'I smoke and drink alcohol during pregnancy, but I'm a good enough mom': a mixed methods study

Abstract

Abstract Background Smoking and alcohol consumption during pregnancy is a major public health concern. The aims of this study were: 1) to examine smoking and alcohol consumption during pregnancy and to investigate their association with maternal attitudes and socio-demographic characteristics; 2) to explore maternal attitudes regarding smoking and alcohol consumption during pregnancy among pregnant and postpartum women in Israel. Methods This mixed methods study is comprised of a self-reported questionnaire for measuring attitudes and behaviors regarding smoking and alcohol consumption among 676 Jewish women, up to 9 months postpartum; and semi-structured interviews with 17 women who smoked cigarettes and/or consumed alcohol during their pregnancy. Results Sixty-four women (9.6%) reported drinking alcohol during pregnancy, and 30 (4.8%) reported smoking. Women with a fewer children (OR 2.25; 99% CI: 1.30, 3.92) and those whose attitudes supported alcohol avoidance (OR 0.52; 99.9% CI: 0.36, 0.74) consumed less alcohol while pregnant. Educated women (OR 0.31; 99% CI: 0.14- 0.71) and women with anti-smoking attitudes (OR 0.50; 99% CI: 0.30, 0.82) were more likely to avoid smoking during pregnancy. Qualitative analyses reveals three major themes: 1) 'A good enough mom': The mothers presented risk-management practices in line with the conflict between their perception of ideal motherhood and that of being an independent person; 2) 'Social acceptance of smoking and alcohol consumption during pregnancy': Social attitudes of spouses, family and friends; 3) 'Lack of reliable information' from healthcare professionals. Conclusions Women's attitudes have a significant impact on their decision to drink alcohol and/or smoke during pregnancy. These attitudes may be a result of their risk management practices and the social acceptance of risk behaviors during pregnancy, and information provided (or not) by healthcare professionals. Key messages The results highlight the importance of creating a supportive environment and shaping health promoting attitudes among pregnant women. Reliable information given by healthcare professionals regarding risk behaviors during pregnancy is needed.