Maternal and Child Health Journal

, Volume 18, Issue 4, pp 1017-1022

First online:

The Relationship Between Maternal–Fetal Attachment and Cigarette Smoking Over Pregnancy

  • Susanna R. MageeAffiliated withDepartment of Family Medicine, Alpert Medical School of Brown University Email author 
  • , Margaret H. BublitzAffiliated withDepartment of Psychiatry and Human Behavior, Alpert Medical School of Brown University
  • , Christina OrazineAffiliated withDivision of State Health Laboratories, RI Department of Health
  • , Bridget BrushAffiliated withCenters for Behavioral and Preventive Medicine, The Miriam and Lifespan Hospitals
  • , Amy SalisburyAffiliated withDepartment of Psychiatry and Human Behavior, Alpert Medical School of Brown UniversityDepartment of Pediatrics, Women & Infants HospitalDepartment of Pediatrics, Alpert Medical School of Brown University
  • , Raymond NiauraAffiliated withSchroder Institute for Tobacco Research and Policy Studies, American LegacyDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
  • , Laura R. StroudAffiliated withDepartment of Psychiatry and Human Behavior, Alpert Medical School of Brown University

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Cigarette smoking during pregnancy is one of the most preventable causes of infant morbidity and mortality, yet 80 % of women who smoked prior to pregnancy continue to smoke during pregnancy. Past studies have found that lower maternal–fetal attachment predicts smoking status in pregnancy, yet past research has not examined whether maternal–fetal attachment predicts patterns or quantity of smoking among pregnant smokers. The aim of this study was to examine the relationship between maternal–fetal attachment and patterns of maternal smoking among pregnant smokers. We used self-reported and biochemical markers of cigarette smoking in order to better understand how maternal–fetal attachment relates to the degree of fetal exposure to nicotine. Fifty-eight pregnant smokers participated in the current study. Women completed the Maternal–Fetal Attachment Scale, reported weekly smoking behaviors throughout pregnancy using the Timeline Follow Back interview, and provided a saliva sample at 30 and 35 weeks gestation and 1 day postpartum to measure salivary cotinine concentrations. Lower maternal–fetal attachment scores were associated with higher salivary cotinine at 30 weeks gestation and 1 day postpartum. As well, women who reported lower fetal attachment reported smoking a greater maximum number of cigarettes per day, on average, over pregnancy. Lower maternal–fetal attachment is associated with greater smoking in pregnancy. Future research might explore whether successful smoking cessation programs improve maternal assessments of attachment to their infants.


Cigarette Smoking Attachment Cotinine Pregnancy