Timing and predictors of postpartum return to smoking in a group of inner-city women: An exploratory pilot study

Background: Approximately 40 percent of women smokers will stop smoking cigarettes during pregnancy; however, 70 percent of those who stop will resume smoking by 6 months postpartum. This exploratory pilot study prospectively examined the timing and predictors of returning to smoking after pregnancy in a group of inner-city women who stopped smoking cigarettes during pregnancy. Methods: We interviewed women who stopped smoking just before or during their pregnancies during their postpartum hospital stay and at their infants' 2-week health supervision visits. Urine cotinine levels were measured at each interview. Results: Forty-nine women were interviewed during the postpartum stay and 37 women at the 2-week follow-up. At follow-up, 40.5 percent (n = 15) of women had returned to smoking. Mothers more frequently returned to smoking if they had a lower level of education, that is, high school graduate/general equivalency diploma versus some college education (13/24 vs 2/13, p < 0.04); if they had someone else in the household who smoked (14/23 vs 1/14, p < 0.003); if they were formula feeding their infant at the time of interview (14/24 vs 1/13, p < 0.005); if they discussed smoking with a doctor or nurse during pregnancy (12/20 vs 3/17, p < 0.02); and if they were African American (10/15 vs 5/22, p < 0.02). Mothers reported the primary reasons for returning to smoking were stress (53%, n = 8) and being around another smoker (40%, n = 6). Conclusions: Almost one-half of the women in this pilot study who stopped smoking cigarettes during pregnancy resumed in the days immediately after delivery. These data suggest that future studies should explore the initiation of postpartum relapse prevention during the prenatal and perinatal period. Interventions may be more effective if they include strategies aimed increasing breastfeeding rates and assisting household members to stop smoking.