Post-partum smoking among Hungarian women who smoked prior to pregnancy

Background: Tobacco use is high among low-income, pregnant women in Hungary. Among our sample of women with live births in 2009, 42% were smokers when they learned they were pregnant. Pregnancy is an excellent motivator for women to quit, but definitive abstinence has been difficult to achieve. Methods: We conducted interviews among 9,040 women for a retrospective cohort study on tobacco use and pregnancy. The analytical sample were known smokers prior to pregnancy and whose post-natal smoking status was known (n=3,164). Logistic regression was used to assess correlates of tobacco use post-partum (significance level, α ≤.01). Results: 82% of women were smoking post-partum. Factors positively correlated with smoking after delivery include older age of the mother (vs. <18), never married/widowed (vs. married), and 3-6 (vs. 1-2) children. Women 18-40 years were 3 ˝ - 4 times more likely to use tobacco post-partum. Women 41+ were almost 15 times more likely to use tobacco after birth. Having 3-6 children increased the likelihood of post-partum smoking by 90% (OR 1.89, 95%CI 1.31-2.74). Women who were never married/widowed were 3.7 times more likely to use tobacco after delivery (95% CI 1.21-11.09). Factors that reduced the likelihood of post-partum tobacco use included living with a non-smoking partner (OR=.42, 95%CI .32-.56) and higher SES (education, employment, and higher family incomes correlated negatively with smoking post-partum). Conclusions: Relying on „pregnancy” as a motivator for definitive cessation is inadequate in this population. Systems-level interventions that target pregnant smokers are needed to increase quitting and reduce recidivism.