Unique influences of pregnancy and anticipated parenting on cigarette smoking: results and implications of a within-person, between-pregnancy study

• Published in: Archives of women's mental health Vol. 27; no. 2; pp. 301 - 308
• Main Authors: Level, Rachel A., Zhang, Yingzhe, Tiemeier, Henning, Estabrook, Ryne, Shaw, Daniel S., Leve, Leslie D., Wakschlag, Lauren S., Reiss, David, Neiderhiser, Jenae M., Massey, Suena H.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.04.2024; Springer Nature B.V
• Subjects: Cigarette smoking; Cigarette Smoking - epidemiology; Female; Fetuses; Humans; Infant, Newborn; Infants; Maternal Age; Medicine; Medicine & Public Health; Mothers; Original Article; Parenting; Parents & parenting; Parity; Pregnancy; Pregnancy complications; Psychiatry; Psychotherapy; Regression analysis; Smoking; Womens health; Substance use; Pregnancy smoking; Tobacco; Protective factors; Nicotine
• ISSN: 1434-1816; 1435-1102; 1435-1102
• DOI: 10.1007/s00737-023-01396-z

Not all pregnant individuals want to become parents and “parenting intention” can also vary within individuals during different pregnancies. Nevertheless, the potential impact of parenting intention on health-related behavior during pregnancy has been heavily underexplored. In this study, we employed a within-person between pregnancy design to estimate the effect of parenting-specific influences on smoking, separate from pregnancy-specific and individual-level influences. We quantified within-mother differences in smoking during pregnancies of infants they reared ( n  = 84) versus pregnancies of infants they placed for adoption at birth ( n  = 65) using multivariate mixed-effects Poisson regression models. Mean cigarettes/day declined as the pregnancy progressed regardless of whether infants were reared or placed. However, participants smoked fewer cigarettes/day during reared pregnancies. Relative to “adopted” pregnancies, smoking during “reared” pregnancies was lower by 24%, 41%, and 54% in first (95% CI 0.64–0.90; p  = 0.001), second (95% CI 0.48–0.72; p  < 0.001), and third trimesters (95% CI 0.36–0.59; p  < 0.001), respectively, independent of between-pregnancy differences in maternal age, fetal sex, parity, and pregnancy complications. Female sex and nulliparity were protective. Parenting intention was associated with a protective effect on pregnancy smoking independent of pregnancy-specific influences and individual characteristics. Failure to consider the impact of parenting intention on health-related behavior during pregnancy could perpetuate an unrealistic expectation to “ do what’s best for the baby ” and stigmatize women with unintended or unwanted pregnancies.