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NAQC Newsroom: Research

Postpartum Changes in Mood and Smoking-Related Symptomatology: An Ecological Momentary Assessment In

Wednesday, June 7, 2017  
Posted by: Natalia Gromov
Alicia Allen, PhD, MPH, Nicole Tosun, MS, Sam Carlson, MPH, Sharon Allen, MD, PhD.
Postpartum Changes in Mood and Smoking-Related Symptomatology: An Ecological Momentary Assessment Investigation.
Nicotine Tob Res 2017 ntx118. doi: 10.1093/ntr/ntx118
 
Postpartum smoking relapse is a highly prevalent public health problem. Mood and breastfeeding are significantly associated with smoking relapse, though less is known about the temporality of these relationships. Therefore, this study utilized ecological momentary assessments (EMA) to prospectively examine changes mood and smoking-related symptomatology in relationship to three events – childbirth, termination of breastfeeding and smoking relapse. We expected all three events to significantly alter mood and smoking-related symptomatology. We enrolled a sample of pregnant women who had recently quit smoking and intended to remain quit during the postpartum. Participants were randomized to active/placebo progesterone to prevent postpartum relapse. Participants also completed daily EMA to collect data mood and smoking-related symptomatology, as well as our three events of interest. Participants (n=46) were, on average, 26.5±0.8 years old and, prior to pregnancy, smoked 10.1±0.7 cigarettes/day. We noted a number of significant within and between subject relationships. For example, participants reported a 24% decline in negative affect after childbirth (p=0.0016). Among those who relapsed to smoking (n=23), participants randomized to placebo had a significant increase in cigarette craving after relapse (β = 1.06, 95% CI = 0.62, 1.49, p-value = 0.0003) whereas participants randomized to active progesterone did not (β = 0.63, 95% CI = -0.35, 1.62, p-value = 0.1824). These observations suggest that mood and smoking-related symptomatology are influenced by childbirth, breastfeeding, smoking relapse and use of exogenous progesterone. Future research should explore how these observations may inform novel postpartum smoking relapse prevention interventions. Postpartum smoking relapse has been a persistent public health problem for more than 40 years. Although a number of significant predictors of postpartum smoking relapse have been identified (e.g., depression, breastfeeding), much of these analyses have relied on cross-sectional and/or self-reported retrospective data. Therefore, for the first time, we utilized ecological momentary assessment to explore the effect of childbirth, termination of breastfeeding and smoking relapse on mood and smoking-related symptomatology (e.g., craving). Numerous significant relationships were observed, including a 96% increase in craving after smoking relapse. These novel observations can inform new and effective postpartum smoking relapse prevention programs.


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