Exposure to environmental tobacco smoke and risk of antenatal depression: application of latent variable modeling

Prevalence and risk factors of antenatal depression in the first trimester: A real-world cross-sectional study in a developed district in South China

BACKGROUND

Antenatal depression may result in adverse outcomes for both the mother and the offspring. However, few studies have focused on the screening of pregnant women at a higher risk for antenatal depression in the first trimester. The present study aimed to assess the effect of lifestyle and family relationships on antenatal depression in the first trimester in a large Chinese population.

METHODS

Cross-sectional population data were obtained from a real-world cross-sectional survey conducted in Shenzhen, China from 2020 to 2024. The data on sociodemographic characteristics, lifestyle, and family relationships were obtained using self-reported questionnaires. Antenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a score of ≥13 indicating the presence of probable antenatal depression. A binary logistic regression model was used to identify the risk factors of antenatal depression.

RESULTS

A total of 42,363 pregnant women in the first trimester were recruited in the cross-sectional survey, among whom 3107 (7.3 %) had probable antenatal depression. We found (1) age < 25 years, (2) low or moderate economic status, (3) smoking, (4) partner smoking, (5) alcohol use, (6) lack of physical exercise, (7) poor or moderate living environment, (8) low or moderate marital happiness, and (9) never talking about problems were associated with antenatal depression. However, level of education, employment status, partner alcohol use, and living alone were not significantly related to antenatal depression in the first trimester.

LIMITATIONS

The cross-sectional design and the use of self-report measures must be considered while interpreting the results.

CONCLUSIONS

This study suggested that the prevalence of antenatal depression in the first trimester was 7.3 %. Public health prevention efforts aimed at reducing the prevalence of antenatal depression are recommended. Early identification of women at a higher risk in early pregnancy is necessary for preventing antenatal depression and improving quality of life.

Utility of salivary biomarkers for diagnosis and monitoring the prognosis of nicotine addiction - A systematic review

Objectives

Tobacco and smoke associated with tobacco comprises of a mixture of more than 9500 chemical compounds, most of which have been identified as harmful. Two of the most potent carcinogens found in cigarette smoke are N'-nitrosonornicotine (NNN) and polycyclic aromatic hydrocarbons (PAHs). The most commonly used method to detect and monitor nicotine addiction is via serum cotinine levels. Though considered the gold standard, there is a decline in preventive screening and diagnostic testing due to the fear of pain from invasive testing.

Data sources and study selection

A structured literature search was performed using the search engines PubMed and Google scholar following the PRISMA guidelines for systematic reviews. The titles and abstracts were retrieved and analysed, followed by full-text relevant data extraction in addition to a risk-of-bias analysis.

Data extraction and synthesis

A total of 37 studies were included in the systematic review. Salivary cotinine levels were compared between smokers and non-smokers, cigarette smokers and water pipe smokers, water pipe smokers and non-smokers. Lactate dehydrogenase salivary levels were compared between smokers and non-smokers, and salivary thiocyanate were compared between smokers and non-smokers.

Conclusions

Identifying biomarkers with high performance in terms of sensitivity and specificity will contribute to accelerating future research in this domain.

Is secondhand smoke associated with mental health issues? A narrative review of the evidence and policy implications

Secondhand smoke (SHS) is a well-established cause of lung cancer, respiratory disease, heart disease and developmental issues in children, with an overwhelming evidence base spanning over four decades. In this narrative review, we describe studies which have also linked self-reported or cotinine-assessed SHS exposure in the home, workplace and other settings to mental health disorders including depression, suicide, anxiety, and psychological distress in children and adults, sleeping disorders, Attention Deficit Hyperactivity Disorder and behavioural issues in children, and dementia in older adults. In general, evidence indicates that SHS exposure is associated with these disorders in a dose-response manner, with higher odds reported in people who are exposed to SHS at high levels, frequently, and in the home environment. Most studies so far are cross-sectional albeit in large, nationally representative samples from various countries with a smaller number of longitudinal studies. More research is needed in this area to determine whether SHS is a direct cause of adverse mental health outcomes, and whether creating smokefree environments leads to improved mental wellbeing. In particular, more research is needed on the impact of smokefree home environments, an area which has received relatively little focus in smokefree interventions which generally target public places.

Sweet foods dietary pattern enhances negative associations of perceived indoor air quality during pregnancy with postpartum depression

Postpartum depression (PPD) is possibly caused by indoor air pollution and may be modified by maternal diet during pregnancy. Using the data from a prospective cohort study, we examined the interaction between indoor air quality and maternal dietary patterns on PPD development. A perceived indoor air quality (PIAQ) score was used to assess indoor air pollution. A higher PIAQ score indicated a worse indoor air quality. Women with higher PIAQ scores were at increased risk for PPD (tertile 3 vs. tertile 1, odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.37-3.29). Compared with a lower adherence to a "sweet foods pattern" (OR = 1.20, 95% CI = 0.66-2.18), a higher adherence to a "sweet foods pattern" enhanced the hazardous associations of the PIAQ on PPD (OR = 3.09, 95% CI = 1.81-5.27, adjusted p for interaction = 0.044). Higher adherence to a "whole grain-seafood pattern" and lower adherence to a "traditional pattern" also increased the risk for PPD, although the p values for the interaction were not significant. Our findings provide further evidence of the link between diet during pregnancy, air pollution, and PPD, and it can be used to develop PPD prevention strategies.

Trimester-specific association of perceived indoor air quality with antenatal depression: China Medical University Birth Cohort Study

Antenatal depression is associated with adverse birth and long-term outcomes for mothers and children. Pregnant women spend 90% of time indoors; however, the association between indoor air quality and risk of antenatal depression has not been established. In this study, we aim to determine the total and trimester-specific association of perceived indoor air quality (PIAQ) with antenatal depression. A total of 2166 pregnant women were enrolled during the first trimester and evaluated during the second and third trimesters in the China Medical University Birth Cohort Study, a prospective pre-birth cohort study in northeastern China. PIAQ scores were obtained during each of three trimesters, which a higher score indicated a worse indoor air quality. Antenatal depression was screened using an Edinburgh Postnatal Depression Scale (EPDS) and defined as an EPDS score ≥ 9. Prevalence of antenatal depression was 26.7%, 20.6%, and 20.9% during the first, second, and third trimesters, respectively. A higher PIAQ score was positively associated with a depression score throughout pregnancy (β = 0.27, 95% CI = 0.15-0.39). Trimester-specific adverse PIAQ exposure was associated with a higher depression score in the same trimester, but not with a higher score in a subsequent trimester. A dose-response pattern and incremental increases in risk of depression were observed with calculated adverse PIAQ exposures across all three trimesters, with the highest risk (OR = 3.24; 95% CI = 2.28-4.78) among women with adverse PIAQ across all three trimesters. The hazardous association between adverse PIAQ exposure and risk of depression were less pronounced among women with higher physical activity levels (P for interaction < 0.001). The results of present study provided important evidence that pregnant women's mental health was linked to indoor air quality during pregnancy. These findings could be helpful in the development of guidelines to prevent antenatal depression by improving indoor air quality.

Exposure to environmental chemicals and perinatal psychopathology

Women are nearly twice as likely to develop mood disorders compared with men, and incidence is greatest during reproductive transitions, including pregnancy and postpartum. Because these periods are characterized by dramatic hormonal and physiologic changes, there is heightened susceptibility to external factors, such as exposure to environmental toxicants, which may play a role in maternal psychopathology. The purpose of this scoping review was to provide an overview of studies conducted in humans and animal models on the effects of nonoccupational exposure to environmental chemicals on maternal psychopathology during the perinatal period. The largest number of studies examined exposure to environmental tobacco smoke and antenatal depression and showed consistently positive findings, although more prospective studies using biomarkers for exposure assessment are needed. The few studies examining persistent organic pollutants such as polybrominated diphenyl ethers and perinatal depression were consistent in showing associations with increased depressive symptoms. Results were mixed for exposure to heavy metals and non-persistent chemicals, but a strong literature in animal models supported an association between bisphenols and phthalates and reduced maternal behavior and care of pups after parturition. Biological mechanisms may include endocrine disruption, neurotransmitter system impairment, alterations in gene expression, and immune activation and inflammation. Additional longitudinal studies that include biospecimen collection are essential to furthering the understanding of how environmental toxicants during pregnancy may affect perinatal psychopathology and the underlying mechanisms of action. Future work should also leverage the parallels between animal and human maternal behavior, thereby highlighting the opportunity for multidisciplinary work in this avenue.

Association between Acrylamide Hemoglobin Adduct Levels and Depressive Symptoms in US Adults: NHANES 2013-2016

Acrylamide (AA) is widely present in heat-processed carbohydrate-rich food, cigarette smoke, and the environment. Prolonged exposure to AA may cause central nervous system damage. However, few epidemiologic studies assessed the association between hemoglobin adduct levels of AA or its metabolite glycidamide (GA) and depressive symptoms. We included 3595 US adults (≥18 years) from the National Health and Nutrition Examination Survey (NHANES) 2013-2016. Data for hemoglobin adduct levels from AA and GA (HbAA and HbGA) were used as a measure of internal dose. Depressive symptom data were from mental health questionnaires and measured by nine-item Patient Health Questionnaire (PHQ-9) scores. Results of logistic regression models showed a positive association between HbAA in quartile 4 and depressive symptoms with ORs and 95% CI of 2.47 (1.29, 4.77) [OR_{continuous HbAA} and 95% CI: 1.006 (1.000, 1.013)], but an inverse association was detected in quartiles 2 and 3 of HbGA/HbAA [0.62 (0.38, 0.99) and 0.54 (0.32, 0.92), respectively]. Especially, an association between HbAA and depressive symptoms was strengthened in smokers, in age 18-39 and 40-59 years and BMI 25-30 kg/m² groups. Further explorations are needed to study the found associations between HbAA, HbGA, and depressive symptoms.

Identification of clinical and psychosocial characteristics associated with perinatal depression in the south Indian population

BACKGROUND

Longitudinal perinatal depression (PND) data is sparsely available in the Indian population. We have employed Edinburgh Postnatal Depression Scale (EPDS) to assess the prevalence and identify characteristics associated with PND in the south Indian population. PND was assessed longitudinally using EPDS scores with traditional cut-off approach as well as a novel method of latent class mixture modeling (LCMM). The LCMM method, to the best of our knowledge, has been used for the first time in the Indian population.

METHODS

Three hundred and forty seven women, predominantly from economically-weaker sections of rural and urban South India were longitudinally assessed for antenatal depression (AD) and postnatal depression (PD) using EPDS cutoff-scores ≥13 and ≥10, respectively. Uni/multivariable analyses were used to identify PND associated characteristics. LCMM was then implemented, followed by risk characteristics identification.

RESULTS

PND prevalence from traditional approach was 24.50 % (12.68 % AD; 18.16% PD). Characteristics associated with PND were urban-site and recent adverse life events. Irregular menstrual history and chronic health issues were associated with AD and PD, respectively. Three distinct PND trajectories were observed from LCMM-analysis: low-risk (76.08%), medium-risk (19.89%) and high-risk (4.04%). Urban-site, recent adverse life events, irregular menstrual history and pregnancy complications were associated with medium-risk/high-risk trajectories.

LIMITATIONS

EPDS is a screening tool and not a diagnostic tool for depression. Since the study population included women from economically-weaker sections, the results need verification in other socio-economic groups.

CONCLUSIONS

Both the traditional cut-off-based approach and LCMM provided very similar conclusions regarding the prevalence of PND and characteristics associated with it. Higher PND prevalence was observed in urban women compared to rural women. In low-income countries, identifying risk characteristics associated with PND is a critical component in designing prevention strategies for PND related conditions because of the limited access to mental health resources.

A Scoping Review of Non-Occupational Exposures to Environmental Pollutants and Adult Depression, Anxiety, and Suicide

PURPOSE OF REVIEW

Despite a call for better understanding of the role of environmental pollutant influences on mental health and the tremendous public health burden of mental health, this issue receives far less attention than many other effects of pollutants. Here we summarize the body of literature on non-occupational environmental pollutant exposures and adult depression, anxiety, and suicide-in PubMed, Embase, Web of Science, and PsychINFO through the end of year 2018.

RECENT FINDINGS

One hundred twelve articles met our criteria for further review. Of these, we found 88 articles on depression, 33 on anxiety, and 22 on suicide (31 articles covered multiple outcomes). The earliest article was published in 1976, and the most frequent exposure of interest was air pollution (n = 33), followed by secondhand smoke (n = 20), metals (n = 18), noise (n = 17), and pesticides (n = 10). Other exposures studied less frequently included radiation, magnetic fields, persistent organic pollutants (POPs), volatile organic compounds, solvents, and reactive sulfur compounds. The current literature, although limited, clearly suggests many kinds of environmental exposures may be risk factors for depression, anxiety, and suicide. For several pollutants, important limitations exist with many of the studies. Gaps in the body of research include a need for more longitudinal, life-course studies, studies that can measure cumulative exposures as well as shorter-term exposures, studies that reduce the possibility of reverse causation, and mechanistic studies focused on neurotoxic exposures.

Effect of Prenatal Smoke Exposure on Birth Weight: The Moderating Role of Maternal Depressive Symptoms

INTRODUCTION

Both prenatal smoke exposure and depression have been linked to lower birth weight, a risk factor for morbidity and mortality. Few studies have looked at the interaction between these risk factors and none have used a biomarker to objectively measure prenatal smoke exposure. The current study sought to examine independent and interactive effects of cotinine and depression on birth weight. The effect of race was also explored.

METHOD

Data were drawn from a prospective study of pregnant women (N = 568) in the southeastern United States. Maternal demographic, health information, depressive symptoms, and birth data were collected via self-report and medical record abstraction. Prenatal blood samples were assayed for cotinine.

RESULTS

Controlling for covariates, multiple regression analyses indicated that both cotinine and depressive symptoms independently predicted lower birth weight and a significant interaction was also observed. Upon probing the interaction, a negative association between cotinine levels and birth weight was found in the context of higher depression but not lower depression scores. Similarly, logistic regression analyses revealed a significant interaction between cotinine and depression, such that cotinine predicted having a baby less than 2500 g among women who fell above the indicated cutoff score. African American women had the highest levels of cotinine and lowest weight babies; however, race was not a significant moderator.

CONCLUSIONS

Results suggest prenatal smoke exposure has a greater negative effect on birth weight for women endorsing co-occurring depressive symptoms. Findings can inform targeted interventions and assist medical providers with identifying women at increased risk for poor perinatal outcomes.

IMPLICATIONS

Despite the common occurrence of smoking during pregnancy and prenatal depression, the interaction between these risk factors on birth weight has rarely been examined. Further, the extant results have been mixed, likely due in part to difficulties in measurement. The current study was the first to use prenatal cotinine to assess bias-free, continuous levels of prenatal smoke exposure. Results indicate that prenatal cotinine was a significant predictor of birth weight only in the context of maternal depressive symptoms. These findings have important implications for mitigating negative perinatal outcomes for pregnant women and their children.

Association of secondhand smoke and depressive symptoms in nonsmoking pregnant Women: A systematic review and meta-analysis

BACKGROUND

Globally about 30% of adult women and 40% of children are exposed to secondhand smoke (SHS) from active smokers. SHS exposure of pregnant women has been associated with postpartum depression. Unexposed women in pregnancy had lower rates of postpartum depression than women exposed to SHS. This systematic review aimed to determine the association of depressive symptoms and exposure to SHS in nonsmoking pregnant women.

METHOD

The case-controlled, cross-sectional, and cohort studies with a comparison group were included. Studies including women who had smoking history during pregnancy were excluded. The comprehensive electronic databases, CINAHL, EMBASE, and Medline were searched.

RESULT

Of the 2777 records screened, seven studies were included in the review for data extraction. The bias of studies was assessed using the RoBANS. We synthesized two studies that showed depressive symptoms at any time during pregnancy and postpartum significantly increased (ORs = 1.77 [95% CI = 1.12 - 2.79]; p = 0.01; I²= 28%, 4103 women, two studies), and significantly increased the odds of antenatal suicidal ideation in SHS exposed women (ORs = 1.75 [95% CI = 1.14 - 2.70]; p = 0.01; I²= 51%, 2670 women, two studies). Lack of studies from counties with the highest smoking rates was a limitation.

CONCLUSIONS

SHS exposure during pregnancy showed a significant increase in the odds of depressive symptoms. Furthermore, research is required to clarify to association between SHS and depression.

Exposure to third-hand smoke during pregnancy may increase the risk of postpartum depression in China

INTRODUCTION

Our aim was to investigate the association between third-hand smoke exposure (THS) during pregnancy and postpartum depression (PPD) among Chinese women.

METHODS

A total of 973 participants that completed the questionnaire and reviews were included in this cross-sectional study. The THS exposure was assessed based on a questionnaire with key questions from the Global Adult Tobacco Survey (2nd edition) while postpartum depression status was assessed using the Edinburgh Postnatal Depression Scale. Logistic regression models were used to estimate the association between THS exposure during pregnancy and risk of PPD, after adjustment for potential confounders.

RESULTS

The prevalence of postpartum depression among all participants was 17.8%. Of the 973 participants, 725 (74.5%) were exposed to THS during pregnancy while 248 (25.5%) were not. Compared with those who were never exposed to passive smoking, puerperal women who were exposed to THS were at higher risk of PPD (OR=1.71, 95% CI: 1.12-2.60) in the logistic regression model.

CONCLUSIONS

Our study suggests that exposure to third-hand smoke may be a risk factor for postpartum depression among Chinese women. Future preventive interventions should include strategies that target the puerperal women who are exposed to THS during pregnancy. Tobacco control measures that are effective in reducing the prevalence of smoking may have little effect in reducing women's exposure to THS during pregnancy, especially in private places that urgently need other public health strategies.

Attention-deficit/hyperactivity disorder symptom clusters differentially predict prenatal health behaviors in pregnant women

OBJECTIVE

To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention-deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use).

METHOD

A total of 198 pregnant women (mean age = 27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression.

RESULTS

Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors.

CONCLUSION

As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD.

Impact of Smoking Ban on Passive Smoke Exposure in Pregnant Non-Smokers in the Southeastern United States

Prenatal passive smoke exposure raises risk for negative birth outcomes. Legislation regulating public smoking has been shown to impact exposure levels, though fewer studies involving pregnant women have been conducted within the U.S. where bans are inconsistent across regions. This study examined the effect of a ban enacted in the southeastern U.S. on pregnant women's cotinine levels. Additional analyses compared self-reported exposure to cotinine and identified characteristics associated with passive exposure. Pregnant women (N = 851) were recruited prospectively between 2005 and 2011 in North Carolina. Sociodemographic and health data were collected via surveys; maternal blood samples were assayed for cotinine. Among non-active smokers who provided self-report data regarding passive exposure (N = 503), 20% were inconsistent with corresponding cotinine. Among all non-smokers (N = 668), being unmarried, African American, and less educated were each associated with greater passive exposure. Controlling for covariates, mean cotinine was higher prior to the ban compared to after, F(1, 640) = 24.65, p < 0.001. Results suggest that banning smoking in public spaces may reduce passive smoke exposure for non-smoking pregnant women. These data are some of the first to examine the impact of legislation on passive smoke exposure in pregnant women within the U.S. using a biomarker and can inform policy in regions lacking comprehensive smoke-free legislation.

The association between second-hand smoke exposure and depressive symptoms among pregnant women

Tobacco smoking and depression are strongly associated, but the possible association between second-hand smoke (SHS) exposure and depression is unclear. This study aimed to examine the possible relation between SHS exposure and depressive symptoms among pregnant women. A cross-sectional survey was conducted in Shenzhen, China, using a multistage sampling method. The univariable and multivariable logistic regression models were used to explore the associations between SHS exposure and depressive symptoms. Among 2176 pregnant women, 10.5% and 2.0% were classified as having probable and severe depressive symptoms. Both binary and multinomial logistic regression revealed that there were significantly increased risks of severe depressive symptoms corresponding to SHS exposure in homes or regular SHS exposure in workplaces using no exposure as reference. In addition, greater frequency of SHS exposure was significantly associated with the increased risk of severe depressive symptoms. Our findings suggest that SHS exposure is positively associated with depressive symptoms in a dose-response manner among the pregnant women.

Secondhand smoke exposure and mental health in adults: a meta-analysis of cross-sectional studies

PURPOSE

Previous studies assessing secondhand smoke (SHS) and risk of mental health problems have yielded inconsistent results. We performed a meta-analysis to statistically assess the association between SHS exposure, depressive symptoms and psychological distress among adults.

METHODS

A systematically search of Pubmed (1946-2015) and EMBASE (1976-2015) was conducted and supplemented by bibliographies of all retrieved articles to find additional relevant citations. Odds ratios (OR) and associated 95 % confidence interval (CI) of each eligible study were extracted and pooled in our meta-analysis.

RESULTS

A total of 11 studies comprising 86,739 participants met the inclusion criteria. A random-effect model was used in meta-analysis since considerable heterogeneity was expected. Our results indicate that SHS exposure was significantly associated with depressive symptoms (OR 1.60, 95 % CI 1.35-1.90) and psychological distress (OR 1.32, 95 % CI 1.11-1.56).

CONCLUSION

Exposure to SHS among non-smoker is associated with depressive symptoms and psychological distress, emphasizing the significance of reducing SHS exposure at a population level.

Effects of tobacco exposure on perinatal suicidal ideation, depression, and anxiety

Background

Previous studies have stressed the importance of tobacco exposure for the mood disorders of depression and anxiety. Although a few studies have focused on perinatal women, none have specifically considered the effects of smoking and secondhand smoke exposure on perinatal suicidal ideation. Thus, this study aimed to investigate the relationships of smoking/secondhand smoke exposure status with suicidal ideation, depression, and anxiety from the first trimester to the first month post partum.

Methods

This cross-sectional study based on self-reported data was conducted at five hospitals in Taipei, Taiwan from July 2011 to June 2014. The questionnaire inquired about women’s pregnancy history, sociodemographic information, and pre-pregnancy smoking and secondhand smoke exposure status, and assessed their suicidal ideation, depression, and anxiety symptoms. Logistic regression models were used for analysis.

Results

In the 3867 women in the study, secondhand smoke exposure was positively associated with perinatal depression and suicidal ideation. Compared with women without perinatal secondhand smoke exposure, women exposed to secondhand smoke independently exhibited higher risks for suicidal ideation during the second trimester (odds ratio (OR) = 7.63; 95 % confidence interval (CI) = 3.25–17.93) and third trimester (OR = 4.03; 95 % CI = 1.76–9.23). Women exposed to secondhand smoke had an increased risk of depression, especially those aged 26–35 years (OR = 1.71; 95 % CI = 1.27–2.29).

Conclusions

Secondhand smoke exposure also considerably contributes to adverse mental health for women in perinatal periods, especially for the severe outcome of suicidal ideation. Our results strongly support the importance of propagating smoke-free environments to protect the health of perinatal women.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3254-z) contains supplementary material, which is available to authorized users.

Factors associated with secondhand smoke exposure in different settings: Results from the German Health Update (GEDA) 2012

BACKGROUND

The ubiquity of secondhand smoke (SHS) exposure at home or in private establishments, workplaces and public areas poses several challenges for the reduction of SHS exposure. This study aimed to describe the prevalence of SHS exposure in Germany and key factors associated with exposure. Results were also differentiated by place of exposure.

METHODS

A secondary data analysis based on the public use file of the German Health Update 2012 was conducted (n = 13,933). Only non-smokers were included in the analysis. In a multivariable logistic regression model the factors associated with SHS exposure were calculated. In addition, a further set of multivariable logistic regressions were calculated for factors associated with the place of SHS exposure (workplace, at home, bars/discotheques, restaurants, at the house of a friend).

RESULTS

More than a quarter of non-smoking study participants were exposed to SHS. The main area of exposure was the workplace (40.9 %). The multivariable logistic regression indicated young age as the most important factor associated with SHS exposure. The odds for SHS exposure was higher in men than in women. The likelihood of SHS exposure decreased with higher education. SHS exposure and the associated factors varied between different places of exposure.

CONCLUSIONS

Despite several actions to protect non-smokers which were implemented in Germany during the past years, SHS exposure still remains a relevant risk factor at a population level. According to the results of this study, particularly the workplace and other public places such as bars and discotheques have to be taken into account for the development of strategies to reduce SHS exposure.

Effects of smoking on perinatal depression and anxiety in mothers and fathers: A prospective cohort study

INTRODUCTION

Considerable concern persists on tobacco use during perinatal periods. No study has simultaneously investigated the longitudinal association of paternal smoking with maternal and paternal depressive and anxiety symptoms during perinatal periods.

METHODS

In this prospective study, 533 couples (pregnant women and their husbands) completed 5 self-report instruments from early pregnancy until 6 months postpartum. Generalized estimating equations were used for the analyses.

RESULTS

We found that fathers who smoked in the mother's presence had higher depressive (regression coefficient=1.0, 95% confidence interval (CI) 0.3-1.8) and anxiety symptoms (3.0, 95% CI=1.2-4.7) during perinatal periods compared with nonsmoking fathers. Paternal smoking in the mother's presence also increased maternal disturbances, especially for depression during pregnancy (1.2, 95% CI=0.1-2.3) and anxiety during the postpartum period (3.4, 95% CI=0.6-6.3). No significant association was found between paternal smoking but not in the mother's presence and maternal emotional disturbances. Paternal smoking but not in the mother's presence affected only paternal anxiety, especially in the postpartum period (regression coefficient 2.7, 95% CI 0.7-4.7) compared with nonsmokers.

LIMITATIONS

Self-report measures were used. The effects of maternal smoking could not be estimated because of the small sample of pregnant women who disclosed their smoking status.

CONCLUSIONS

These findings imply a necessity to combine strategies for smoking cessation with interventions for affective disturbances in fathers. We also stress the importance of at least restricting the father's smoking in the presence of the pregnant wife during perinatal periods if smoking cessation is tentatively unattainable.

Substance Use in the Perinatal Period

Perinatal substance use remains a major public health problem and is associated with a number of deleterious maternal and fetal effects. Polysubstance use in pregnancy is common and can potentiate adverse maternal and fetal outcomes. Tobacco is the most commonly used substance in pregnancy, followed by alcohol and illicit substances. The treatments for perinatal substance use are limited and consist mostly of behavioral and psychosocial interventions. Of these, contingency management has shown the most efficacy. More recently, novel interventions such as progesterone for postpartum cocaine use have shown promise. The purpose of this review is to examine the recent literature on the use of tobacco, alcohol, cannabis, stimulants, and opioids in the perinatal period, their effects on maternal and fetal health, and current treatments.

Prenatal and Early Postnatal Exposure to Cigarette Smoke Decreases BDNF/TrkB Signaling and Increases Abnormal Behaviors Later in Life

BACKGROUND

Cigarette smoke exposure during prenatal and early postnatal periods increases the incidence of a variety of abnormal behaviors later in life. The purpose of this study was to identify the possible critical period of susceptibility to cigarette smoke exposure and evaluate the possibe effects of cigarette smoke during early life on brain-derived neurotrophic factor/neurotrophic tyrosine kinase receptor B signaling in the brain.

METHODS

Three different age of imprinting control region mice were exposed to cigarette smoke or filtered air for 10 consecutive days beginning on either gestational day 7 by maternal exposure, or postnatal days 2 or 21 by direct inhalation. A series of behavioral profiles and neurotrophins in brain were measured 24 hours after mice received acute restraint stress for 1 hour on postnatal day 59.

RESULTS

Cigarette smoke exposure in gestational day 7 and postnatal day 2 produced depression-like behaviors as evidenced by significantly increased immobility in both tail suspension and forced-swim test. Increased entry latencies, but not ambulation in the open field test, were also observed in the gestational day 7 and postnatal day 2 cigarette smoke exposure groups. Genetic analysis showed that gestational day 7 cigarette smoke exposure significantly altered mRNA level of brain-derived neurotrophic factor/tyrosine kinase receptor B in the hippocampus. However, behavioral profiles and brain-derived neurotrophic factor/tyrosine kinase receptor B signaling were not significantly changed in PND21 cigarette smoke exposure group compared with FA group.

CONCLUSIONS

These results suggest that a critical period of susceptibility to cigarette smoke exposure exists in the prenatal and early postnatal period, which results a downregulation in brain-derived neurotrophic factor/tyrosine kinase receptor B signaling in the hippocampus and enhances depression-like behaviors later in life.

Prenatal exposure to secondhand smoke may increase the risk of postpartum depressive symptoms

BACKGROUND

The harmful effects of smoking during pregnancy on occurrence of postpartum depressive symptoms (PPDS) have been well studied, but there is little research on the association of secondhand smoke (SHS) exposure during pregnancy with PPDS. This study aimed to explore the relationship between prenatal exposure to SHS during pregnancy and PPDS.

METHODS

The authors analyzed data from 6884 women who participated in the North Carolina Pregnancy Risk Assessment and Monitoring System survey (2004-08). Data on the exposure (prenatal SHS), outcome (PPDS) and covariates were obtained from self-reported questionnaires. Univariable and multivariable logistic regression was used for data analysis.

RESULTS

The prevalence of PPDS was 16.5%. In the unadjusted analysis, women exposed to SHS during pregnancy had nearly twice the odds of PPDS than the unexposed (odds ratio, OR = 1.90, 95% confidence interval, CI: 1.61-2.26). After adjusting for potential confounders, the association between SHS and PPDS was weakened but remained statistically significant (OR = 1.49, 95% CI: 1.23-1.80). A dose-response relationship was not evident in the analyses. Maternal smoking during pregnancy did not appear to modify the association between SHS and PPDS.

CONCLUSIONS

The current study identified a positive association between SHS and PPDS.