Postpartum Smoking Relapse Among Women Who Quit During Pregnancy: Findings from the US Pregnancy Risk Assessment Monitoring System (2016–2022)

BACKGROUND: Postpartum smoking adversely affects maternal and infant health outcomes. Although many women discontinue cigarette smoking during pregnancy, relapse patterns remain underexplored. OBJECTIVE: To estimate the prevalence and identify demographic and behavioral correlates of postpartum smoking relapse among women who exclusively smoked cigarettes before pregnancy and discontinued smoking during pregnancy. METHODS: We analyzed 2016-2022 Pregnancy Risk Assessment Monitoring System data to examine postpartum smoking relapse among 15,981 women (weighted population: 770,973) who reported exclusive prepregnancy cigarette smoking and discontinued smoking during pregnancy. Weighted frequency estimates and logistic regression were used to evaluate the prevalence of postpartum smoking relapse and its associated factors, with results reported as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Sensitivity analysis excluding postpartum covariates was also performed. RESULTS: Postpartum smoking relapse occurred in 39.8% (95% CI:38.6-41.0) of women who quit smoking during pregnancy. Higher odds of relapse were observed among women aged below 20 years [AOR:1.7 (95% CI:1.3-2.4)], non-Hispanic Black women [AOR:1.6 (95% CI: 1.3-1.9)], and multiparous women [AOR: 1.6 (95% CI: 1.4-1.8)]. Mothers who never breastfed [AOR: 4.0 (95% CI: 3.3-4.8)] or discontinued breastfeeding [AOR: 3.1 (95% CI: 2.7-3.6)] had significantly greater relapse odds compared with those who continued breastfeeding. Sensitivity analysis excluding postpartum factors yielded similar associations with younger age, non-Hispanic Black race, and multiparity. CONCLUSION: Postpartum smoking relapse is common among women who were exclusive cigarette smokers before pregnancy and discontinued smoking during pregnancy and is associated with distinct demographic and behavioral factors. Postpartum cessation support targeting high-risk groups may improve maternal and infant health outcomes.