Psychiatric disorders and gestational weight gain among women who quit smoking during pregnancy
Introduction
Among women, pregnancy is strongly related to weight gain and obesity risk [1], [2], [3], [4], [5], [6], [7], [8], [9]. Excessive gestational weight gain (GWG), or weight gain that exceeds the amount recommended by the Institute of Medicine (IOM)'s 2009 guidelines, is a robust predictor of postpartum weight retention [1], [10], and although the amount of weight retained after pregnancy varies widely [4], postpartum weight retention has been associated with long-term overweight and obesity more generally [1], [2], [11]. Thus, understanding pregnancy related changes in weight has become a focus of research.
Importantly, pregnancy also is associated with changes in other health-related behaviors that may, in turn, affect changes in eating and weight-related behaviors. For example, pregnancy is a common time for women to quit smoking [12], [13], which has well-documented maternal and fetal health benefits [14], [15]. However, smoking cessation also is robustly associated with weight gain in general [16], [17]. Indeed, continuing to smoke during pregnancy has been linked to lower GWG, and quitting smoking, particularly quitting earlier in pregnancy [18], has been related larger GWG [19], [20], [21].
In addition to smoking cessation, pregnancy-related declines in the use of other substances as well as changes in psychiatric symptoms during pregnancy might affect GWG. Although research on psychosocial predictors of GWG has been limited, initial data suggest that self-reported depressive symptoms are associated with excessive GWG [1]. Similarly, there is evidence that the presence of specific types of psychopathology can affect GWG. Using a Norwegian data set, researchers found that women with current or recent (i.e., within the last 6 months) DSM-IV eating disorder symptoms gained more gestational weight than did those without eating disorder symptoms [22], [23]. Finally, evidence suggests that smokers have high rates of psychiatric disorders [24], [25], [26], [27] and psychological distress [28], [29], which also have an impact on changes in weight [30], [31]. For example, considerable evidence has linked mood disorders to weight gain and obesity in smokers [30] as well as in the general population [32].
Given that psychiatric disorders are related to obesity and weight gain [33], and smokers have high rates of psychiatric disorders, it is plausible that psychiatric disorders affect GWG, particularly among women who have quit smoking as a result of pregnancy. Thus, in this study, we sought to examine the relationship between maternal psychiatric disorders and excessive GWG in a sample of former women smokers. We hypothesized that psychiatric disorders would be related to excessive GWG among women smokers. We further expected women with a history of mood or substance use disorders to gain more weight than those without a history of these disorders.
Section snippets
Participants
Participants for the current study were enrolled in a larger randomized controlled trial investigating the efficacy of a postpartum smoking relapse prevention intervention. Eligibility for the larger study, which has been detailed elsewhere [34], required women to have stopped smoking during or immediately prior to this pregnancy. Participants for this study were 281 pregnant former smokers who completed the Structured Clinical Interview for DSM-IV-TR Axis I Disorders: Non-Patient Version
Results
Total GWG ranged from a loss of 12.5 kg to a gain of 50.9 kg, with an average GWG of 15.6 (± 8.5) kg. Overall, more than half of the women (56%, n = 157) gained excessively according to the IOM guidelines for their prepregnancy BMI. More than one-third (34.3%, n = 96) of pregnant former smokers had a lifetime history of at least one diagnosable psychiatric disorder, 14.3% (n = 40) had a lifetime history of two disorders, and 8.2% (n = 23) had a lifetime history of 3 or more disorders. The remaining 43.2% (
Discussion
Smoking cessation and the regulation of gestational weight are important behavioral health goals for pregnant women. Results from the current analysis suggest that a large proportion of women who quit smoking in association with pregnancy have a history of a diagnosable psychiatric disorder and that more than half of the women who stop smoking exceed the IOM guidelines for GWG. However, contrary to expectations, a history of psychiatric disorder generally was not associated with GWG, with one
Acknowledgments
This research was supported by NIH/NIDA R01DA021608 (PI: Levine). The authors have no conflicts of interest to report. We acknowledge the skilled psychiatric interviewing of Jennifer Grace and thank the women who participated in the research.
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