Systematic review of the impact of depression on subsequent smoking cessation during pregnancy

Objective: Smoking during pregnancy is the most significant modifiable risk factor for adverse pregnancy outcomes. Tobacco use has a long-standing relationship with depression, but has not been critically investigated in pregnancy. We systematically reviewed studies of the association between depression and subsequent smoking cessation during pregnancy.

Methods: A systematic literature search was conducted in electronic databases including all dates up to April 2016 (PubMed, Cochrane, Psychinfo, CINAHL) for prospective studies of pregnant women, which measured depression at baseline (e.g., pre-pregnancy or during pregnancy) and smoking status at follow-up.

Results: A total of 1,526 articles were retrieved after removing duplicates. Of the 1,526 articles, 193 were then selected to be reviewed and evaluated in full. After the final review, 20 articles were selected for this systematic review. These papers included two repeat datasets, leaving 18 datasets for review. Of these, 12 papers showed the significance of the effect of depression on smoking cessation during pregnancy and the remaining eight papers reported a null hypothesis.

Conclusions: Depression is associated with poor smoking cessation rates in pregnancy. Future research is needed to focus on depression and smoking status as an outcome of interest in pregnancy with repeatable and objective measures used for data collection.