Smoking and mental health - NCSCT

Smoking and mental disorders: special circumstances 7
associated with other markers of social disadvantage including low income, lower
levels of education, domestic violence and mental disorders. 128–130
7.5.2 Mental disorders and smoking in pregnancy
Mental disorders are common during pregnancy, 131,132 particularly
depression, 133 with a prevalence of around 12%. 134 There is increasing evidence
that women with mental disorders are at increased risk of poor pregnancy
outcome, including low birthweight and prematurity, 133,135 stillbirth 136,137 and
SIDS, and this is at least in part due to smoking. Mental disorders are strongly
associated with cigarette use among pregnant women. 130,140 Current evidence is
consistent with a self-medication hypothesis, whereby smoking is used to
alleviate symptoms of depression, 141 but there have been few prospective studies
of mental health in pregnancy in women who stop smoking compared with
those who do not. However, there is evidence that smoking cessation in
pregnancy is associated with improvements in symptoms of depression. 142 Public
health campaigns, such as the SIDS reduction campaigns, also impact on
antenatal smoking in women with severe mental disorders, although smoking
rates in women with a history of a severe mental disorder remain high. 139
7.5.3 Smoking cessation in pregnancy
Smoking cessation interventions in pregnancy are effective in preventing
smoking and improving fetal outcomes, 119,124 although options for
pharmacotherapy are limited by concerns over the safety of varenicline and
bupropion, and uncertainty over the effectiveness of conventional-dose NRT. 143
Uptake of smoking cessation services during pregnancy is low, however, 144 and
many women do not use NRT when it is prescribed. 143 The American Congress
of Obstetricians and Gynecologists 145 and the UK National Institute for Health
and Clinical Excellence (NICE) 119 emphasise that pregnant women who continue
to smoke are often heavily addicted to nicotine and should be encouraged at
every follow-up visit to seek help to stop smoking. However, translation of this
guidance into practice is far from complete, and a recent audit in a south London
hospital found that smoking was rarely discussed after the initial antenatal
booking visit. 146
7.5.4 Smoking cessation in pregnant women with mental disorders
Data from the UK suggest that primary care staff are less likely to record
antenatal smoking behaviour in pregnant women with major mental health
problems, 147 although recent UK data suggest that, when smoking is raised by
© Royal College of Physicians 2013 147