Pregnant women with mental health disorders are facing too many barriers to help them quit smoking during pregnancy despite their willingness to accept support, finds a new study published today (21 November) in BJOG: An International Journal of Obstetrics and Gynaecology.
The study, undertaken by researchers at King's College London, looked at referrals to smoking cessation services and what barriers pregnant women with mental health disorders face compared to those women without disorders.
Overall 400 women, who reported smoking at their first appointment, were monitored and 237 accepted referrals to smoking cessation services. Approximately one quarter of the women studied (97) were diagnosed as having a mental disorder (i.e. depression, schizophrenia, eating disorder) and were found to be more willing to accept referrals to smoking cessation services compared to those women who did not have a mental disorder (69% vs. 56%).
However the women with these pre-existing mental health problems were also more likely to still be smoking by the time of delivery (80% vs. 60% for women with no mental health problems), leading researchers to conclude that the barriers for smoking cessation are much harder to overcome for women with mental health disorders.
The researchers conducted interviews with an additional 27 pregnant smokers to gauge some of the perceived barriers to quitting, which were common to all women whether they had mental health problems or not.
The women cited negative impacts from their social and physical environments, including physical addiction, as barriers to quitting. However the women with mental health disorders described heavier addiction and reported a different type of relationship with smoking (for example they continued to smoke when acutely ill or to stay thin).
Of particular importance was that women with mental health disorders described how they, and their healthcare providers, often prioritised the management of mental health care over stopping smoking due to the perceived negative impact that stopping smoking would have on their mental health symptoms.
Professor Louise Howard from King's College London's Institute of Psychiatry, and co-author of the study, said:
"We found that the women with mental disorders were more motivated to participate in the smoking cessation programmes at the start of their pregnancy, but by delivery they were significantly less likely to have stopped smoking.
"The perceived barriers to quitting were common among both groups, and the additional psychological condition of the women with mental disorders is clearly a major factor contributing to them not stopping smoking. The women who we interviewed said that they and their doctors prioritised their mental health over their smoking problem as they were worried that if they tried to stop smoking their mental health could deteriorate.