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Study: Pregnant smokers may suffer depression
By Lauran Neergaard
Associated Press
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WASHINGTON, D.C. -- More than one in 10 pregnant women smoke, and new research suggests many of them also may suffer from depression, making 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 that 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 non-drug 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's harder if the smoker has depression or anxiety disorders. In fact, one prescription anti-smoking pill is actually 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 birthweight, death from SIDS, and learning and behavior disorders.

But only recently have researchers begun to delve into why, despite the enormous stigma, so many pregnant smokers don't 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 nicotine-dependent.

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

But strikingly, 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 haven't proven the patches' role in pregnancy, and some suggest pregnant women metabolize nicotine faster and thus 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 haven't 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, and counting, 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 problem-solve 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. But they volunteered for the study because they want to quit smoking.

It's not clear yet if 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's 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."

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Reader comments on this story - 13 total

Note: All views and opinions expressed in reader comments are solely those of the individual submitting the comment, and not those of the Pantagraph or its staff.

Gabe wrote on Sep 21, 2007 10:50 AM:

" If you smoke you are pro-choice! If you are not than you are ridiculous! "

To A Friend: wrote on Sep 12, 2007 11:28 AM:

" There is a lot of things pregnant mothers do to harm there fetus. So do not just Target smoking. Target fast food, soda, taking any type of medications even Tylenol, not exercising. This whole smoking issue is stupid. Especially when other things cause danger too. So anyone caught in any of these other behaviors must go to jail too. How stupid! "

Fatso wrote on Sep 12, 2007 10:07 AM:

" I agree with "A Friend": We need more pests on the loose, protecting everyone from themselves. "

A Friend wrote on Sep 11, 2007 8:55 PM:

" Smoking at all is stupid, but doing while pregnant is unforgiveable. I agree with Dr D., anyone caught smoking while pregnant should be locked up. It does indicate what kind of a parent they are. They are a selfish uncaring person who puts their own addiction ahead of the health of their child. The poster who claimed she wasn't harmed by their mother smoking is wrong. The mere fact that they made such a ludicrous statement is proof they are brain damaged. Whenever I see a pregnant woman smoking I ALWAYS tell them they are harming their baby and ask them to please stop. It is the worst form of child abuse I can think of. They are not fit to parent. "

Our choice wrote on Sep 11, 2007 8:10 PM:

" I smoked before pregnancy and a little durning. I would have to say I would only smoke one to four cigarettes a day durning pregnancy. And all my kids are healthy and very smart they are in the High classed in school. When they were born they all were 7lbs or more. And to say that smokers are depressed more than non-smokers i would have to say false. I'm very happy with myself and my family. So are my friends that smoke. Now on the other hand I have a sister that never smoked a day in her life and she really needs help. Can't say there are not people out there that smoke that are not depressed but to say that a lot are you are checking the wrong people. It's our choice not yours if we smoke durning pregnancy or not. Last I knew you didn't go to jail for smoking. And that DCFS didn't take your kids away for smoking so get over it. And let people live their life the way they want to. Last I know this was the United States. We could do what we wanted to. "

fred wrote on Sep 11, 2007 8:04 AM:

" why no mention of microwave popcorn?? "

Nova wrote on Sep 11, 2007 12:05 AM:

" To Dr. D YOu need to becareful of your wording. Yes, smoking while pregnant is pretty irresponsible, but in no way will is show what kind of parent she will become. Of course today,we know how harmful it is to smoke while pregnant. My mother was a smoker and did a pretty good job at being a parent... none of us are in jail and all of us have jobs. Matter of fact, she was an actual parent and not a birth giver/ friend like today's parents are. "

To Todd the Bod wrote on Sep 10, 2007 5:47 PM:

" Keep Working out, for you have no brain-just like all jocks... "

Yuk! wrote on Sep 10, 2007 5:42 PM:

" Guess I'd be depressed too if I harmed my unborn child and did nothing about it. Thank GOD I did'nt!!! :) "

Dr. D. wrote on Sep 10, 2007 4:49 PM:

" If women are smoking while they are pregnant they should be confined to jail until the birth of their child. This is absolutely the most irresponsible thing a woman could do and it indicates exactly what type of parent she will be. "

Todd the Bod wrote on Sep 10, 2007 4:34 PM:

" Well duh. Smokers in general are more depressed than non-smokers. "

according to this Volkow wrote on Sep 10, 2007 4:31 PM:

" smoking is a disease so being a smoker makes one eligible for disability? interesting so now instead of smoking in bars, I can go on disability and milk the system. interesting..... careful what you ask for non-smokers :-) "

chavery wrote on Sep 10, 2007 4:15 PM:

" I smoked before pregnancy, during and after pregnancy and enjoyed every cigarette I smoked. Then I quit smoking for three years and felt terrible. Decided to quit and that was 23 years ago and now I can't stand the smell of cigarette smoke. "
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