Tobacco smoking and postpartum depression symptoms in the Pregnancy Risk Assessment and Monitoring System (PRAMS) study

Background: Although previous studies have documented the association between tobacco smoking and mental health disorders, its association with postpartum depression (PPD) severity remains unclear. This study aims to assess the association between tobacco smoking and the severity of PPD. Methods: We conducted a cross-sectional analysis of 218,128 mothers participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) study from 2015 to 2020. We assessed the prevalence OR of PPD symptom levels using multinomial logistic regression models. We used the Marginal effects to quantify the difference in the prevalence of PPD symptoms of new mothers by their recent tobacco use status. We performed a sensitivity analysis for unmeasured confounders. Results: Tobacco was associated with all levels of PPD severity prevalence in the adjusted model, 1.33 (1.27, 1.39), 1.58(1.50, 1.66), 2.10 (1.95, 2.26), 2.35 (2.04, 2.71) for mild, moderate, high, and severe PPD, respectively. These findings on tobacco smoking corresponded to a lower prevalence of PPD-free by 8.83 (7.97, 9.70) and a higher prevalence of PPD of all levels of severity: 0.84 % (-0.05, 1.72) for mild, 4.24 % (3.46, 5.03) for moderate, 3.03 % (2.57, 3.48) for high, and 0.73 % (0.53, 0.92) for severe PPD, respectively. Conclusion: Tobacco smoking is associated with a higher prevalence of all levels of PPD symptoms. While these findings are not causal, they suggest the need for continual education and tobacco cessation interventions for women of childbearing age during their routine healthcare management and perinatal care.