Smoking is the single most preventable cause
of perinatal morbidity. This study examines smoking
behaviors during pregnancy in a high risk population of
African Americans. The study also examines risk factors
associated with smoking behaviors and cessation in
response to a cognitive behavioral therapy (CBT) intervention.
This study is a secondary analysis of data from a
randomized controlled trial addressing multiple risks during
pregnancy. Five hundred African-American Washington,
DC residents who reported smoking in the 6 months
preceding pregnancy were randomized to a CBT intervention.
Psycho-social and behavioral data were collected.
Self-reported smoking and salivary cotinine levels were
measured prenatally and postpartum to assess changes in
smoking behavior. Comparisons were made between active
smokers and those abstaining at baseline and follow-up in
pregnancy and postpartum. Sixty percent of participants
reported quitting spontaneously during pregnancy. In
regression models, smoking at baseline was associated with
older age,a high school education and illicit drug use. At
follow-up closest to delivery, smoking was associated with
lower education, smoking and cotinine level at baseline
and depression. At postpartum, there was a relapse of 34%.
Smokers postpartum were significantly more likely to
smoke at baseline and use illicit drugs in pregnancy.
Mothers in the CBT intervention were less likely to
relapse. African-American women had a high spontaneous
quit rate and no response to a CBT intervention during
pregnancy. Postpartum mothers’ resolve to maintain a quit
status seems to wane despite their prolonged period of
cessation. CBT reduced postpartum relapse rates.