‘Substantial opportunity’ to prevent postpartum smoking relapse, improve maternal health
Key takeaways:
- Younger women were more likely to never smoke or experience postpartum relapse.
- White women had the highest smoking and relapse rates, but Black women were more likely to initiate postpartum smoking.
Smoking patterns during preconception, pregnancy and the postpartum period vary based on maternal age, race and ethnicity, geographical location and insurance type, according to a research letter published in JAMA Network Open.
“Our study shows that a significant percentage of people quit smoking during pregnancy only to resume smoking during the postpartum period,” Heidi Allen, MSW, PhD, associate professor at the School of Social Work at Columbia University, told Healio. “As people transition back into primary care settings after having a baby, this is a good opportunity to provide support to help them maintain abstinence. Additionally, policy efforts to promote abstinence, particularly in Medicaid, could have profound positive consequences for family health and health disparities.”
Allen and colleagues conducted a cohort study with longitudinal linked data from 4,547 postpartum women who gave birth in 2020, using birth certificates, the Pregnancy Risk Assessment Monitoring System and the Postpartum Assessment of Health Survey. Researchers measured self-reported maternal smoking at preconception, during pregnancy, early postpartum and late postpartum to assess smoking patterns and differences by age, race and ethnicity, insurance at birth and geography.
Overall, 54% of postpartum women were white, 58.4% were commercially insured and 89.1% lived in an urban or suburban area.
Smoking prevalence was 14.6% at preconception, 7.2% during pregnancy, 7% during early postpartum and 11.5% during late postpartum.
Postpartum women aged 18 to 24 years were less likely to report never smoking (5.2%) and more likely to relapse during postpartum (3.8%) if they quit smoking vs. those aged 30 to 34 years (5.8% and 1.1%, respectively) or 35 years or older (4.1% and 0.8%, respectively). White postpartum women had the highest rates of always smoking at 7.1% and postpartum relapse at 5.1% compared with other races and ethnicities. Black postpartum women were more likely to initiate smoking during postpartum vs. other races and ethnicities (P < .001).
Rural postpartum women had nearly three times higher always smoking rates compared with urban and suburban postpartum women (12.4% vs. 4.2%; P < .001). Postpartum women with Medicaid vs. commercial insurance were more likely to be always smokers (10% vs. 1.5%; P < .001) and to quit and resume smoking (5.5% vs. 2.6%; P < .01). Postpartum women with Medicaid insurance had higher smoking rates with an 11% decline from preconception to late postpartum vs. a 37% decline among women with commercial insurance.
In addition, 93.7% of women reported discussing smoking during prenatal care visits vs. 47.9% who discussed smoking during routine postpartum visits.
“These findings suggest that there is substantial opportunity to prevent smoking relapses and initiation in the postpartum year, which would promote the short- and long-term health of families,” the researchers wrote. “Individuals who are younger, Medicaid-insured, identify as white or Black and live in rural areas should be of particular focus.”
For more information:
Heidi Allen, MSW, PhD, can be reached at ha2332@columbia.edu and Bluesky: @prof-heidiallen.bsky.social.