Postpartum Changes in Mood and Smoking-Related Symptomatology: An Ecological Momentary Assessment Investigation

Nicotine Tob Res. 2018 May 3;20(6):681-689. doi: 10.1093/ntr/ntx118.


Introduction: Postpartum smoking relapse is a highly prevalent public health problem. Mood and breast feeding are significantly associated with smoking relapse, although less is known about the temporality of these relationships. Therefore, this study utilized ecological momentary assessments (EMA) to prospectively examine changes in mood and smoking-related symptomatology in relationship to three events-childbirth, termination of breast feeding, and smoking relapse. We expected all three events to significantly alter mood and smoking-related symptomatology.

Methods: We enrolled a sample of pregnant women who had recently quit smoking and intended to remain quit during the postpartum. Participants were randomized to active/placebo progesterone to prevent postpartum relapse. Participants also completed daily EMA to collect data mood and smoking-related symptomatology as well as our three events of interest.

Results: Participants (n = 46) were, on average, 26.5 ± 0.8 years old and, prior to pregnancy, smoked 10.1 ± 0.7 cigarettes/day. We noted a number of significant within- and between-subject relationships. For example, participants reported a 24% decline in negative affect after childbirth (p = .0016). Among those who relapsed to smoking (n = 23), participants randomized to placebo had a significant increase in cigarette craving after relapse (β = 1.06, 95% confidence interval [CI] = 0.62 to 1.49, p value = .0003), whereas participants randomized to active progesterone did not (β = 0.63, 95% CI = -0.35 to 1.62, p value = .1824).

Conclusions: These observations suggest that mood and smoking-related symptomatology are influenced by childbirth, breast feeding, smoking relapse, and use of exogenous progesterone. Future research should explore how these observations may inform novel postpartum smoking relapse-prevention interventions.

Implications: Postpartum smoking relapse has been a persistent public health problem for more than 40 years. Although a number of significant predictors of postpartum smoking relapse have been identified (eg, depression and breast feeding), much of these analyses have relied on cross-sectional and/or self-reported retrospective data. Therefore, for the first time, we utilized ecological momentary assessment to explore the effect of childbirth, termination of breast feeding, and smoking relapse on mood and smoking-related symptomatology (eg, craving). Numerous significant relationships were observed, including a 96% increase in craving after smoking relapse. These novel observations can inform new and effective postpartum smoking relapse-prevention programs.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Affect* / drug effects
  • Affect* / physiology
  • Breast Feeding / psychology*
  • Breast Feeding / trends
  • Cross-Sectional Studies
  • Depression / diagnosis
  • Depression / drug therapy
  • Depression / psychology
  • Ecological Momentary Assessment*
  • Female
  • Humans
  • Postpartum Period / drug effects
  • Postpartum Period / physiology
  • Postpartum Period / psychology*
  • Pregnancy
  • Pregnant Women / psychology
  • Progesterone / pharmacology
  • Progesterone / therapeutic use
  • Recurrence
  • Retrospective Studies
  • Self Report
  • Smoking / psychology*
  • Smoking / therapy
  • Smoking / trends*
  • Smoking Cessation / methods
  • Smoking Cessation / psychology
  • Smoking Prevention / methods
  • Smoking Prevention / trends
  • Young Adult


  • Progesterone