Postpartum Smoking Relapse and Breast Feeding: Defining the Window of Opportunity for Intervention

Background: Though many women spontaneously quit smoking during pregnancy, a large proportion relapse after delivery. Efforts aimed at reducing postpartum smoking relapse have been largely ineffective. Several studies have reported breast feeding as a primary factor influencing smoking abstinence duration. However, data on the potential role of breast feeding in smoking intervention efforts remain incomplete.

Methods: The Ulm SPATZ Health Study cohort consists of 1006 newborns of 970 mothers recruited in the University Medical Center Ulm, Germany. Kaplan-Meier plots, log-rank tests, and Cox proportional hazards models were used to assess differences in predominant and total breast-feeding duration stratified by smoking abstinence at 2 years and relapse period (by 6 weeks, 6 months, and 2 years postdelivery). Chi-square and Kruskal-Wallis tests were performed to identify significant differences in demographic and lifestyle factors across smoking categories.

Results: Approximately 70% of previous smokers who initiated breast feeding relapsed within 2 years. Relapse by 6 months was significantly associated with noninitiation of predominant breast feeding. Total breast-feeding duration rates among abstaining mothers and those who relapsed after 6 weeks mirrored those of nonsmokers respectively up to 1 year and 3 months. Lower age and education were mostly associated with smoking by 6 weeks. First parity and having a nonsmoking partner were associated with abstinence up to 2 years.

Conclusions: Interventions promoting breast feeding to incentivize continued smoking abstinence may be effective prior to weaning. Those promoting breast feeding longer than 6 months and partner smoking cessation may increase rates of long-term smoking abstinence lasting longer than 2 years postdelivery.

Implications: Most mothers who quit smoking during pregnancy relapse within 6 months of delivery. Though interventions targeting new mothers have been largely unsuccessful, relapse is often delayed until after weaning and targeted breast-feeding promotion has been suggested to enhance smoking cessation interventions. In this study, we assess the relationship between breast-feeding duration and long-term smoking abstinence by longitudinally investigating predominant and total breast-feeding patterns among mothers with a recent history of smoking stratified by period of relapse up to 2 years after delivery.