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Studies Link Depression to Smoking During Pregnancy, AP/Yahoo! News Reports

September 12, 2007
Kaisernetwork.org's Daily Reproductive Health Report

Recently released studies indicate that many pregnant women who smoke also might suffer from depression, indicating that "quit for your baby" messages are "too simplistic an approach for many women," the AP/Yahoo! News reports. The U.S. government estimates that about 12% of pregnant women smoke despite evidence that it increases the risk of miscarriage, premature birth, low birthweight, sudden infant death syndrome, and learning and behavior disorders.

According to a study published in the April issue of the journal Obstetrics and Gynecology, pregnant smokers were about three times as likely to have a mental health disorder as pregnant nonsmokers. For the study, Renee Goodwin, a Columbia University epidemiologist, and colleagues followed more than 1,500 pregnant women who took part in an expanded study of the health of U.S. residents.

Twenty-two percent of the women smoked at some point during pregnancy, and about 12% were classified as nicotine-dependent. The pregnant smokers were typically poor, less educated and had less access to health care. According to the study, a majority of the women who smoked suffered from depression. Thirty percent of the smokers and more than 50% of the women who were nicotine-dependent had a mental health disorder, the study found.

Smaller studies also have found a link between depression and smoking during pregnancy, the AP/Yahoo! News reports. Nora Volkow, director of NIH's National Institute on Drug Abuse, said nicotine and other chemicals in cigarette smoke can act in the brain like mild antidepressants. Women "are not just smoking to get the habit-forming aspects ... they are seeking the therapeutic effect," Volkow said. She added that because it often is difficult for people who are depressed to realize they need help, smoking can become more of "a disease instead of a choice."

M.D. Anderson Study
The University of Texas' M.D. Anderson Cancer Center recently launched a study, called Project Baby Steps, which aims to determine whether nondrug depression therapy helps pregnant smokers quit. The study has enrolled more than 250 poor, inner-city pregnant women who smoke to examine whether a form of cognitive therapy for depression is more effective in helping them stop smoking than anti-smoking counseling alone.

Nearly half of the women are currently experiencing major depression, and many also have a history of abuse or other trauma, Jan Blalock of M.D. Anderson said. The women volunteered for the study because they want to quit smoking. The psychological therapy teaches women to problem-solve so they can improve unhealthy relationships that can cause the depression and the smoking, Blalock said. She added that researchers do not know if depression is a factor for pregnant smokers in general or is an added risk mostly for poor women.

"These ladies all know ... about the health risks" of smoking, Blalock said, adding, "We should at least understand more about why these ladies don't quit." Goodwin said, "There's a lot of social disdain" for pregnant smokers, adding, "There aren't a lot of treatment programs. There's just advice ... not to smoke, but that's not going to do the job" (Neergaard, AP/Yahoo! News, 9/11).

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