WASHINGTON (AP) -- More than one in 10 pregnant women smoke, and new research
suggests many of them also may suffer from depression, making kicking the habit
even harder.
The emerging science suggests that decades-old "quit for your baby" messages are
too simplistic an approach for many women -- and that perhaps prenatal checkups
should include screening pregnant smokers for mental health disorders that
themselves require care.
"These ladies all know, I promise you, about the health risks. That's not what
it is," says Dr. Jan Blalock of the University of Texas M.D Anderson Cancer
Center, which has begun a first-of-a-kind study, Project Baby Steps, to test
whether non-drug depression therapy helps pregnant smokers quit.
"We should at least understand more about why these ladies don't quit. We should
be looking more carefully instead of just saying, 'Whoop, got this group of
hard-core smokers.'"
Nearly 45 million Americans, or one in five adults, smoke. Quitting takes on
average three to five attempts, and scientists know it's harder if the smoker
has depression or anxiety disorders. In fact, one prescription anti-smoking pill
is actually the old antidepressant Wellbutrin sold under a different name, Zyban.
Certainly learning how dangerous smoking is to their developing baby can prompt
women to try to quit. It increases the risk of miscarriage, premature birth, low
birthweight, death from SIDS, and learning and behavior disorders.
But only recently have researchers begun to delve into why, despite the enormous
stigma, so many pregnant smokers don't quit. The government estimates about 12
percent of pregnant women smoke.
Dr. Renee Goodwin, a Columbia University epidemiologist, tracked more than 1,500
pregnant women who took part in a larger study of Americans' health. A
surprising 22 percent smoked at some point during pregnancy, and about 12
percent were classified as nicotine-dependent.
Pregnant smokers were typically poor, less educated and had less access to
health care.
But strikingly, 30 percent of the smokers had a mental health disorder, as did
more than half who were nicotine-addicted -- and the vast majority suffered
depression. The smokers were about three times as likely to have a disorder as
pregnant nonsmokers, Goodwin recently reported in the journal Obstetrics and
Gynecology.
Smaller studies also have linked depression to smoking during pregnancy.
Nicotine and other chemicals in cigarette smoke can act in the brain like weak
antidepressants, says Dr. Nora Volkow, director of the National Institute on
Drug Abuse.
"They are not just smoking to get the habit-forming aspects," Volkow explains.
"On top of that, they are seeking the therapeutic effect. It comes at a very,
very high cost."
It can be hard for the depressed to realize when they need help. And chances of
relapse increase when would-be quitters feel worsening sadness, lethargy or
other depression symptoms.
That makes the smoking more "a disease instead of a choice," Volkow says.
"Society's responsibility is to provide a treatment. Because here you have two
individuals that will be affected."
But how to treat pregnant smokers?
While many smokers turn to medication to ease quitting pangs, doctors hesitate
to prescribe even nicotine patches during pregnancy. Studies so far haven't
proven the patches' role in pregnancy, and some suggest pregnant women
metabolize nicotine faster and thus need higher doses, raising fetal safety
questions. A major study is beginning in Britain to try to settle those
questions.
What about alleviating depression to help them quit?
Antidepressants haven't been studied specifically in pregnant smokers.
Generally, those drugs are reserved for severe symptoms during pregnancy,
although recent studies suggest the risk of birth defects is low.
Enter Texas' Project Baby Steps. More than 250 pregnant smokers, and counting,
are testing whether a form of cognitive therapy for depression helps them kick
the habit better than anti-smoking counseling alone.
The psychological therapy is intense, teaching women to problem-solve so they
can improve dysfunctional relationships that can fuel both the depression and
the smoking, Blalock explains.
This is a high-risk group of poor, inner-city women. Almost half are currently
suffering major depression, and Blalock says many also have a history of abuse
or other trauma. But they volunteered for the study because they want to quit
smoking.
It's not clear yet if depression plays a role for pregnant smokers in general,
or is an added risk mostly for the poor, Blalock stresses.
Still, NIDA's Volkow says it's crucial to develop ways to help this uniquely
vulnerable group.
"There's a lot of social disdain" for pregnant smokers, adds Columbia's Goodwin.
"There aren't a lot of treatment programs. There's just advice ... not to smoke,
but that's not going to do the job."
Source : The Associated Press.
