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Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort
  1. Sue Cooper1,
  2. Sophie Orton1,
  3. Jo Leonardi-Bee2,
  4. Emma Brotherton1,
  5. Laura Vanderbloemen3,
  6. Katharine Bowker1,
  7. Felix Naughton4,
  8. Michael Ussher5,
  9. Kate E Pickett6,
  10. Stephen Sutton7,
  11. Tim Coleman1
  1. 1 Division of Primary Care, University of Nottingham, University Park, Nottingham, UK
  2. 2 Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
  3. 3 Department of Primary Care and Public Health, Imperial College London, London, UK
  4. 4 School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
  5. 5 Population Health Research Institute, St George’s University of London, London, UK
  6. 6 Department of Health Sciences, University of York, York, UK
  7. 7 Behavioural Science Group, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Sue Cooper; Sue.cooper{at}nottingham.ac.uk

Abstract

Objectives Pregnancy motivates women to try stopping smoking, but little is known about timing of their quit attempts and how quitting intentions change during pregnancy and postpartum. Using longitudinal data, this study aimed to document women’s smoking and quitting behaviour throughout pregnancy and after delivery.

Design Longitudinal cohort survey with questionnaires at baseline (8–26 weeks’ gestation), late pregnancy (34–36 weeks) and 3 months after delivery.

Setting Two maternity hospitals in one National Health Service hospital trust, Nottingham, England.

Participants 850 pregnant women, aged 16 years or over, who were current smokers or had smoked in the 3 months before pregnancy, were recruited between August 2011 and August 2012.

Outcome measures Self-reported smoking behaviour, quit attempts and quitting intentions.

Results Smoking rates, adjusting for non-response at follow-up, were 57.4% (95% CI 54.1 to 60.7) at baseline, 59.1% (95% CI 54.9 to 63.4) in late pregnancy and 67.1% (95% CI 62.7 to 71.5) 3 months postpartum. At baseline, 272 of 488 current smokers had tried to quit since becoming pregnant (55.7%, 95% CI 51.3 to 60.1); 51.3% (95% CI 44.7 to 58.0) tried quitting between baseline and late pregnancy and 27.4% (95% CI 21.7 to 33.2) after childbirth. The percentage who intended to quit within the next month fell as pregnancy progressed, from 40.4% (95% CI 36.1 to 44.8) at baseline to 29.7% (95% CI 23.8 to 35.6) in late pregnancy and 14.2% (95% CI 10.0 to 18.3) postpartum. Postpartum relapse was lower among women who quit in the 3 months before pregnancy (17.8%, 95% CI 6.1 to 29.4) than those who stopped between baseline and late pregnancy (42.9%, 95% CI 24.6 to 61.3).

Conclusions Many pregnant smokers make quit attempts throughout pregnancy and postpartum, but intention to quit decreases over time; there is no evidence that smoking rates fall during gestation.

  • smoking cessation
  • pregnancy
  • longitudinal research
  • quit attempts
  • postpartum relapse
  • survey research

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors SC helped to conceive the study, made a substantial contribution to the development of the protocol and questionnaires, assisted with day-to-day troubleshooting during the data collection phase and drafted and revised this manuscript. SO helped to design the data collection process, recruited participants into the cohort, managed the day-to-day running, assisted with data analysis and contributed to the drafting of this manuscript. JL-B contributed to the development of the study protocol and questionnaires, advised on analysis and contributed to the preparation of this manuscript. EB undertook the analyses and interpretation of data in table 2 as part of a Bachelor of Medical Sciences project and contributed to the preparation of this manuscript. LV assisted with data analysis and interpretation and contributed to the preparation of this manuscript. KB helped to design the data collection process, recruited participants into the cohort, managed the day-to-day running and contributed to the preparation of this manuscript. FN, MU, KEP and SS all contributed to the development of the study protocol and questionnaires, contributing expertise from their own particular knowledge base, and to the preparation of this manuscript. TC conceived the study and made substantial contributions to the development of the study protocol and questionnaires and to the preparation of this manuscript. All authors read and approved the final manuscript. Rachel Whitemore assisted with study administration, telephone follow-ups and data entry.

  • Funding This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (grant number RP-PG 0109-10020). The views expressed in this paper are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. SC, SO, JL-B, KB, FN, MU, SS and TC are members of the UK Centre for Tobacco and Alcohol Studies (UKCTAS), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. UKCTAS receives core funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council and the Department of Health under the auspices of the UK Clinical Research Collaboration. SC, SO, KB, SS and TC are members of the NIHR School for Primary Care Research. TC acknowledges the support of the NIHR Collaboration for Leadership in Applied Health Research.

  • Competing interests KEP is a trustee of The Equality Trust (a registered charity) and receives occasional honoraria, all of which are donated to The Equality Trust or for student support at the University of York. In the last 5 years, TC has been paid honoraria on two occasions for speaking at meetings or conferences organised by Pierre Fabre Laboratories (a nicotine replacement therapy manufacturer).

  • Ethics approval Derbyshire Research Ethics Proportionate Review Sub-Committee gave ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The dataset is still subject to further analyses. Relevant anonymised data available from the authors on reasonable request.

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