Weight Worries Sap Motivation to Stay Smoke-Free After Pregnancy

PITTSBURGH, Sept. 15 -- Fear of weight gain may sabotage a pregnant woman's motivation not to resume smoking after her baby is born, researchers reported.

Of women who quit smoking when pregnant, 60% to 70% are likely to light up six months after giving birth, with concern about weight gain and body shape a driving force, according to a report in the October issue of the Annals of Behavioral Medicine.

Michele Levine, Ph.D., of the University of Pittsburgh, and colleagues, set out to examine why this happens and why the best intentions of women to remain smoke-free after pregnancy wane.

They found out that 65% of the women reported being highly motivated not to relapse, and they studied these motivations, but not the actual behavior.

To understand how factors such as depression, postpartum blues, and weight concerns might affect women's motivation to remain abstinent after delivery, the researchers interviewed 119 women who had smoked at least eight cigarettes a day for at least one month prior to quitting. The pregnant former smokers completed assessments of smoking, weight concerns, depressive symptoms, perceived stress, and partner's smoking habits.

All the women had quit after learning they were pregnant, were in the third trimester of pregnancy at the time of the interview, and had been smokers for an average of 9.1 (SD = 5.9) years prior to this pregnancy. Forty-four percent (n = 51) were African American, 1.7% (n = 2) were American Indian, and 53.9% (n = 62) were Caucasian. Women who were and were not motivated were similar in age, race, and nicotine dependence.

On average, the women were 24.2 (SD 5.9) years old, and 77.8% reported quitting at some point during the first trimester while 89.1% did so on their own without formal programs or materials.

In a comparison of the motivated and the less-motivated women, the researchers found that overall, 65.6% (N=78) were highly motivated to remain abstinent postpartum, and 74% (n=88) felt sure of their ability to do so.

Not surprisingly, motivation to remain smoke-free was associated with confidence to remain so postpartum, whereas only 7.3% of the less motivated women expressed confidence in their ability to stay quit.

The highly motivated women reported more perceived stress, greater confidence in maintaining weight (weight self-efficacy), less smoking for weight control, and less hunger than those who were less motivated. Motivated women were also more likely to report an intention to breast-feed their infant.

Specifically, greater feelings of self-control over weight without smoking (? =.31, SE= 0.11, P= .004) remained significantly related to post-partum motivation (odds ratio: 1.38, 95% confidence interval: 1.11-1.72). For every unit increase in weight self-efficacy, women were 1.4 times more likely to report high motivation.

After controlling for intention to breast-feed, nicotine dependence, years of smoking, partner smoking, and race, weight self-efficacy remained significantly related to postpartum motivation, the researchers reported. This finding, they added, held even after controlling for mood and other variables known to relate to post-partum smoking.

Although quitting smoking during pregnancy is common, motivation to remain abstinent appears to wane postpartum, and most women resume smoking, Dr. Levine said. In commenting on the findings, the researchers noted as follows:

• The fact that intention to breast-feed was related to a decreased likelihood of smoking relapse suggests that motivation to remain smoke free reflects a general desire to adopt behavior related to the child's health.
• Depressive symptoms toward the end of pregnancy are often high, and it is possible that the lack of an association between mood and postpartum abstinence may reflect the fact that both motivated and unmotivated women reported considerable depressive symptoms.
• Although a partner's smoking has been a consistent predictor of postpartum relapse, it was not associated with motivation to quit postpartum in this study. This discrepancy may reflect a difference between factors relevant to a pregnant woman's motivation and the factors that relate to actual resumption of smoking after delivery.

In discussing the study's limitation, the researchers mentioned that in answering the questionnaire assessing motivation, women may have provided a more socially desired answer. As such, more valid and thorough assessments are needed, they said.

A second limitation is that concerns about eating and weight may be different during pregnancy, and these concerns may change after the baby is born.

Finally, information about motivation collected during pregnancy may not accurately reflect a woman's behavior postpartum. Prospective data are necessary to fully evaluate these relationships, Dr. Levine said.

Nonetheless, this study suggested several modifiable targets for enhancing women's motivation, the investigators said. Weight issues play a role in smoking relapse, and interventions designed to prevent relapse may need to address women's concerns about eating and weight during the postpartum period.

Smoking cessation programs that target these concerns have been developed, and "programs such as these could be adapted to the specific concerns of mothers during the postpartum period," Dr. Levine wrote.

The next step, she added, "is to see whether weight concerns play a role in women's actual behavior."