The relationship between maternal-fetal attachment and cigarette smoking over pregnancy

Matern Child Health J. 2014 May;18(4):1017-22. doi: 10.1007/s10995-013-1330-x.


Cigarette smoking during pregnancy is one of the most preventable causes of infant morbidity and mortality, yet 80 % of women who smoked prior to pregnancy continue to smoke during pregnancy. Past studies have found that lower maternal-fetal attachment predicts smoking status in pregnancy, yet past research has not examined whether maternal-fetal attachment predicts patterns or quantity of smoking among pregnant smokers. The aim of this study was to examine the relationship between maternal-fetal attachment and patterns of maternal smoking among pregnant smokers. We used self-reported and biochemical markers of cigarette smoking in order to better understand how maternal-fetal attachment relates to the degree of fetal exposure to nicotine. Fifty-eight pregnant smokers participated in the current study. Women completed the Maternal-Fetal Attachment Scale, reported weekly smoking behaviors throughout pregnancy using the Timeline Follow Back interview, and provided a saliva sample at 30 and 35 weeks gestation and 1 day postpartum to measure salivary cotinine concentrations. Lower maternal-fetal attachment scores were associated with higher salivary cotinine at 30 weeks gestation and 1 day postpartum. As well, women who reported lower fetal attachment reported smoking a greater maximum number of cigarettes per day, on average, over pregnancy. Lower maternal-fetal attachment is associated with greater smoking in pregnancy. Future research might explore whether successful smoking cessation programs improve maternal assessments of attachment to their infants.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Birth Weight
  • Cotinine / metabolism
  • Cross-Sectional Studies
  • Female
  • Fetal Development / physiology
  • Gestational Age
  • Health Behavior
  • Humans
  • Incidence
  • Infant, Premature
  • Interviews as Topic
  • Maternal-Fetal Relations / psychology*
  • Multivariate Analysis
  • Pregnancy / psychology*
  • Pregnancy Outcome*
  • Prenatal Care / methods
  • Risk Assessment
  • Self Report
  • Smoking / adverse effects
  • Smoking / psychology*
  • Socioeconomic Factors
  • Time Factors
  • Tobacco Use Disorder / complications
  • Tobacco Use Disorder / psychology*
  • United States
  • Young Adult


  • Cotinine