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.
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Data Availability
The data that support the findings of this study are available from the corresponding author, S.M.H., upon reasonable request.
References
Bates D, Mächler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models Usinglme4. J Stat Softw 67(1). https://doi.org/10.18637/jss.v067.i01
Bearak J, Popinchalk A, Ganatra B, Moller AB, Tuncalp O, Beavin C, Kwok L, Alkema L (2020) Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health 8(9):e1152–e1161. https://doi.org/10.1016/S2214-109X(20)30315-6
Caspi A, Moffitt TE, Thornton A, Freedman D, Amell JW, Harrington H, Smeijers J, Silva PA (1996) The life history calendar: a research and clinical assessment method for collecting retrospective event-history data. Int J Methods Psychiatr Res 6(2):101–114. https://doi.org/10.1002/(SICI)1234-988X(199607)6:2%3c101::AID-MPR156%3e3.3.CO;2-E
Chisolm MS, Coleman-Cowger VH (2011) Response: how to use a window of opportunity. Addict Sci Clin Pract 6(1):71–72
Coleman PK, Garratt D (2016) From birth mothers to first mothers: toward a compassionate understanding of the life-long act of adoption placement. Issues L Med 31:139
Cnattingius S (2004) The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res: Off J Soc Res Nicotine Tob 6(Suppl 2):S125–S140. https://doi.org/10.1080/14622200410001669187
Curry SJ, McBride C, Grothaus L, Lando H, Pirie P (2001) Motivation for smoking cessation among pregnant women. Psychol Addict Behav 15(2):126
DiClemente CC, Dolan-Mullen P, Windsor RA (2000) The process of pregnancy smoking cessation: implications for interventions. Tob Control 9 Suppl 3(Suppl 3):III16–III21. https://doi.org/10.1136/tc.9.suppl_3.iii16
Diggle P, Diggle PJ, Heagerty PJ, Liang KY, Zeger SL (2002) Analysis of longitudinal data. Oxford University Press
Duffy JC, Waterton JJ (1984) Under-reporting of alcohol consumption in sample surveys: the effect of computer interviewing in fieldwork. Br J Addict 79(3):303–308. https://doi.org/10.1111/j.1360-0443.1984.tb00278.x
Edwards AC, Ohlsson H, Svikis DS, Sundquist J, Sundquist K, Kendler KS (2019) Protective effects of pregnancy on risk of alcohol use disorder. Am J Psychiatry 176(2):138–145. https://doi.org/10.1176/appi.ajp.2018.18050632
Edwards CE, Williams CL (2000) Adopting change: birth mothers in maternity homes today. Gender Soc 14(1):160–183. http://www.jstor.org/stable/190426
Graham H, Francis B, Inskip HM, Harman J, SWS Study Team (2006) Socioeconomic lifecourse influences on women’s smoking status in early adulthood. J Epidemiol Community Health 60(3):228–233. https://doi.org/10.1136/jech.2005.039784
Grant A, Morgan M, Gallagher D, Mannay D (2020) Smoking during pregnancy, stigma and secrets: visual methods exploration in the UK. Women Birth: J Australian College Midwives 33(1):70–76. https://doi.org/10.1016/j.wombi.2018.11.012
Harris LH (2000) Rethinking maternal-fetal conflict: gender and equality in perinatal ethics. Obstet Gynecol 96(1):786–791. https://doi.org/10.1016/S0029-7844(00)01021-8
Hensley Alford SM, Lappin RE, Peterson L, Johnson CC (2009) Pregnancy associated smoking behavior and six-year postpartum recall. Matern Child Health J 13:865–872
Hester RK, Miller JH (2006) Computer-based tools for diagnosis and treatment of alcohol problems. Alcohol Res Health: J Natl Inst Alcohol Abuse Alcoholism 29(1):36–40
Hoff GL, Cai J, Okah FA, Dew PC (2007) Changes in smoking behavior between first and second pregnancies. Am J Health Behav 31(6):583–590. https://doi.org/10.5555/ajhb.2007.31.6.583
Huizink AC, Menting B, De Moor MHM, Verhage ML, Kunseler FC, Schuengel C, Oosterman M (2017) From prenatal anxiety to parenting stress: a longitudinal study. Arch Womens Ment Health 20:663–672
Kendler KS, Ohlsson H, Svikis DS, Sundquist K, Sundquist J (2017) The protective effect of pregnancy on risk for drug abuse: a population, co-relative, co-spouse, and within-individual analysis. Am J Psychiatry 174(10):954–962. https://doi.org/10.1176/appi.ajp.2017.16091006
Leve LD, Neiderhiser JM, Ganiban JM, Natsuaki MN, Shaw DS, Reiss D (2019) The Early Growth and Development Study: a dual-family adoption study from birth through adolescence. Twin Res Hum Genet 22(6):716–727. https://doi.org/10.1017/thg.2019.66
Marceau K, De Araujo-Greecher M, Miller ES, Massey SH, Mayes LC, Ganiban JM, Reiss D, Shaw DS, Leve LD, Neiderhiser JM (2016) The perinatal risk index: early risks experienced by domestic adoptees in the United States. PLoS One 11(3):e0150486. https://doi.org/10.1371/journal.pone.0150486
Massey SH, Lieberman DZ, Reiss D, Leve LD, Shaw DS, Neiderhiser JM (2011) Association of clinical characteristics and cessation of tobacco, alcohol, and illicit drug use during pregnancy. Am J Addict 20(2):143–150
Massey SH, Neiderhiser JM, Shaw DS, Leve LD, Ganiban JM, Reiss D (2012) Maternal self concept as a provider and cessation of substance use during pregnancy. Addict Behav 37(8):956–961
Massey SH, Compton MT (2013) Psychological differences between smokers who quit during pregnancy and those who do not: a review of observational studies and directions for future research. Nicotine Tob Res 15(2):307–319
Massey SH, Bublitz MH, Magee SR, Salisbury A, Niaura RS, Wakschlag LS, Stroud LR (2015) Maternal-fetal attachment differentiates patterns of prenatal smoking and exposure. Addict Behav 45:51–56. https://doi.org/10.1016/j.addbeh.2015.01.028
Massey SH, Reiss D, Neiderhiser JM, Leve LD, Shaw, DS, Ganiban JM (2016) Maternal personality traits associated with patterns of prenatal smoking and exposure: Implications for etiologic and prevention research. Neurotoxicology and teratology, 53:48-54
Massey SH, Decety J, Wisner KL, Wakschlag LS (2017) Specification of change mechanisms in pregnant smokers for malleable target identification: a novel approach to a tenacious public health problem. Front Public Health 5:239
Massey SH, Newmark RL, Wakschlag LS (2018a) Explicating the role of empathic processes in substance use disorders: a conceptual framework and research agenda. Drug Alcohol Rev 37(3):316–332
Massey SH, Estabrook R, Lapping-Carr L, Newmark RL, Decety J, Wisner KL, Wakschlag LS (2022a) Are empathic processes mechanisms of pregnancy’s protective effect on smoking? Identification of a novel target for preventive intervention. Soc Sci Med 305:115071. https://doi.org/10.1016/j.socscimed.2022.115071
Massey SH, Pool LR, Estabrook R, Level RA, Shisler S, Stacks AM, Neiderhiser JM, Espy KA, Wakschlag LS, Eiden RD, Allen NB (2022b) Within-person decline in pregnancy smoking is observable prior to pregnancy awareness: evidence across two independent observational cohorts. Addict Biol 27(6):e13245. https://doi.org/10.1111/adb.13245
Massey SH, Mroczek DK, Reiss D, Miller ES, Jakubowski JA, Graham EK, Shisler SM, McCallum M, Huestis MA, Ganiban JM, Shaw DS, Leve LD, Eiden RD, Stroud LR, Neiderhiser JM (2018b) Additive drug-specific and sex-specific risks associated with co-use of marijuana and tobacco during pregnancy: evidence from 3 recent developmental cohorts (2003–2015). Neurotoxicol Teratol 68:97–106. https://doi.org/10.1016/j.ntt.2018.06.002
Natsuaki MN, Neiderhiser JM, Harold GT, Shaw DS, Reiss D, Leve LD (2019) Siblings reared apart: a sibling comparison study on rearing environment differences. Dev Psychol 55(6):1182–1190. https://doi.org/10.1037/dev0000710
Newman JC, Des Jarlais DC, Turner CF, Gribble J, Cooley P, Paone D (2002) The differential effects of face-to-face and computer interview modes. Am J Public Health 92(2):294–297. https://doi.org/10.2105/ajph.92.2.294
O’Leary J (2004) Grief and its impact on prenatal attachment in the subsequent pregnancy. Arch Women’s Mental Health 7:7–18
O’Campo P, Faden RR, Brown H, Gielen AC (1992) The impact of pregnancy on women’s prenatal and postpartum smoking behavior. Am J Prev Med 8(1):8–13
Pickett KE, Wilkinson RG, Wakschlag LS (2009) The psychosocial context of pregnancy smoking and quitting in the Millennium Cohort Study. J Epidemiol Community Health 63(6):474–480
Ramos AM, Marceau K, Neiderhiser JM, De Araujo-Greecher M, Natsuaki MN, Leve LD (2020) Maternal consistency in recalling prenatal experiences at 6 months and 8 years postnatal. J Dev Behav Pediatr: JDBP 41(9):698
Riaz M, Lewis S, Naughton F, Ussher M (2018) Predictors of smoking cessation during pregnancy: a systematic review and meta-analysis. Addiction (Abingdon, England) 113(4):610–622. https://doi.org/10.1111/add.14135
Schoenaker DAJM, Ploubidis GB, Goodman A, Mishra GD (2017) Factors across the life course predict women’s change in smoking behaviour during pregnancy and in midlife: results from the National Child Development Study. J Epidemiol Community Health 71(12):1137–1144. https://doi.org/10.1136/jech-2017-209493
Schneider S, Huy C, Schütz J, Diehl K (2010) Smoking cessation during pregnancy: a systematic literature review. Drug Alcohol Rev 29(1):81–90. https://doi.org/10.1111/j.1465-3362.2009.00098.x
Solomon L, Quinn V (2004) Spontaneous quitting: self-initiated smoking cessation in early pregnancy. Nicotine Tob Res: Off J Soc Res Nicotine Tob 6(Suppl 2):S203–S216. https://doi.org/10.1080/14622200410001669132
Tran DT, Roberts CL, Jorm LR, Seeho S, Havard A (2014) Change in smoking status during two consecutive pregnancies: a population-based cohort study. BJOG: Int J Obstet Gynaecol 121(13):1611–1620. https://doi.org/10.1111/1471-0528.12769
Wakschlag LS, Pickett KE, Middlecamp MK, Walton LL, Tenzer P, Leventhal BL (2003) Pregnant smokers who quit, pregnant smokers who don’t: does history of problem behavior make a difference? Soc Sci Med 56(12):2449–2460
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 reflect the views of NIDA, NIMH, NICHD, or the NIH.
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After ethical review of the protocol, this study was determined to be exempt from Institutional Review Board review at Brigham and Women's Hospital due to its exclusive use of secondary analysis of existing data that were and remained de-identified.
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Level, R.A., Zhang, Y., Tiemeier, H. et al. Unique influences of pregnancy and anticipated parenting on cigarette smoking: results and implications of a within-person, between-pregnancy study. Arch Womens Ment Health 27, 301–308 (2024). https://doi.org/10.1007/s00737-023-01396-z
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DOI: https://doi.org/10.1007/s00737-023-01396-z