Maternal and Child Health Journal

, Volume 22, Issue 5, pp 660–669 | Cite as

Transitions in Smoking Across a Pregnancy: New Information from the Growing Up in New Zealand Longitudinal Study

  • Chris Schilling
  • Mary R. Hedges
  • Polly Atatoa Carr
  • Susan Morton


Introduction Maternal smoking remains a modifiable cause of adverse maternal and child health outcomes. This study investigated smoking transitions across pregnancy. Methods Data from the contemporary child cohort study Growing Up in New Zealand (n = 6822) were used to analyse smoking status across three points across a pregnancy: pre-pregnancy, during pregnancy and after pregnancy. Odds-ratios (OR) were calculated for maternal, socio-economic and pregnancy-related factors associated with each transition using multivariate logistic regression. Results The prevalence of smoking pre-pregnancy was 20.3%. The cessation rate during pregnancy was 48.5%, while the postpartum relapse rate was 36.0%. Heavy smokers were less likely to quit during pregnancy (OR 0.13, 95% CI 0.08–0.20), and more likely to relapse at 9 months (OR 2.63, CI 1.60–4.32), relative to light smokers. Women in households with another smoker were less likely to quit during pregnancy (OR 0.35, CI 0.25–0.48), and more likely to relapse postpartum (OR 2.00, CI 1.14–3.51), relative to women in a smoke-free household. Women without high school qualifications were less likely to quit during pregnancy than women with bachelor degrees (OR 0.21, CI 0.11–0.41) but no more likely to relapse. Maori women were less likely to quit during pregnancy than European women (OR 0.35, CI 0.25–0.49) but no more likely to relapse. Conclusion Heavy smokers and those with another smoker in the household are at high risk of smoking during pregnancy or relapsing after pregnancy. Decreasing smoking across a pregnancy therefore requires a focus on cessation in all households with heavy smokers of child-bearing age. The association between smoking and ethnicity may be confounded as it not consistent across the pregnancy.


Smoking Pregnancy Postpartum Longitudinal study 



We acknowledge the key role of the Ministry of Social Development in identifying the need for a longitudinal study that reflects the diversity of today’s New Zealand and for its ongoing support. Other agencies, as well as The University of Auckland, have contributed to the cost of the study to-date. These are: the Ministry of Health, the New Zealand Police, the Ministry of Justice, the Families Commission, the Children’s Commission, the Department of Labour, the Ministry of Education, Housing New Zealand and Sport and Recreation New Zealand. The funders have had no role in the design, analysis or writing of this article.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no competing interests.


  1. AIHW (2011). 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW.Google Scholar
  2. Allen, A. M., Prince, C. B., et al. (2009). Postpartum depressive symptoms and smoking relapse. American Journal of Preventive Medicine, 36(1), 9–12.CrossRefPubMedGoogle Scholar
  3. American College of Obstetricians and Gynecologists (2011). Smoking cessation during pregnancy: A clinician’s guide to helping pregnant women quit smoking.Google Scholar
  4. Andrews, A., Dixon, L., et al. (2014). Smoking prevalence trends: An analysis of smoking at pregnancy registration and at discharge from a midwife Lead Maternity Carer, 2008 to 2010. New Zealand College of Midwives Journal, 49, 17–22.CrossRefGoogle Scholar
  5. Came, H. (2014). Sites of institutional racism in public health policy making in New Zealand. Social Science & Medicine, 106(0), 214–220.CrossRefGoogle Scholar
  6. Centre for Disease Control (2011). PRAMS online data for epidemiologic research.Google Scholar
  7. Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Research, 6(Suppl 2), S125–S140.CrossRefGoogle Scholar
  8. Craig, E., Dell, R., et al. (2012). The determinants of health for children and young people in New Zealand. Dunedin: New Zealand Child and Youth Epidemiology Service, University of Otago.Google Scholar
  9. Dietz, P. M., Homa, D., et al. (2011). Estimates of nondisclosure of cigarette smoking among pregnant and nonpregnant women of reproductive age in the United States. American Journal of Epidemiology, 173(3), 355–359.CrossRefPubMedGoogle Scholar
  10. Flower, A., Shawe, J., et al. (2013). Pregnancy planning, smoking behaviour during pregnancy, and neonatal outcome: UK Millennium Cohort Study. BMC Pregnancy and Childbirth, 13(1), 238.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Flower, A., Shawe, J., et al. (2013). Pregnancy planning, smoking behaviour during pregnancy, and neonatal outcome: UK Millennium Cohort Study. BMC Pregnancy and Childbirth, 13, 238–238.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Glover, M., & Kira, A. (2011). Why Māori women continue to smoke while pregnant. The New Zealand Medical Journal, 29, 22–31.Google Scholar
  13. Gyllstrom, M., Hellerstedt, W., et al. (2012). The association of maternal mental health with prenatal smoking cessation and postpartum relapse in a population-based sample. Maternal & Child Health Journal, 16(3), 685–693.CrossRefGoogle Scholar
  14. Harmer, C., & Memon, A. (2013). Factors associated with smoking relapse in the postpartum period: An analysis of the Child Health Surveillance System data in Southeast England. Nicotine & Tobacco Research, 15(5), 904–909.CrossRefGoogle Scholar
  15. Harris, R., Tobias, M., et al. (2006). Effects of self-reported racial discrimination and deprivation on Māori health and inequalities in New Zealand: Cross-sectional study. The Lancet, 367(9527), 2005–2009.CrossRefGoogle Scholar
  16. Harris, R. B., Cormack, D. M., et al. (2013). The relationship between socially-assigned ethnicity, health and experience of racial discrimination for Māori: Analysis of the 2006/07 New Zealand Health Survey. BMC Public Health, 13(1), 1–11.CrossRefGoogle Scholar
  17. Haug, K., Aarø, L. E., et al. (1994). Pregnancy—a golden opportunity for promoting the cessation of smoking? Scandinavian Journal of Primary Health Care, 12(3), 184–189.CrossRefPubMedGoogle Scholar
  18. Lumley, J., Chamberlain, C., et al. (2009). Interventions for promoting smoking cessation during pregnancy. The Cochrane database of systematic reviews, 3(3), CD001055.Google Scholar
  19. Makowharemahihi, C., Lawton, B., et al. (2014). Initiation of maternity care for young Māori women under 20 years of age. The New Zealand Medical Journal, 127, 1393.Google Scholar
  20. McLeod, D., Pullon, S., et al. (2003). Factors that influence changes in smoking behaviour during pregnancy. The New Zealand Medical Journal 116, 1173.Google Scholar
  21. Ministry of Health (2013). New Zealand Health Survey 2012/2013.Google Scholar
  22. Morton, S., Atatoa Carr, P., et al. (2012). Growing Up in New Zealand: A longitudinal study of New Zealand children and their families. Report 2: Now we are born. Auckland.Google Scholar
  23. Morton, S. M., Atatoa Carr, P., et al. (2010). Growing Up in New Zealand: A longitudinal study of New Zealand children and their families. Report 1: Before we are born. Auckland: Growing Up in New Zealand, Growing Up in New Zealand.Google Scholar
  24. Morton, S. M., Atatoa Carr, P. E., et al. (2013). Cohort profile: Growing up in New Zealand. International Journal of Epidemiology, 42(1), 65–75.CrossRefPubMedGoogle Scholar
  25. Morton, S. M. B., Grant, C. C., et al. (2012). How do you recruit and retain a pre-birth cohort? lessons learnt from growing up in New Zealand. Evaluation & the Health Professions. Scholar
  26. Morton, S. M. B., Ramke, J., et al. (2014). Growing Up in New Zealand cohort alignment with all New Zealand births. Melbourne: Australian And New Zealand Journal Of Public Health.Google Scholar
  27. Pickett, K. E., Wakschlag, L. S., et al. (2003). Fluctuations of maternal smoking during pregnancy. Obstetrics & Gynecology, 101(1), 140–147.Google Scholar
  28. Salmond, C. E., Crampton, P., & Atkinson, J. (2007). NZDep2006 index of deprivation, (pp. 1–61) Wellington: Department of Public Health, University of Otago Wellington.Google Scholar
  29. Satcher, D., Thompson, T. G., et al. (2002). Women and smoking: A report of the Surgeon General. Nicotine & Tobacco Research, 4(1), 7.CrossRefGoogle Scholar
  30. Schneider, S., Huy, C., et al. (2010). Smoking cessation during pregnancy: A systematic literature review. Drug & Alcohol Review, 29(1), 81–90.CrossRefGoogle Scholar
  31. Shipton, D., Tappin, D. M., et al. (2009). Reliability of self reported smoking status by pregnant women for estimating smoking prevalence: A retrospective, cross sectional study. British Medical Journal, 339, b4347.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Simmons, V. N., Sutton, S. K., et al. (2013). Prepartum and postpartum predictors of smoking. Nicotine & Tobacco Research, 16(4), 461–468CrossRefGoogle Scholar
  33. Simmons, V. N., Sutton, S. K., et al. (2014). “Prepartum and Postpartum Predictors of Smoking. Nicotine & Tobacco Research, 16(4), 461–468.CrossRefGoogle Scholar
  34. Smedberg, J., Lupattelli, A., et al. (2014). Characteristics of women who continue smoking during pregnancy: A cross-sectional study of pregnant women and new mothers in 15 European countries. BMC Pregnancy & Childbirth, 14(1), 1–27.CrossRefGoogle Scholar
  35. Statistics New Zealand (2014). Infoshare: Births—VSB. Live births (Annual-Dec).Google Scholar
  36. U.S. Department of Health and Human Services. (2014). International comparisons of infant mortality and related factors: United States and Europe 2010. from

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Chris Schilling
    • 1
  • Mary R. Hedges
    • 2
  • Polly Atatoa Carr
    • 3
  • Susan Morton
    • 2
  1. 1.Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
  2. 2.Centre for Longitudinal ResearchThe University of AucklandAucklandNew Zealand
  3. 3.National Institute of Demographic and Economic Analysis, Facility of Arts and Social SciencesThe University of WaikatoHamiltonNew Zealand

Personalised recommendations