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Editor's Note
April 2016

Preventing Smoking Relapse After Delivery—Maintaining a Pregnant Pause

JAMA Intern Med. 2016;176(4):452. doi:10.1001/jamainternmed.2016.0360

It is a public health success that 55% of women smokers quit during pregnancy.1 Women understand that smoking can harm their developing fetus, including premature birth, birth defects, and stillbirth, and this provides the necessary motivation for overcoming the tobacco addiction.

Sadly, 40% of women who quit smoking relapse within 6 months of delivery.1 This is not surprising. Anyone who has cared for a newborn understands the multiple stresses of this period, exacerbated by loss of sleep. Postpartum depression is common, and the desire to lose weight after pregnancy may also drive women back to smoking. Also, women may be more aware of the harms of smoking to their developing fetus than to themselves or to their growing child.

To decrease relapse to smoking, Levine and colleagues2 developed an innovative intervention based on cognitive behavioral techniques to challenge thoughts and beliefs relating to mood, stress, and weight gain. Women who had stopped smoking during pregnancy were randomized to this intervention vs a control group that received support in maintaining smoking cessation. At 52 weeks postpartum, there was no difference between the 2 groups.

Overall, 228 of 300 women (76.0%) were back to smoking at 52 weeks, after being able to stop smoking during pregnancy. Now, the challenge for interventionists is to build on that initial success.

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Article Information

Conflict of Interest Disclosures: None reported.

References
1.
Centers for Disease Control and Prevention. Tobacco use and pregnancy. http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/TobaccoUsePregnancy/index.htm. Accessed January 31, 2016.
2.
Levine  MD, Cheng  Y, Marcus  MD, Kalarchian  MA, Emery  RL.  Preventing postpartum smoking relapse: a randomized clinical trial [published online March 21, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.0248.
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