Abstract
BackgroundSmoking in pregnancy constitutes a preventable risk factor for fetal/child development and maternal-fetal attachment (MFA) seems to contain a momentum that can break the chain of adverse outcomes by promoting maternal prenatal health practices. This study aimed to explore the association of MFA with smoking at any time during pregnancy and smoking cessation in early pregnancy, and the modifying role of MFA on the expected effects of education and prenatal psychological distress (PPD) on prenatal smoking behavior.MethodsThe pregnant women (n = 3766) participated in the The FinnBrain Birth Cohort Study in Finland between December 2011 and April 2015. The binary outcomes, smoking at any time during pregnancy and smoking cessation in early pregnancy, were obtained from self-reports at gestational weeks (gwks) 14 and 34 and The Finnish Medical Birth Register. MFA was assessed with the Maternal-Fetal Attachment Scale (MFAS) at gwks 24 and 34. Logistic regression analyses were used to determine the association between MFA and maternal prenatal smoking behavior.FindingsThe prevalence of smoking was 16.5%, and 58.1% of the smokers quit smoking during pregnancy. The independent associations of total MFA scores with prenatal smoking behavior were not established (aOR = 1.00-1.02, multiplicity adjusted p > 0.05). A higher score in the altruistic subscale of MFA, Giving of self, associated with a higher probability of smoking cessation (24 gwks: aOR = 1.13, 95% CI [1.04, 1.24], p = 0.007, multiplicity adjusted p = 0.062; 34 gwks: aOR = 1.17, 95% CI [1.07, 1.29], p < 0.001, multiplicity adjusted p = 0.008). The modifying effect of MFA on the observed associations between PPD and smoking in pregnancy and between maternal education and smoking in pregnancy / smoking cessation in early pregnancy was not demonstrated.ConclusionsThe altruistic dimension of maternal-fetal attachment associates with an increased probability of smoking cessation during pregnancy and therefore strengthening altruistic maternal-fetal attachment may constitute a promising novel approach for interventions aiming at promoting smoking cessation during pregnancy.
Highlights
Smoking in pregnancy constitutes a preventable risk factor for fetal/child development and maternalfetal attachment (MFA) seems to contain a momentum that can break the chain of adverse outcomes by promoting maternal prenatal health practices
The altruistic dimension of maternal-fetal attachment associates with an increased probability of smoking cessation during pregnancy and strengthening altruistic maternal-fetal attachment may constitute a promising novel approach for interventions aiming at promoting smoking cessation during pregnancy
A difference in age was not displayed between those women who quit smoking in early pregnancy compared to the women who continued smoking in late pregnancy Myears = 28.4(SD 5.0) vs. Myears = 27.8(SD 5.5) respectively, t(511.6) = 1.6, p = 0.12
Summary
Smoking in pregnancy constitutes a preventable risk factor for fetal/child development and maternalfetal attachment (MFA) seems to contain a momentum that can break the chain of adverse outcomes by promoting maternal prenatal health practices. The association between educational disadvantage and maternal prenatal smoking has been widely recognized [1, 7, 8]. In Finland, low maternal education constitutes the strongest predictor of smoking in pregnancy [9]. Low educational attainment may be a marker for both familial risk [11] and difficulty adapting behavior to environmental contingencies. This possibility is supported by one prior study linking lower self-directedness to persistent smoking during pregnancy [12]. A tendency towards co-occurrence of prenatal smoking, stress and socioeconomic disadvantage have been found to indicate an accumulative burden for maternal and child health [1, 17]
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