Emma Hitt, PhD

April 29, 2012

April 29, 2012 (Atlanta, Georgia) — Screening for smoking among pregnant women may be useful for revealing concurrent illicit drug use and possibly mental health disorders, according to the findings of a new study.

Mishka Terplan, MD, MPH, in the Department of Obstetrics, Gynecology and Reproductive Health at the University of Maryland, in Baltimore, presented the findings here at the American Society of Addiction Medicine (ASAM) 43rd Annual Medical-Scientific Conference.

"Smoking is an important and modifiable behavior during pregnancy," Dr. Terplan told Medscape Medical News. "As it is associated with other drug problems and mental disorders, clinicians should screen for all the above and offer referrals for treatment as appropriate," he said.

According to Dr. Terplan, several studies suggest that drug and alcohol dependence are linked to illicit drug use and psychiatric comorbidities; however, this relationship has not been closely examined in pregnant women.

The current study involved medical chart extraction for all new obstetrical visits between July 2009 and July 2010 at a single low-income clinic. Demographic, obstetric, and drug use covariates were compared between those patients who had a psychiatric diagnosis and those who did not.

Among 397 evaluable patients, 65 (16%) had a psychiatric diagnosis, with the most common diagnoses being depression and bipolar disorder. In addition, drug use was common (33%), as was smoking (34%), whereas current alcohol use was rare (4%).

There was no increased risk of having a psychiatric diagnosis in patients using illicit drugs or vice versa. However, smoking was a confounding variable — for women who smoked, the odds of illicit substance use was 4.1 compared with those who did not smoke.

Although the findings also hint at a link between smoking and psychiatric diagnoses, the study fell short of identifying a relationship between the two. Dr. Terplan pointed out that further research on the relationship between smoking and mood disorders during pregnancy and postpartum is needed.

Marker for Mood/Anxiety Disorders?

Asked to comment on the study for Medscape Medical News, Margaret S. Chisolm, MD, from the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University, in Baltimore, noted that in her clinical experience with opioid-dependent pregnant women, "cigarette smoking in pregnancy in general is one of the best markers of mood/anxiety disorders."

"I've not compared it scientifically to other screening tests for depression, but based on my research and experience, I think smoking may be one of the best screening tests for depression/anxiety in this population," she said in an interview.

According to Dr. Chisholm, not everyone who smokes during pregnancy has a psychiatric illness, but "it may be the best screening tool we have for psychiatric illness in pregnancy."

She also pointed out that "more conventional screening tools, for example, the Beck Depression Inventory, have a number of physically-related questions, such as about sleep and energy level, which may be altered by the pregnancy and not be a symptom of depression," she added.

The presentation was not commercially funded. The authors and Dr. Chisholm have disclosed no relevant financial relationships.

American Society of Addiction Medicine (ASAM) 43rd Annual Medical-Scientific Conference. Article session 6, presented April 20, 2012.


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