Symptoms of depression may be an independent contributor to continued smoking during pregnancy. Depressed persons may smoke in order to immediately ameliorate their sense of well-being or as a quick reward, which makes it harder for them to quit smoking compared to non-depressed persons.

We want to explore the association of depressive symptoms with smoking in a longitudinal study and to identify characteristics that predict the risk of continued smoking during pregnancy and in postpartum.

An observational, prospective, non-interventional study was performed.
Data of 605 women were collected between September 2008 and December 2010 at two moments during pregnancy (before 16 weeks and between 32 and 34 weeks pregnancy) and at one moment postpartum (after 6 weeks PP) on the participants’ smoking behavior and of their partners. Feelings of depression using the Beck Depression Inventory (BDI), level of education and socio-demographic variables were registered.

Smokers overall reported significantly more symptoms of depression compared to non-smokers and recent ex-smokers.
Lower educated pregnant smokers reported more feelings of dysphoria than smokers with a higher education.
BDI-score ≥ 15, respondent’s age < 29 year, having a smoking partner, a lower education and no paid job indicated a tendency toward continued smoking during pregnancy and postpartum.

Smokers reported more symptoms of depression compared to recent ex-smokers and non-smokers, independently of education. This means that smoking cessation does not aggravate depressive symptoms.

Smoking behavior of the partner was the most important predictor of smoking behavior of the pregnant woman.
Paying attention to depressive symptoms and offering adapted stop-smoking advice to lower educated pregnant women and their smoking partners might reduce the prevalence of smoking among pregnant and postpartum women.

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