BROWN / JOHNS HOPKINS (US) — Pregnant women who smoke and don’t feel strong emotional attachment to their unborn babies may smoke more than those who smoke and are emotionally attached, a small study suggests.
“It would make sense psychologically that women who feel less attached to their fetus are going to smoke more, because they aren’t necessarily thinking about the repercussions,” says Susanna Magee, assistant professor of family medicine at Brown University.
To test that theory, Magee and co-author Laura Stroud, a research associate professor of psychiatry and human behavior looked to a subpopulation of women participating in the Behavior and Mood in Babies and Mothers (BAM BAM) study which tracks smoking during pregnancy.
Subjects participate in the Timeline Follow Back interview where they are asked to recall their weekly smoking history during pregnancy.
Researchers also measured participants’ saliva levels of the chemical cotinine, a metabolic byproduct of nicotine use that varies with the amount a person has smoked in the last day or so. The researchers sampled cotinine at weeks 30 and 35 of pregnancy and on the day after delivery.
For this study, published in Maternal and Child Health Journal, researchers also asked 58 pregnant smokers to answer the 24 questions of the Maternal-Fetal Attachment Scale (MFAS) at weeks 30 and 35 of gestation. The scale provides a standardized assessment of each woman’s feelings about her fetus.
For analysis, Magee then divided the women into two groups of 30 and 28 based on their MFAS scores.
Women in the lower attachment group had significantly higher levels of cotinine—an indicator that they smoked more—at week 30 and on the day after delivery. (At week 35 their levels were also comparatively high, but not to a statistically significant degree.)
In another result that was suggestive but fell just short of statistical significance, women in the lower attachment group also reported smoking a higher maximum number of cigarettes per day.
While the study should be repeated with a larger sample, it fits within a narrative emerging in the literature that has documented associations between fetal attachment and maternal behavior during pregnancy. There are at least two previous studies, for example, in which researchers found that women who felt less attachment to their fetuses were more likely to smoke at all during pregnancy.
The study highlights the importance of assessing maternal-fetal attachment, Stroud says. “This study is building a case that maternal-fetal attachment, while it may be a more warm and fuzzy concept, actually has cold hard implications for health outcomes.”
In particular the new study is the first to present statistically significant evidence that low attachment may be associated with smoking more among pregnant smokers.
It therefore adds support for the hypothesis that finding ways to improve a mother’s feelings of attachment for her fetus may help her reduce smoking, if not quit altogether, Magee says.
“Quitting is really important and as a family doctor I can’t stress enough that I think the ideal thing is for women to quit, but this speaks to cutting down also.”
The stakes are high. Prior research has shown that 80 percent of women who smoke continue to do so after becoming pregnant, meaning that 500,000 fetuses are exposed to tobacco in utero every year in the United States.
“It’s very, very hard for moms to quit,” Stroud says. “Having another way to get at smoking beyond the typical techniques via increasing attachment may be another path to helping moms quit. I think that’s very exciting.”
Researchers from Johns Hopkins University and the Schroeder Institute for Tobacco Research and Policy Studies contributed to the study, which was funded by the National Institutes of Health and the Flight Attendants Medical Research Institute.
Source: Brown University