title: Smoking patterns, depression, and sociodemographic variables among Flemish women during pregnancy and the postpartum period.
abstract: BACKGROUND
  Relationships among feelings of depression, smoking behavior, and educational level during pregnancy have been documented. Feelings of depression may contribute to persistent smoking during pregnancy. No longitudinal studies assessing feelings of depression in women with different antepartum and postpartum smoking patterns are available.
  
  
  OBJECTIVE
  The aim was to determine relationships between depressive symptoms, sociodemographic characteristics, and smoking pattern during and after pregnancy.
  
  
  METHODS
  An observational, prospective, noninterventional study was conducted. Data were collected during two stages of pregnancy (T0: <;16 weeks and T1: 32-34 weeks) and postpartum (T2: >6 weeks) in 523 Flemish women. Feelings of depression (measured using the Beck Depression Inventory [BDI]), smoking behavior, and sociodemographic variables were analyzed using a general linear mixed model implemented in SAS Proc MIXED.
  
  
  RESULTS
  Smokers and initial smokers reported significantly more depressive symptoms at all time points compared with recent ex-smokers, nonsmokers, and initial nonsmokers (p <; .001). The three-way interaction among time point, smoking pattern, and educational level was significant (p = .02). Evolution of mean BDI over time differed by educational level. Among participants with a secondary school certificate or less, differences were observed between smokers and nonsmokers, recent ex-smokers and initial nonsmokers, and nonsmokers and initial nonsmokers. Among participants with a college or university degree, no differences were observed.
  
  
  CONCLUSIONS
  A wide variety of smoking patterns were observed during pregnancy and early postpartum. Smoking patterns were associated with depression and showed complex interactions with educational level. Assessment and intervention for both smoking and depression are needed throughout the perinatal period to support the health of mothers, their infants, and families.
authors.affiliation: Katrien S. De Wilde, MSc, Doctoral candidate; Leen C. Trommelmans, PhD, is Staff Member; and Hans H. Laevens, DVM, PhD, is Staff Member, Department of Health, Catholic University College Ghent, Belgium. Lea R. Maes, PhD, is Professor, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium. Marleen Temmerman, MD, MPH, PhD, is Professor, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Ghent University, Belgium. Hedwig L. Boudrez, PhD, is Staff Member, Stop-Smoking Clinic, Ghent University, Belgium.
authors.forename: Katrien S
authors.initials: KS
authors.lastname: De Wilde
authors.forename: Leen C
authors.initials: LC
authors.lastname: Trommelmans
authors.forename: Hans H
authors.initials: HH
authors.lastname: Laevens
authors.forename: Lea R
authors.initials: LR
authors.lastname: Maes
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.forename: Hedwig L
authors.initials: HL
authors.lastname: Boudrez
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001530:Belgium; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D012959:Socioeconomic Factors; D055815:Young Adult