Pregnant Smokers May Suffer Depression

New Research Suggests Mental Health Problems Are Making It Harder For Many Of Them To Quit

(AP)  More than one in 10 pregnant women smoke in the United States, and new research suggests many of them also may suffer from depression, which makes kicking the habit even harder.

The emerging science suggests that decades-old "quit for your baby" messages are too simplistic an approach for many women, and perhaps prenatal checkups should include screening pregnant smokers for mental health disorders that themselves require care.

"These ladies all know, I promise you, about the health risks. That's not what it is," says Dr. Jan Blalock of the University of Texas M.D. Anderson Cancer Center, which has begun a first-of-a-kind study, Project Baby Steps, to test whether nondrug depression therapy helps pregnant smokers quit.

"We should at least understand more about why these ladies don't quit. We should be looking more carefully instead of just saying, `Whoop, got this group of hard-core smokers."'

Nearly 45 million Americans, or one in five adults, smoke. Quitting takes on average three to five attempts, and scientists know it is harder if the smoker has depression or anxiety disorders. One prescription anti-smoking pill actually is the old antidepressant Wellbutrin sold under a different name, Zyban.

Certainly learning how dangerous smoking is to their developing baby can prompt women to try to quit. It increases the risk of miscarriage, premature birth, low birth weight, death from sudden infant death syndrome and learning and behavior disorders.

But only recently have researchers begun to delve into why, despite the enormous stigma, so many pregnant smokers do not quit. The government estimates about 12 percent of pregnant women smoke.

Dr. Renee Goodwin, a Columbia University epidemiologist, tracked more than 1,500 pregnant women who took part in a larger study of Americans' health. A surprising 22 percent smoked at some point during pregnancy, and about 12 percent were classified as dependent on nicotine.

Pregnant smokers were typically poor, less educated and had less access to health care.

Strikingly, however, 30 percent of the smokers had a mental health disorder, as did more than half who were nicotine-addicted, and the vast majority suffered depression. The smokers were about three times as likely to have a disorder as pregnant nonsmokers, Goodwin recently reported in the journal Obstetrics and Gynecology.

Smaller studies also have linked depression to smoking during pregnancy.

Nicotine and other chemicals in cigarette smoke can act in the brain like weak antidepressants, says Dr. Nora Volkow, director of the National Institute on Drug Abuse.

"They are not just smoking to get the habit-forming aspects," Volkow explains. "On top of that, they are seeking the therapeutic effect. It comes at a very, very high cost."

It can be hard for the depressed to realize when they need help. And chances of relapse increase when would-be quitters feel worsening sadness, lethargy or other depression symptoms.

That makes the smoking more "a disease instead of a choice," Volkow says. "Society's responsibility is to provide a treatment. Because here you have two individuals that will be affected."

But how to treat pregnant smokers?

While many smokers turn to medication to ease quitting pangs, doctors hesitate to prescribe even nicotine patches during pregnancy. Studies so far have not proved the patches' role in pregnancy, and some suggest pregnant women metabolize nicotine faster and thus would need higher doses, raising fetal safety questions. A major study is beginning in Britain to try to settle those questions.

What about alleviating depression to help them quit?

Antidepressants have not been studied specifically in pregnant smokers. Generally, those drugs are reserved for severe symptoms during pregnancy, although recent studies suggest the risk of birth defects is low.

Enter Texas' Project Baby Steps. More than 250 pregnant smokers are testing whether a form of cognitive therapy for depression helps them kick the habit better than anti-smoking counseling alone.

The psychological therapy is intense, teaching women to solve problems so they can improve dysfunctional relationships that can fuel both the depression and the smoking, Blalock explains.

This is a high-risk group of poor, inner-city women. Almost half are currently suffering major depression, and Blalock says many also have a history of abuse or other trauma. They volunteered for the study because they wanted to quit smoking.

It is not clear yet whether depression plays a role for pregnant smokers in general or is an added risk, mostly for the poor, Blalock stresses.

Still, NIDA's Volkow says it is crucial to develop ways to help this uniquely vulnerable group.

"There's a lot of social disdain" for pregnant smokers, adds Columbia's Goodwin. "There aren't a lot of treatment programs. There's just advice ... not to smoke, but that's not going to do the job."

[drivelphobe]

last121868....

It is a good thing that you no longer smoke. You are to be congratulated. Your life will be better for it.

I am not angry with the children of smokers, just disgusted with all of them. I believe that offspring are replicas of the parents and therefore nature will take care of the rest. Smoking parents damage their children. The children will grow up and probably smoke as well, and the cycle continues. That is nature. Sometimes, a child will break the mold and cast off the damaging effects of the parents. That is what we would all hope for. Unfortunately, most children grow up to mimic many of their parents'' behaviours, the bad as well as the good. Smoking seems to be predictably prevalent in definable groups of people. Smoking is just one of their repugnant habits.

Good luck! Your friends will enjoy the new freshness in your breath, hair and clothing. Watch and see how many new friends will be wiling to hang out or go to dinner, etc. that used to say no. Your social life won''t be restricted to smokers.

[last121868]

drivelphobe~You are very welcome for that "compliment". I do have a confession to make..I quit smoking in January : ) (No multiple addictions, no health problems, no smoking while pregnant.)I am very glad I did, but I don''t have any anger towards those who smoke or, most importantly, their children. Children, unfortuantely, cannot choose their parents. I feel bad for you that you hold so much hostility towards children of smokers. I am wondering why you feel that "nature should take care of them".... Very sad : (

[drivelphobe]

last121868.....

Thank you for the compliment. You give me more credit than I deserve. I have very little insight into anything except the behaviour of smokers, their medical conditions, and their multiple addicitons. I have retired. I found too many therapists smoke.

I am having a wonderful fresh-air day. The same to you.

[drivelphobe]

Wow susieq_13 smoker-breath......

This is a comment section and I have my observations and opinions just as you have. The fact that you smoked during the three pregnancies speaks for itself. How is your opinion of me and my lack of qualifcations to judge any different than my opinion of smokers? You are not me so "light"en up!

[susieq_13]

Well driverphobe...I guess you don''t know too much. I''m not poor, I do not have a low IQ, I''m not an alcoholic or overweight and I''m relatively healthy and I am a smoker! I also smoked when I was pregnant with all 3 of my children. I''m not proud of it, but my children are all very healthy and very intelligent. Smoking is not a practice of defective beings. It''s a very very bad habit and not an easy one to quit. So if I was you, I would keep those kind of comments to yourself. You are not one to judge!

[horse3farm]

More smoking propaganda. I smoked all through my pregnancy, my mother did too, as well as my grandmother. No one in our family has major medical problems. My daughter is now 23 and in her entire life she''s never been in a hospital, been to the doctor maybe half a dozen times, in her life, and has no diseases. Me and my sister are never sick either and we are in our 50s. I still smoke.

Smoking and secondhand smoke are nothing compared to the other environmental factors in this country. My GYN says he is seeing more women with breast cancer....none of them smoke...and his comment was "something is wrong in this country."

And it ain''t smoking.

[horse3farm]

More smoking propaganda. I smoked all through my pregnancy, my mother did too, as well as my grandmother. No one in our family has major medical problems. My daughter is now 23 and in her entire life she''s never been in a hospital, been to the doctor maybe half a dozen times, in her life, and has no diseases. Me and my sister are never sick either and we are in our 50s. I still smoke.

Smoking and secondhand smoke are nothing compared to the other environmental factors in this country. My GYN says he is seeing more women with breast cancer....none of them smoke...and his comment was "something is wrong in this country."

And it ain''t smoking.

[last121868]

drivelphone~you have such a wonderful insight on EVERYTHING. Are you some sort of therapist? Someone who helps people with their problems?
If not, you should look into that field!
Have a GREAT day! : )
(FYI: I am not pregnant, nor do I smoke)

[drivelphobe]

Which comes first, the smoking or the depression? Who really cares about the children of smokers anyway? Sounds like another attempt by the medical community to get in on the cash flow with treatment plans and prescription drugs.

"Smoking might be more a disease than a choice?" "Pregnant smokers are typically poor, less educated and had less access to health care." Don''t forget to mention low IQ, probably alcoholic, usually overweight, horrible breath, unhealthy, and in general just plain disgusting.

Children of smokers have rights too. They are entitled to the same, wonderful environment of their parents. Leave them be and nature will take care of them. That''s why the survival rates are altered when the "Mommy" has to smoke. Smoking is no disease. It is a practice of defective beings.