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Better smoking interventions needed for pregnant women with mental disorders

Pregnant women with mental health disorders were less likely to quit smoking by the time of delivery compared with pregnant women without mental health disorders, researchers at King’s College London reported. The study results underscore the importance of addressing the barriers to quitting smoking for pregnant women with mental health disorders.

“It is plausible that modification of smoking cessation interventions or contemporaneous delivery of mental health interventions alongside a smoking cessation programme are needed to improve smoking, obstetric and mental health outcomes,” the researchers wrote.

The researchers obtained the case notes of 400 pregnant women who reported smoking at the time of their first appointment at an inner city maternity service from January 2010 to May 2011. Approximately one-quarter of the pregnant women were diagnosed with a mental health disorder, which included depression, schizophrenia and eating disorders. A total of 237 women (59.3%) accepted referrals to smoking cessation services.

Pregnant women with mental health disorders were more likely to accept referrals vs. pregnant women without mental health disorders (69% vs. 56%; adjusted OR=1.70; 95% CI, 1.03-2.79). However, pregnant women were more likely to still smoke at the time of delivery (69% vs. 56%; AOR=2.63; 95% CI, 1.41-4.92).

The researchers interviewed an additional 27 pregnant smokers, both with and without mental health disorders, to better understand the barriers to smoking cessation.

“The perceived barriers to quitting were common among both groups, and the additional psychological condition of the women with mental disorders is clearly a major factor contributing to them not stopping smoking,” study researcher Louise Howard, PhD, said in a press release. “The women who we interviewed said that they and their doctors prioritized their mental health over their smoking problem as they were worried that if they tried to stop smoking their mental health could deteriorate.”

Howard and colleagues argued for more investigations of smoking cessation interventions for pregnant women with mental health disorders.

“At the maternity service level, there is clearly unrealized potential for health professionals to improve their interactions regarding smoking when seeing pregnant women with mental disorders,” they wrote. “Otherwise, the failure to overcome barriers to smoking cessation will continue to compound intergenerational health impacts and inequities for vulnerable and deprived women.”

Disclosure: The researchers reported no relevant financial disclosures.