509 - 17.538; B (SE)=1.638 (.626); p=.009].

Women who reported a greater desire to maintain their personal health for the health of their fetus were more likely to quit smoking during pregnancy. Implications of findings for interventions and understanding mechanisms of risk are discussed.