Maternal Prenatal Depressive Symptoms, Nicotine Addiction, and Smoking-Related Knowledge, Attitudes, Beliefs, and Behaviors

Maternal smoking is a key preventable cause of poor pregnancy outcomes, such as low birthweight. In many areas of the United States, including Eastern North Carolina, rates of prenatal smoking are high. Prenatal depressive symptoms are associated with maternal smoking, but there remains much to learn about this relationship, especially among Black women, who have double the risk of poor pregnancy outcomes of White women. In the study reported in this paper, we investigated the relationship between maternal prenatal depressive symptoms with smoking behaviors, beliefs and attitudes, environmental factors which promote smoking and nicotine addiction. Pregnant women were enrolled in the study at the first prenatal visit to the clinics of the Departments of Obstetrics and Gynecology and Family Medicine of the Brody School of Medicine, East Carolina University. An interviewer administered a questionnaire to each woman about smoking, smoking-related attitudes, knowledge, beliefs and behaviors, nicotine addiction, and home environmental factors that encourage smoking. The CES-D was used to measure depressive symptoms. We used the cut-point score of 23 or greater to indicate elevated depressive symptoms, which is thought to represent major depressive disorder. The sample consisted of 810 Black women, of whom 18% were smokers. CES-D score was associated with nicotine addiction, not thinking of quitting smoking, and not expecting support from family and friends if they decided to quit. Prenatal depressive symptoms may be a barrier to smoking cessation.