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

Rachel A. Level, Yingzhe Zhang, Henning Tiemeier, Ryne Estabrook, Daniel S. Shaw, Leslie D. Leve, Lauren S. Wakschlag, David Reiss, Jenae M. Neiderhiser, Suena H. Massey*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)301-308
Number of pages8
JournalArchives of Women's Mental Health
Volume27
Issue number2
DOIs
StatePublished - Apr 2024

Funding

This research was supported by grants R01 DA050700 (PI Massey), R01 DA035062 (PI Leve), and R01 DA020585 (PI Neiderhiser) from the National Institute on Drug Abuse (NIDA); grant R01 MH092118 (Neiderhiser and Leve MPI’s) from the National Institute of Mental Health (NIMH); grant R01 HD042608 (Reiss, Years 1–5; Leve, Years 6–10) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and grant UH3 OD023389 ((Leve, Neiderhiser, Ganiban MPI’s) from the National Institutes of Health (NIH). The design and results of this study and the decision to submit this manuscript for publication are the responsibility of the authors alone and do not necessarily refect the views of NIDA, NIMH, NICHD, or the NIH. This research was supported by grants R01 DA050700 (PI Massey), R01 DA035062 (PI Leve), and R01 DA020585 (PI Neiderhiser) from the National Institute on Drug Abuse (NIDA); grant R01 MH092118 (Neiderhiser and Leve MPI’s) from the National Institute of Mental Health (NIMH); grant R01 HD042608 (Reiss, Years 1–5; Leve, Years 6–10) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and grant UH3 OD023389 ((Leve, Neiderhiser, Ganiban MPI’s) from the National Institutes of Health (NIH). The design and results of this study and the decision to submit this manuscript for publication are the responsibility of the authors alone and do not necessarily reflect the views of NIDA, NIMH, NICHD, or the NIH.

Keywords

  • Nicotine
  • Pregnancy smoking
  • Protective factors
  • Substance use
  • Tobacco

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Psychiatry and Mental health

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