Mailman School of Public Health study shows smoking common during pregnancy

While pregnancy may be considered an effective motivator for smoking cessation, results of a new study by researchers at the Mailman School of Public Health indicate that pregnant U.S. women commonly smoke, placing themselves and their unborn children at risk for health and developmental complications. The research also finds a significant association between cigarette use, nicotine dependence, and the presence of mental disorders among pregnant women.

The data show that almost 22 percent of these women smoked cigarettes and more than 10 percent were nicotine dependent. The results also indicate that approximately 30 percent of pregnant women who used cigarettes had a mental disorder, with personality disorders, major depressive disorder, and specific phobia among the most common psychological ailments. Mental disorders were even more common among pregnant women with nicotine dependence, affecting more than 57 percent. In terms of specific disorders, the strongest associations with nicotine dependence were seen for prolonged depression, panic disorder, and major depressive disorder.

"Our research shows that prenatal smoking appears to be more common in pregnant women who are already vulnerable—those who are unmarried, have less than high school education, and have lower personal incomes," says Renee Goodwin, assistant professor of Epidemiology at the Mailman School, and lead scientist. "They also are likely to have limited access to health care services, which may contribute to a lower likelihood of some women quitting smoking upon becoming pregnant."

The study included 1,516 pregnant women at least 18 years old who took part in the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions, a nationally representative survey of more than 43,000 U.S. adults administered by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Mental disorders and nicotine dependence were diagnosed through use of the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV.

The findings were published in the April 2007 issue of Obstetrics and Gynecology. The study was supported in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

"Cigarette smoking during pregnancy is the single most preventable cause of illness and mortality among mothers and infants, yet cigarette use continues among pregnant women in the United States," says NIDA Director Dr. Nora D. Volkow, National Institute on Drug Abuse. "While the study showed the strongest association between nicotine dependence and prolonged depression, it also demonstrated significant associations between nicotine dependence and panic disorder and major depressive disorder. Thus, there is an urgent need for outreach programs to effectively deal with both nicotine addiction and mental health disorders in conjunction with prenatal care."

The only accredited school of public health in New York City, and among the first in the nation, Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 950 graduate students in pursuit of masters and doctoral degrees. Its students and more than 300 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences. (www.mailman.hs.columbia.edu)