Factors Associated with Smoking Relapse in the Early Postpartum Period: A Prospective Longitudinal Study in Spain

A high proportion of women who quit smoking during pregnancy relapse during the postpartum period. However, research on smoking relapse in the early postpartum period is scarce. The aims of this study were to estimate rates of smoking relapse at 2 months postpartum and to analyze the factors (sociodemographic, psychological and pregnancy- and tobacco-related variables) involved in relapse and maintenance of abstinence.

Eight hundred and fifty-three pregnant women in Spain were interviewed in the first and third trimesters of pregnancy and 2 months postpartum. Assessment included administration of an ad hoc questionnaire, to obtain socio-demographic and obstetric data and determine tobacco consumption status, the State Anxiety Inventory and the Edinburgh Postnatal Depression Scale. Biochemical tests were used to confirm smoking abstinence at each assessment. The study sample consisted of 125 women who smoked before becoming pregnant and who had spontaneously quit smoking during pregnancy.

At 2 months postpartum, 17.6% of the sample had relapsed. Stepwise logistic regression analysis showed that the women significantly most likely to relapse in the early postpartum period were those who quit smoking later than the first month of pregnancy (OR = 18.51), those with high levels of anxiety (OR = 6.15) and those who smoked more cigarettes before pregnancy (OR = 4.91).

The moment of smoking cessation during pregnancy, the level of consumption prior to pregnancy and anxiety levels should be considered in interventions aimed at maintaining smoking abstinence in pregnant women and preventing postpartum relapse.