A Critical Review on Association Between Maternal Smoking During Pregnancy and Psychopathology Symptoms View PDF

Health practices during pregnancy are poorly understood by some women but are crucial to ensuring optimal health outcomes for women and their children. This is especially true for pregnant women who smoke. Smoking continues to be a habit for about half of pregnant women. There is evidence that smoking during pregnancy is associated with sub-optimal prenatal health practices, including inadequate prenatal care and poor adherence to guidelines for taking prenatal folate supplements. When women are having difficulty quitting smoking during pregnancy, they are more likely to be nicotine dependent and to smoke six or more cigarettes per day, which has been linked to significant adverse effects on the fetal nervous system. During this study, women who did or did not smoke heavily during pregnancy were compared on other suboptimal prenatal health practices, including symptoms of psychopathology [1]. It is possible to identify additional
risks to offspring that are not directly associated with intrauterine nicotine exposure by clarifying the interrelationships among pregnancy health practices associated with heavy smoking during pregnancy. To explain why pregnant women may continue to smoke during pregnancy and engage in other poor prenatal health practices, previous investigations suggest two models, each involving a different pattern of psychopathology [2]. First of all, depression is common among pregnant smokers, but there is still uncertainty about the exact nature and direction of this relationship. Pregnant smokers may use cigarette smoking to help alleviate symptoms associated with depression and anxiety [3]. Literature suggests that women with depression or anxiety symptoms are more likely to smoke during pregnancy or be unable to  stop. Prenatal health practices are also negatively affected by depression during pregnancy. There are, however, few studies that examine whether depressive symptoms and smoking during pregnancy may affect mothers’ prenatal health behaviors differently [4-6]. Another model is based on a broader pattern of externalizing behaviors, specifically antisocial behaviors, to explain suboptimal prenatal health practices among pregnant smokers. Antisocial behavior is defined as one that violates social norms and rights of others, either intentionally or unintentionally, and commonly involves disrespecting others, impulsive behavior, or substance abuse [7, 8]. As a result of this theory, smoking during pregnancy, taking prenatal folate as recommended, and receiving adequate prenatal care may be related to an underlying disposition to violate social norms, break rules, and lack of self regulation, which can lead to antisocial behavior [9]. The antisocial model of prenatal health practices in relation to pregnancy smoking has been found to be valid based on a review of literature on psychological characteristics that differentiate smokers who spontaneously quit during pregnancy from those who do not. In particular, a history of conduct disorders as a child, a predictor of antisocial behavior in adulthood, has been linked to failure to quit smoking during pregnancy [10]. When nicotine dependence is controlled, other mental disorders such as depression, anxiety, bipolar disorder, and schizophrenia are not associated with failure to quit smoking during pregnancy. During pregnancy, women who smoke at heavy levels may experience variations in prenatal health practices. The purpose of this study was to examine the relationships between prenatal folate supplementation frequency, prenatal care visits attended, prenatal antisocial behaviors, and prenatal depression and anxiety symptoms. Several papers on PubMed, PMC discussed on the possible differences in associations between women who smoke heavily during pregnancy and those who do not [11]. By examining the relationship between heavier prenatal smoking and additional prenatal health practices, this study extended the work of two models of addiction and sometimes opioid use too. This paper also examined whether the findings were consistent with a depression or antisocial model of sub-optimal prenatal health care [2].