Factors Associated with Smoking Relapse in the Early Postpartum Period: A Prospective Longitudinal Study in Spain

Coping strategies during pregnancy and their relationship with anxiety and depression

How individuals perceive and cope with stressful situations may determine their level of anxiety or depression. The identification of coping strategies (CS) in pregnancy could help prevent depression and anxiety (D&A), and their consequent effects on the health of the mother and the baby. A cross-sectional descriptive correlational study was conducted to identify the CS most commonly used by pregnant women in a Spanish population and to evaluate the association of these CS with D&A. A consecutive sample of 282 pregnant women over 18 years of age were recruited when attended midwife consultations and through snowball sampling between December 2019 and January 2021 in the Basque public health system. CS were measured using the RevisedPrenatal Coping Inventory (NuPCI) questionnaire, assigning the score to an avoidant, preparatory or spiritual scale. Cutoff points were established to categorize anxiety and depressive symptomatology, using the STAI-S and EPDS scales. Multivariate logistic regression models were constructed to analyze the association between CS and D&A. The results show that the higher the score on the avoidance subscale, the higher the likelihood of having an anxiety disorder (OR: 8.88  (95 percent Confidence Interval [CI] 4.26-20.1), and depressive symptoms (OR: 8.29 (95 percent CI 4.24-17.4). Multiparous women are more likely to have anxiety (OR: 3.41  (95 percent CI 1.58-7.5) or depressive symptomatology (OR: 4.1 (95 percent CI 2.04-8.53) during pregnancy. These results highlight the need to consider the evaluation of CS used during pregnancy to tailor the care provided, but further studies on the implementation and effectiveness of interventions are needed.

Tobacco consumption from the 1st trimester of pregnancy to 7 months postpartum: Effects of previous tobacco consumption, and depression and anxiety symptoms

OBJECTIVE

Previous tobacco consumption, and depression and anxiety symptoms are major predictors of women's tobacco consumption during pregnancy and the postpartum period. However, the joint effect of these predictors is still unexplored. This study aimed to analyse the effects of previous tobacco consumption, and depression and anxiety symptoms on women's tobacco consumption status and quantity from the 1st trimester of pregnancy to 7 months postpartum.

METHOD

A sample of 803 Spanish women was assessed at the 1st and the 3rd trimester of pregnancy, and at 2 and 7 months postpartum. Previous tobacco consumption, and depression and anxiety symptoms were self-reported. Pregnancy and postpartum tobacco consumption were confirmed with biochemical tests.

RESULTS

Women with more previous tobacco consumption or more anxiety symptoms presented a steeper decrease in the number of cigarettes smoked per week from the 1st trimester of pregnancy to the childbirth, although smoking more cigarettes than women with less previous tobacco consumption or less anxiety symptoms. Women with more depression symptoms showed a higher tendency to relapse smoking during the first 2 months postpartum.

CONCLUSIONS

Previous tobacco consumption and anxiety symptoms were associated with higher smoking quantity during pregnancy, while depression symptoms were associated with consumption relapse during postpartum period.

Bupropion for postpartum smoking relapse: A remote protocol for a two-arm, double-blind, placebo-controlled randomized clinical trial

Cigarette smoking among postpartum women remains a significant public health problem despite known health risks to women and their newborns. It is estimated that over 50% of women quit smoking during pregnancy but 90% relapse by one year. Safe and effective postpartum relapse prevention strategies are urgently needed. In an attempt to address this deficit, we will investigate the efficacy of bupropion vs. placebo as a smoking relapse prevention aid in postpartum women. The objective of this paper is to detail an approach to investigate bupropion's efficacy for preventing postpartum smoking relapse among women who quit smoking during pregnancy. Specifically, we designed a two-arm, double-blind, placebo-controlled randomized trial testing the efficacy of bupropion vs. placebo as a relapse prevention tool. Mothers of healthy infants who quit smoking while pregnant will be stratified based on current or past history of major depressive disorder or persistent depressive disorder and randomized to receive either active (bupropion XL 300 mg/day) or placebo medication for 12 weeks. To respond to safety concerns associated with participant and staff exposure to COVID-19, we revised our original protocol and present procedures which allow our trial to be conducted entirely remotely. Primary and secondary outcomes will be assessed at weeks 12, 24, 36 and 52 post-randomization. The primary outcome is 7-day point prevalence abstinence at 24 weeks. Results of this work have the potential to positively impact women and their children by promoting lifelong cessation, eliminating secondhand smoke exposure, and modelling of abstinence to children.