Addressing Multiple Behavioral Risks in Prenatal Care: Smoking, Mental Health, and Continuity of Care

A project integrating routine, standardized mental health and behavioral risk factor (BRF) screening among patients at eight reproductive health centers includes efforts to identify links among behavioral, mental and reproductive health. Data analyses of patients initiating prenatal care between January 2005-May 2006 included visit data and screening outcome. Among 2,678 patients studied, mean age was 25, 64% were Latina, and 64% were foreign-born representing 60 countries of birth. Patients who smoked in the last three months (10%) were significantly more likely to present with symptoms of anxiety (measured by PRIME-MD, OR=3.08, 95%CI: 2.17-4.37) or depression (measured by PHQ-9, OR=2.50, 95%CI:1.73-3.61); history of physical and/or sexual violence as an adult (OR=6.02, 95%CI:4.26-8.52) or child (OR=3.45, 95%CI:2.26-5.27); illicit drug use (OR=19.97, 95%CI:12.03-33.12) and alcohol use during pregnancy (OR=16.99, 95%CI: 8.68-33.27). After controlling for these mental health and behavioral risks, age, and race/ethnicity, being a recent smoker remained the single strongest predictor of receiving sporadic prenatal care (care in only one trimester, in trimesters 1 and 3 only, or in trimesters 1 and 2 only; AOR=1.70, 95%CI:1.28-2.26); not returning to site for postpartum care (AOR=2.16, 95%CI:1.60-2.93); and not returning for family planning care within 12 months of expected delivery date (AOR=2.03, 95%CI:1.48-2.79). The health risks of smoking in pregnancy have been well documented. These analyses indicate that pregnant women who smoke or have recently quit need referral and treatment to address significant mental health needs and social stressors to ensure adequate prenatal, postpartum, and interconception care as well as smoking cessation.