The Association Between Second-hand Smoke Exposure and Psychiatric Distress Among Naturally Pregnant Women and Pregnant Women After Assisted Reproductive Technology Treatment: a Birth Cohort Study

Abstract

Second-hand smoke (SHS) has been shown to be associated with psychiatric distress in pregnant women spontaneously conceived (SC), but this has never been investigated in pregnant women with assisted reproductive technology (ART) treatment. This study aimed to investigate and compare the associations of SHS with psychiatric distress among SC and ART pregnant women. Participants (1467 SC and 857 ART women) were from the sub-study of Chinese National Birth Cohort (CNBC) in Anhui Province. SHS was assessed by the self-reported questionnaire. The symptoms of depression, anxiety, stress, and poor sleep quality were assessed using CES-D, SAS, CPSS, and PSQI questionnaire. Multivariable linear regression was used to determine the association between SHS and psychiatric distress in each trimester. In SC women, SHS (yes or no) was associated with depression and anxiety symptoms in the 3rd trimester (β = 0.90, 95% CI 0.07–1.73 for depression and β = 1.21, 95% CI 0.39–2.04 for anxiety) and stress symptom and poor sleep quality in both the 2nd and 3rd trimesters (β = 0.85, 95% CI 0.20–1.49 in the 2nd trimester and β = 0.69, 95% CI 0.07–1.32 in the 3rd trimester for stress, and β = 1.32, 95% CI 0.68–1.96 in the 2nd trimester and β = 1.38, 95% CI 0.64–2.11 in the 3rd trimester for poor sleep quality). By contrast, in ART women, SHS was associated with depression and stress symptoms in the 1st trimester (β = 1.97, 95% CI 0.59–3.35 for depression and β = 1.18, 95% CI 0.24–2.12 for stress) and poor sleep quality throughout the pregnancy (β = 0.64, 95% CI 0.22–1.06 in the 1st trimester, β = 0.77, 95% CI 0.35–1.18 in the 2nd trimester, and β = 0.99, 95% CI 0.50–1.48 in the 3rd trimester, respectively). Our findings indicate a universal and detrimental effect of SHS on psychiatric health among both SC and ART pregnant women. However, the SHS impact may be more substantial at the early stage of pregnancy for ART women and at later stages for SC women. This implies the importance of reducing SHS exposure during pregnancy and the necessary to be aware of the difference in the effect of SHS on psychiatric distress between SC and ART women.