Prevention of postpartum smoking relapse in mothers of infants in the neonatal intensive care unit

Abstract

Objective: Approximately 40% of women who smoke tobacco quit smoking during pregnancy, yet up to 85% relapse after delivery. Those who resume smoking often do so by 2 to 8 weeks postpartum. Smoking mothers are more than twice as likely to quit breastfeeding by 10 weeks postpartum. The hospitalization of a newborn, while stressful, is an opportunity to emphasize the importance of a smoke-free environment for babies. Supporting maternal-infant bonding may reduce maternal stress and motivate mothers to remain smoke free and continue breastfeeding. The objective of this study was to reduce postpartum smoking relapse and prolong breastfeeding duration during the first 8 weeks postpartum in mothers who quit smoking just before or during pregnancy and have newborns admitted to the Neonatal Intensive Care Unit (NICU).

Study design: This study was an Institutional Review Board-approved prospective randomized clinical trial. After informed consent, mothers of newborns admitted to the NICU were randomized to a control or intervention group. Both groups received weekly encouragement to remain smoke free and routine breastfeeding support. Mothers in the intervention group were also given enhanced support for maternal-infant bonding including information about newborn behaviors, and were encouraged to frequently hold their babies skin-to-skin.

Result: More mothers were smoke free (81 vs 46%, P<0.001) and breastfeeding (86 vs 21%, P<0.001) in the intervention than in the control group at 8 weeks postpartum.

Conclusion: Interventions to support mother-infant bonding during a newborn's hospitalization in the NICU are associated with reduced rates of smoking relapse and prolonged duration of breastfeeding during the first 8 weeks postpartum.

Figure 1

Enrollment population.

Figure 2

(a) Proportion of smoke-free mothers by postpartum weeks. Significantly more mothers in the intervention group (solid line) were smoke free at 8 weeks postpartum compared with mothers in the control group (dotted line), P<0.001, Kaplan–Meier survival. (b) Proportion of breastfeeding mothers by postpartum weeks. Significantly more mothers in the intervention group (solid line) were breastfeeding at 8 weeks postpartum compared with mothers in the control group (dotted line), P<0.001, Kaplan–Meier survival.