NEW YORK (Reuters Health) - Many women who successfully kick the smoking habit during pregnancy pick it back up after they give birth, new study findings show.

"We think this is an opportunity lost for those concerned with public health because studies show that the longer a person is away from cigarettes, the less likely she is to resume," Dr. Gregory J. Colman of Pace University in New York told Reuters Health. "Perhaps health professionals should increase their efforts to keep women off cigarettes during this post-natal period, when these efforts are most likely to be rewarded," he added. The findings are based on 1993 to 1999 surveys of 115,000 new mothers from 10 US states. During the past decade, smoking has declined both among pregnant women and among women of reproductive age, note Colman and his co-author Dr. Ted Joyce, of City University of New York. The reason for this decline, the authors suggest, could be due in part to the increased number of anti-smoking campaigns that target pregnant women, the flurry of media attention surrounding the recent tobacco settlement between tobacco companies and 46 states, and increasing cigarette prices. In the current study, roughly one in four women reported smoking three months before pregnancy, but the proportion of women who reported quitting during pregnancy jumped from 37% in 1993 to 46% in 1999. In fact, pregnant women were 51% more likely to quit smoking in 1999 than in 1993, the researchers report in the January issue of the American Journal of Preventive Medicine. Still, about half of the women who quit smoking during pregnancy picked the habit back up within six months of giving birth. Black women, college-educated women, those with private insurance, and first-time mothers were least likely to resume the habit than were their counterparts. Teenagers, on the other hand, who were more likely to quit than older women, were also more likely to start lighting up again after pregnancy. Finally, women who smoked ten or fewer cigarettes each day before becoming pregnant were more likely to quit smoking before delivery than heavy smokers. Heavy smokers who did quit smoking during pregnancy were more likely to resume smoking after delivery, the report indicates. "This suggests that if someone plans to quit during pregnancy, she is more likely to be successful if she starts cutting down well before she becomes pregnant," Colman said. Yet despite their findings, Colman and Joyce say they "cannot dismiss the possibility" that women under-reported their smoking during pregnancy or over-reported their quit rates due to the stigma surrounding the practice. "There may be less stigma associated with smoking before pregnancy and after delivery, especially if the baby is healthy," they write. To decrease smoking after delivery, Colman recommends that health officials emphasize to pregnant women "that smoking around infants puts their health at risk." "Since more educated women not only quit more but resume less, perhaps their better understanding of the risks of maternal smoking helps them better resist the urge to resume," he said. A grant from the National Institute for Child Health and Human Development funded the study.

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