Although many women quit smoking during pregnancy, the majority resume smoking during the year following childbirth. By 4 months postpartum, approximately 50% of women have resumed smoking, and 60% to 70% of women have returned to smoking by 6 months postpartum (1
). The health risks of maternal pre- and postnatal smoking for infants have been well documented and include sudden infant death syndrome, ear infections, respiratory illness, and asthma (6
). Smoking also increases a woman's risk for cancer (8
), respiratory symptoms (12
), and reproductive complications (13
Research on postpartum relapse has documented several correlates of a woman's return to smoking (14
). One factor—having a partner who smokes—has received consistent support as a correlate of postpartum smoking (2
). In addition, alcohol use (16
), membership in a minority group (19
), higher levels of nicotine dependence (5
), and a lack of intention to remain quit after delivery (4
) have been related to relapse. In contrast, support for another frequently hypothesized risk factor—bottle- rather than breast-feeding—has been inconsistent (2
), with some studies reporting a protective effect of breast-feeding (2
) and others finding no effect of breast-feeding on postpartum smoking (17
Several lines of research also suggest that the extent to which a pregnant woman is motivated to remain abstinent after delivery relates to the likelihood of a resumption of smoking postpartum. First, motivation for smoking cessation during pregnancy is affected by a woman's beliefs about the consequences of smoking and her ratings of the temptation to smoke. Pregnant smokers rate the negative consequences of smoking as less important and experience more habit-related temptations than do nonpregnant smokers (21
). These differences in beliefs and temptations may affect a woman's motivation to sustain longer term cessation after the end of pregnancy.
Second, evidence suggests that the strategies used by women who quit smoking during pregnancy differ from those used by nonpregnant quitters. Specifically, regardless of the length of their cessation, pregnant quitters engage in fewer cognitive or experiential strategies, such as consciousness raising, self-reevaluation, or reevaluation of their environment, to modify their smoking behaviors than do nonpregnant female quitters (22
). Presumably, pregnant quitters rely more on external factors associated with pregnancy, such as social stigma and the health of the developing child, to achieve cessation. Stotts, DiClemente, Carbonari, and Mullen (18
) argued that because the coping strategies used to maintain cessation by pregnant women differ from those used by nonpregnant women, the resumption of smoking postpartum represents the end of a temporary suspension of smoking rather than a failure to maintain a long-term behavior change.
Finally, motivation for cessation during pregnancy predicts postpartum smoking. Curry, McBride, Grothaus, Lando, and Pirie (23
) examined the relation between motivation to quit during pregnancy and postpartum relapse. They found that women who relapsed during the first 2 months postpartum were less intrinsically motivated (i.e., motivated by health) and more extrinsically motivated (i.e., motivated by social consequences) to quit smoking during pregnancy than were those who remained abstinent postpartum. Thus, motivation for the maintenance of smoking abstinence after childbirth may be an important, and potentially modifiable, predictor of women's ultimate relapse to smoking postpartum. However, relatively little is known about factors that affect pregnant women's motivation to remain abstinent postpartum.
Two factors that may affect women's motivation to remain abstinent during the postpartum period are changes in mood and concerns about body shape and weight. A considerable number of women report the use of smoking to control their body weight (24
) or concerns about weight gain related to quitting smoking (26
). Evidence suggests that shape and weight concerns increase during the postpartum period (28
), and preliminary data indicate that concerns about weight (2
) relate to postpartum smoking. Thus, for vulnerable women, such as those who have a tendency to easily lose control over food intake, the resumption of smoking postpartum may represent an effort at weight control.
Similarly, many women experience an increase in depressive symptoms toward the end of pregnancy (30
), and depressive symptomatolgy is common in the postpartum period. Because mild levels of depressive symptomatology have been associated with a resumption of smoking, independent of nicotine dependence (33
), depressive symptoms also may decrease a woman's motivation to remain abstinent postpartum. Thus, both changes in mood and concerns about body shape and weight may play a role in women's attitudes toward smoking during the postpartum period (34
). However, the relation between these factors and a pregnant woman's motivation for postpartum abstinence is not known. This study is designed to determine the proportion of pregnant women that are motivated to remain abstinent postpartum and examine the salience of shape, weight, and mood concerns on motivation to remain abstinent. We hypothesized that mood and weight concerns during the third trimester of pregnancy would be associated with motivation to maintain smoking abstinence postpartum and that this relationship will persist even after controlling for factors previously associated with postpartum smoking relapse.