Faisal-Cury Alexandre, Matijasevich Alicia
Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
University of Sao Paulo, Av Dr Arnaldo 455, Room 2214, São Paulo, 01246-903, Brazil.
Matern Child Health J. 2022 Jun;26(6):1246-1254. doi: 10.1007/s10995-021-03306-0. Epub 2021 Nov 30.
Maternal postpartum smoking is associated with several negative outcomes for mother and child. The relationship between bonding impairment (BI) and maternal postpartum smoking is less known. The aim of the present study was to assess the relationship between BI and maternal postpartum smoking at 6 to 8 months after childbirth in a primary care sample of low-income mothers who had depression during the previous pregnancy.
We performed a cross-sectional, secondary analysis from a community trial with 356 postpartum women from public primary care clinics in São Paulo, Brazil. The main outcome measure was maternal postpartum smoking. The main exposure variable was BI assessed with the Postpartum Bonding Questionnaire. A socio-demographic questionnaire evaluated maternal and obstetric characteristics. Postpartum depression was assessed with the Patient Health Questionnaire. Crude and adjusted prevalence ratios (PR) of the association between BI and maternal postpartum smoking, with 95% confidence intervals (CI), were calculated using Poisson regression. Multivariate analysis was performed using three models (Model 1 adjusted for randomization during pregnancy, Model 2 adjusted for Model 1 plus mother's socioeconomic and obstetric characteristics, and Model 3 adjusted for Model 2 plus postpartum depression).
Maternal postpartum smoking occurred in 16.7% of our sample. In the multivariable analysis, BI was associated with maternal postpartum smoking (PR:2.04; CI 95% 1.08:3.84).
Women presenting bonding problems are at higher risk of smoking after childbirth. Intervention to enhance mother-child bonding may have the potential to decrease maternal postpartum smoking.
母亲产后吸烟与母婴的多种负面结局相关。母婴联结障碍（BI）与母亲产后吸烟之间的关系鲜为人知。本研究的目的是在一个先前孕期患有抑郁症的低收入母亲的初级保健样本中，评估产后6至8个月时BI与母亲产后吸烟之间的关系。
我们对一项社区试验进行了横断面二次分析，该试验纳入了来自巴西圣保罗公立初级保健诊所的356名产后女性。主要结局指标是母亲产后吸烟情况。主要暴露变量是用产后联结问卷评估的BI。一份社会人口学问卷评估了母亲和产科特征。用患者健康问卷评估产后抑郁症。使用泊松回归计算BI与母亲产后吸烟之间关联的粗患病率比（PR）和调整患病率比及95%置信区间（CI）。使用三个模型进行多变量分析（模型1针对孕期随机分组进行调整，模型2在模型1的基础上加上母亲的社会经济和产科特征进行调整，模型3在模型2的基础上加上产后抑郁症进行调整）。
我们样本中16.7%的母亲产后吸烟。在多变量分析中，BI与母亲产后吸烟相关（PR：2.04；95%CI 1.08：3.84）。
存在联结问题的女性产后吸烟风险更高。增强母婴联结的干预措施可能有降低母亲产后吸烟的潜力。
