The association between second-hand smoke exposure and depressive symptoms among pregnant women

The longitudinal association between second-hand smoke exposure and maternal depression among non-smoking pregnant women in East China: A prospective birth cohort study

OBJECTIVES

Second-hand smoke (SHS) exposure during pregnancy is common and may negatively impact maternal mental health. Recent evidence on the association between SHS exposure and depression during pregnancy remains inconsistent. This study aims to examine the longitudinal association between SHS exposure and maternal depression.

STUDY DESIGN

A prospective birth cohort study.

METHODS

From October 2017 to September 2021, we conducted a prospective birth cohort study including 5311 pregnant women. We applied mixed-effects models and group-based multivariate trajectory modeling to estimate the longitudinal association between SHS exposure and depression during pregnancy.

RESULTS

The prevalence of depression during pregnancy was 40.61 %, 19.00 %, and 20.35 % in the first, second, and third trimesters, respectively; 50.52 % of the women were exposed to SHS during pregnancy. Compared to unexposed women, those with SHS exposure had higher odds of depression in the first (OR: 1.34, 95 % CI: 1.19-1.51), second (OR: 1.70, 95 % CI: 1.45-1.98), and third trimesters (OR: 1.71, 95 % CI: 1.47-1.99). Exposure in one, two, or three trimesters showed progressively stronger associations (ORs: 1.37, 1.89, 2.08, respectively). SHS exposure was associated with an increased trajectory of depression (OR: 1.38, 95 % CI: 1.05-1.81). The association between SHS and depression was more pronounced among unemployed mothers who had good sleep quality during pregnancy.

CONCLUSIONS

Exposure to SHS during pregnancy affects current and subsequent depression. Addressing SHS exposure is essential to promote mental health and improve the health outcomes of mothers and offspring.

The impact of an online educational program to reduce second-hand exposure to smoke among nonsmoking pregnant women; a hospital-based intervention study

Background

Second-hand smoke is recognized as a public health concern, especially for pregnant women.

Objectives

To compare pregnant women's exposure and perceptions of SHS pre-and post-intervention.

Materials and methods

The study was conducted with a sample of 32 pregnant women at a tertiary university hospital in Jordan. Using a semi-structured questionnaire, researchers asked women about their knowledge, attitude and behavior regarding prenatal exposure to smoke before and after an intervention that included motivation, communication, education and counselling by using a range of media. A cotinine test was conducted to measure levels in second-hand smokers.

Results

The average maternal age was 30.88 ± 1.69 years; 68% were highly educated, 43% were employed, 37% reported not having sufficient income, and 62% did not attend for antenatal care on a regular basis. There was a significant increase in knowledge and awareness regarding second-hand smoking and its effect on pregnancy outcomes after the intervention. More than 90% of pregnant women supported a comprehensive policy in relation to smoking, and 33% of used to leave the room where others smoked. This percentage increased to 70% after the intervention. Cotinine level decreased after the intervention in 81% of cases.

Conclusions

There is an increase in knowledge and awareness regarding second-hand smoking and its effects on pregnancy outcomes after implementation of an educational intervention.

Association between secondhand smoke exposure in pregnant women and their socioeconomic status and its interaction with age: a cross-sectional study

Background

Existing evidence highlights that exposure to secondhand smoke (SHS) is a risk factor for pregnant women’s health and is possibly affected by individual characteristics. This study aimed to explore the effect of individual socioeconomic status (SES) on SHS exposure among pregnant women in the third trimester and the interaction effect of age.

Methods

A total of 678 nonsmoking pregnant women with a median age of 29.0 years from 14 communities in a medium-sized city were recruited for this survey. Exposure to SHS was defined as the self-reported smoking habit of a spouse/partner. Individual SES characteristics consisted of marital status, educational attainment, employment and per capita monthly income.

Results

There were 238 (35.1%) participants who suffered from SHS exposure. Compared to the pregnant women who were employed, those who were unemployed were more likely to suffer from SHS exposure (OR = 1.572, 95% CI: 1.013–2.441). Participants who had a high school or technical secondary school education were more likely to be exposed to SHS than those with a college education or above (OR = 1.601, 95% CI: 1.029–2.449). Advanced age was a protective factor for participants with a college education or above (OR = 0.939, 95% CI: 0.884–0.997), but age increased the risk of SHS exposure among women who had unstable marriages (OR = 1.256, 95% CI: 1.019–1.549).

Conclusion

Exposure to SHS was very common among pregnant women in the third trimester. Pregnant women with a low SES and an older age should be considered a key population for the implementation of public health interventions.

Exposure to environmental chemicals and perinatal psychopathology

Women are nearly twice as likely to develop mood disorders compared with men, and incidence is greatest during reproductive transitions, including pregnancy and postpartum. Because these periods are characterized by dramatic hormonal and physiologic changes, there is heightened susceptibility to external factors, such as exposure to environmental toxicants, which may play a role in maternal psychopathology. The purpose of this scoping review was to provide an overview of studies conducted in humans and animal models on the effects of nonoccupational exposure to environmental chemicals on maternal psychopathology during the perinatal period. The largest number of studies examined exposure to environmental tobacco smoke and antenatal depression and showed consistently positive findings, although more prospective studies using biomarkers for exposure assessment are needed. The few studies examining persistent organic pollutants such as polybrominated diphenyl ethers and perinatal depression were consistent in showing associations with increased depressive symptoms. Results were mixed for exposure to heavy metals and non-persistent chemicals, but a strong literature in animal models supported an association between bisphenols and phthalates and reduced maternal behavior and care of pups after parturition. Biological mechanisms may include endocrine disruption, neurotransmitter system impairment, alterations in gene expression, and immune activation and inflammation. Additional longitudinal studies that include biospecimen collection are essential to furthering the understanding of how environmental toxicants during pregnancy may affect perinatal psychopathology and the underlying mechanisms of action. Future work should also leverage the parallels between animal and human maternal behavior, thereby highlighting the opportunity for multidisciplinary work in this avenue.

Prevalence and Sources of Second-Hand Smoking Exposure among Non-Smoking Pregnant Women in an Urban Setting of Vietnam

Exposure to second-hand smoke (SHS) among non-smoking pregnant women can lead to adverse maternal and fetal outcomes. A cross-sectional study was performed from July to August 2016 among 432 pregnant women at Bach Mai Hospital, Hanoi, Vietnam, to assess the prevalence and sources of SHS exposure among non-smoking pregnant women. Socio-economic characteristics and information regarding SHS exposure of participants were collected. Multivariable logistic regression was employed to identify associated factors. Overall, 92.6% and 64.5% of pregnant women were exposed to SHS in their lifetime and in the last 30 days, respectively. Cafeterias and restaurants had the highest proportion of pregnant women exposed to SHS. Those who reported that “smoking is allowed at home” (OR = 3.18; 95%CI = 1.97–5.13); going to working place (OR = 1.86; 95%CI = 1.08–3.19), going to state authority offices (OR = 1.98; 95%CI = 1.15–3.41), and cafeterias (OR = 1.96; 95%CI = 1.22–3.16) had the highest risk of SHS exposure in the last 30 days. We have found a high proportion of SHS exposure among non-smoking pregnant women in Vietnam. This comes from a multitude of sources, including homes, workplaces, cafeterias, and restaurants. The data emphasises the need for further intervention to address this health issue.

Relationship Between Secondhand Smoke Exposure and Depressive Symptoms: A Systematic Review and Dose⁻Response Meta-Analysis

Previous studies have suggested an association between secondhand smoke (SHS) exposure and risk of depressive symptoms. However, it remains unclear whether there is a dose-response relationship. The effect estimates were pooled using fixed-effect or random-effect models based on homogeneity analysis. The dose-response meta-analysis was performed by linear and non-linear regression. Subgroup analyses were conducted to explore the possible sources of heterogeneity. Twenty-four studies were included in this meta-analysis. SHS exposure was significantly associated with increased odds of depressive symptoms (odds ratio (OR) = 1.32, 95% confidence interval (CI) 1.25-1.39). For SHS exposure expressed as an ordinal variable, the dose-response meta-analysis revealed a monotonically increasing relationship between SHS exposure and depressive symptoms. A similar dose-response relationship was observed for SHS exposure expressed as a continuous variable (OR = 1.57, 95% CI = 1.26-1.87). Our findings suggest that SHS exposure is associated with increasing odds of depressive symptoms in a dose-response manner.

Setting-Specific and Symptom-Specific Association between Secondhand Smoke Exposure and Depressive Symptoms

Few studies have focused on the potential relationship between secondhand smoke (SHS) exposure and depressive symptoms. This study aimed to explore the potential association between SHS exposure and depressive symptoms and differentiate this association in setting-specific exposure and symptom-specific outcomes. A cross-sectional study was conducted in Guangdong province of China from September to December 2010 using a multistage sampling method to randomly sample adults aged 18 years and older. SHS exposure was defined as inhalation by non-smokers of the smoke exhaled from smokers for at least 1 day a week in the past 30 days. Depressive symptoms were measured using the nine-item Patient Health Questionnaire. The zero-inflate negative binomial regression models were used to explore the associations between SHS exposure and depressive symptoms. A total of 2771 non-smokers were included in this study, with mean age of 49.6 ± 14.0 years and 70.3% of females. The prevalence of depressive symptoms was significantly higher in participants with SHS exposure than in those without exposure (incidence rate ratio (IRR) = 1.32, 95% confidence interval (CI) 1.16⁻1.51), and there were similar positive associations for SHS exposure in medical facilities (IRR = 1.37, 95% CI 1.17⁻1.61) and in schools (IRR = 1.46, 95% CI 1.20⁻1.77). Notably, there was a monotonically increasing dose-response relationship between frequency of SHS exposure and depressive symptoms. When differentiating this relationship by the dimensions of depressive symptoms, there were similar dose-response relationships for cognitive-affective and somatic symptoms. When differentiating this relationship by sex, only females showed a significant dose-response relationship. Our findings suggest dose-response relationships between SHS exposure and depressive symptoms in sex-specific and symptom-specific manners. Future longitudinal studies are needed to establish the biological mechanisms of the impact of SHS exposure.

The association between exposure to second-hand smoke and major depressive disorder in perimenopausal women: results from apopulation-based study

PURPOSE

The aim of this study was to test the hypothesis that exposure to second-hand smoke (SHS) would be positively associated with major depressive disorder (MDD) in perimenopausal women from a population-based perspective, after adjustment for all potential confounders.

METHODS

This study used the National Health and Nutrition Examination Survey (NHANES) database, 2005-2012, to report on MDD in perimenopausal women.

RESULTS

The odds ratio (OR) for MDD increased when there was a smoker was in the home, as compared to not having a smoker in the home (aOR = 2.97, 95% confidence interval [CI] = 1.15-7.67); however, in the non-poor group, the OR for MDD showed no difference between those who had or did not have a smoker in their home. For participants who self-rated their health condition as excellent, very good or good, the OR for MDD increased; it also increased if there were smokers in the home, as compared to those without smokers in the home (aOR = 2.58, 95% CI = 1.08-6.14).

CONCLUSIONS

The present study results augment our understanding of the clinical and public health significance of SHS, as well as the role of various socioeconomic and self-rated health conditions, in perimenopausal women. Key messages An increasing OR for MDD was demonstrated with regard to health status such as CVD, chronic respiratory tract disease, arthritis, thyroid problems, lower eGFR, fair or poor self-rated health condition, and elevated CRP level. Participants who self-rated their health condition as excellent, very good or good had an increased OR for MDD. The OR also increased if the women had smokers in their home versus women who did not have smokers in the home.

Dose⁻Response Relationships between Second-Hand Smoke Exposure and Depressive Symptoms among Adolescents in Guangzhou, China

There has been little focus on the possible association between second-hand smoke (SHS) exposure and depressive symptoms among adolescents. Thus, this study aimed to explore the dose–response relationships between SHS exposure and depressive symptoms among adolescents and differentiate these associations in setting-specific exposure and severity-specific outcomes. A cross-sectional study was conducted using a stratified cluster sampling method to obtain a representative sample of high school students in Guangzhou, China. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Univariable and multivariable logistic regression models were used to explore the potential associations between SHS exposure and depressive symptoms. Among 3575 nonsmoking students, 29.6% were classified as having probable depressive symptoms and 9.6% had severe depressive symptoms. There were monotonically increasing dose–response relationships between setting-specific (public places, homes, or indoor/outdoor campuses) SHS exposure and severity-specific (probable or severe) depressive symptoms. When examining these relations by source of exposure, we also observed similar dose–response relationships for SHS exposure in campuses from smoking teachers and from smoking classmates. Our findings suggest that regular SHS exposure is associated with a significant, dose-dependent increase in risk of depressive symptoms among adolescents, and highlight the need for smoke-free environments to protect the health of adolescents.

Principal component analysis of early alcohol, drug and tobacco use with major depressive disorder in US adults

Early alcohol, tobacco and drug use prior to 18 years old are comorbid and correlated. This study included 6239 adults with major depressive disorder (MDD) in the past year and 72,010 controls from the combined data of 2013 and 2014 National Survey on Drug Use and Health (NSDUH). To deal with multicollinearity existing among 17 variables related to early alcohol, tobacco and drug use prior to 18 years old, we used principal component analysis (PCA) to infer PC scores and then use weighted multiple logistic regression analyses to estimate the associations of potential factors and PC scores with MDD. The odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. The overall prevalence of MDD was 6.7%. The first four PCs could explain 57% of the total variance. Weighted multiple logistic regression showed that PC1 (a measure of psychotherapeutic drugs and illicit drugs other than marijuana use), PC2 (a measure of cocaine and hallucinogens), PC3 (a measure of early alcohol, cigarettes, and marijuana use), and PC4 (a measure of cigar, smokeless tobacco use and illicit drugs use) revealed significant associations with MDD (OR = 1.12, 95% CI = 1.08-1.16, OR = 1.08, 95% CI = 1.04-1.12, OR = 1.13, 95% CI = 1.07-1.18, and OR = 1.15, 95% CI = 1.09-1.21, respectively). In conclusion, PCA can be used to reduce the indicators in complex survey data. Early alcohol, tobacco and drug use prior to 18 years old were found to be associated with increased odds of adult MDD.

Changes in the smoking behavior of pregnant women andtheir family members during pregnancy: A cross-sectional study in China

INTRODUCTION

Studies regarding the changes in smoking behavior of pregnant women have been mostly conducted in high income countries but rarely in China. This study thus focused on investigating the changes in smoking behavior among pregnant women and their family members in China, both before and during pregnancy.

METHODS

A cross-sectional study was carried out at nine Women and Children’s Hospitals in Shanghai, China, in 2014. A total of 2831 gestational households were recruited. The chi-squared test, paired sample t-test and logistical regression analysis were used during statistical analysis.

RESULTS

The prevalence of smoking for all household members significantly declined during pregnancy: 76.2% of the pregnant women, 19.2% of their husbands and 14.0% of other family members quit smoking entirely. The average daily cigarette consumption rate decreased from 5.9 to 0.9 among pregnant women, 11.4 to 9.5 for husbands, and 11.4 to 9.5 for other family members (paired sample t-test, p<0.001). The likelihood that husbands continued smoking during pregnancy was significantly lower for those with a shorter history of smoking, had a lower daily cigarette consumption rate and a household registration in Shanghai.

CONCLUSIONS

The prevalence of smoking among pregnant women, husbands and other family members significantly declines during pregnancy. Thus, pregnancy is most likely a key period in which to provide families with health education regarding the effects of smoking, both during the pregnancy period and in general. Intervention programs designed to reduce smoking among husbands during pregnancy should focus on those with a long history of smoking, a high rate of daily cigarette consumption, and those with household registration not in Shanghai.