Stressful events and continued smoking and continued alcohol consumption during mid-pregnancy.
OBJECTIVE
to examine whether the severity of different categories of stressful events is associated with continued smoking and alcohol consumption during mid-pregnancy. Also, we explored the explanation of these associations by anxiety and depressive symptoms during pregnancy. Finally, we studied whether the severity of stressful events was associated with the amount of cigarettes and alcohol used by continued users.


METHODS
We conducted a cross-sectional analysis using data from a population-based prospective cohort study. Pregnant women were recruited via midwifery practices throughout The Netherlands. We analyzed women who continued smoking (n = 113) or quit (n = 290), and women who continued alcohol consumption (n = 124) or quit (n = 1403) during pregnancy. Smoking, alcohol consumption, and perceived severity of stressful events were measured at 19 weeks of gestation. The State Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale were filled out at 14 weeks of gestation. Odds ratios were calculated as association measures and indicated the relative increase for the odds of continuation of smoking and alcohol consumption for the maximum severity score compared to the minimum score.


RESULTS
Severity of the following stressful event categories was associated with continued alcohol consumption: 'conflict with loved ones' (OR = 10.4, p<0.01), 'crime related' (OR= 35.7, p<0.05), 'pregnancy-specific' (OR = 13.4, p<0.05), and the total including all events (OR = 17.2, p<0.05). Adjustment for potential confounders (age, parity and educational level) did not notably change the estimates. There was no association of anxiety and depressive symptoms with continued smoking or alcohol consumption. No associations emerged for continued smoking and severity of stressful events. The amount of cigarettes and alcohol consumption among continued users was not associated with severity of stressful events.


CONCLUSIONS
Our findings may be relevant for health care providers, in particular midwives and general practitioners. The impact of stressful events may be considered when advising pregnant women on smoking and alcohol consumption.
University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion regulation, Groningen, The Netherlands.
Chantal
C
Beijers
University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion regulation, Groningen, The Netherlands.
Johan
J
Ormel
University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.
Judith L
JL
Meijer
University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.
Tjitte
T
Verbeek
University of Groningen, Department of Clinical Psychology, Groningen, The Netherlands.
Claudi L H
CL
Bockting
University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion regulation, Groningen, The Netherlands ; University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.
Huibert
H
Burger
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D001007:Anxiety / Q000150:complications; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications; D005260:Female; D006801:Humans; D008016:Life Change Events; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology*; D013315:Stress, Psychological; D011795:Surveys and Questionnaires