Continued smoking and continued alcohol consumption during early pregnancy distinctively associated with personality
Introduction
Smoking and alcohol consumption during pregnancy hold several risks for both mother and child. Smoking during pregnancy increases the risk of adverse pregnancy outcomes such as reduced birth weight, lower Apgar scores, preterm delivery (Hammoud et al., 2005), placental abruption (Castles, Adams, Melvin, Kelsch, & Boulton, 1999), changes in brain development (Booij et al., 2012) and a 150% increase in overall perinatal mortality (Andres & Day, 2000). Prenatal alcohol consumption has been associated with reduced birth weight (Bada et al., 2005), preterm delivery (Sokol et al., 2007), spontaneous abortion (Andersen, Andersen, Olsen, Gronbaek, & Strandberg-Larsen, 2012) and the fetal alcohol syndrome (Jones, Smith, Ulleland, & Streissguth, 1973). However, studies investigating the effects of small to moderate amounts of alcohol show a lack in consensus regarding the negative effects (Kelly et al., 2012). Nevertheless, pregnant women are typically advised to abstain completely from alcohol consumption throughout their pregnancy (Health Council of the Netherlands, 2005).
Pregnancy is considered a unique window of opportunity to quit smoking and alcohol consumption. Indeed, women appear to be both intrinsically and extrinsically motivated to change their health behavior (Curry et al., 2001, Dunn et al., 2003, Higgins et al., 1995). Notwithstanding these motivations, many women do not try or do not succeed in quitting smoking or alcohol consumption when pregnant. In western countries it is estimated that between 5% and 21% of all women smoke during pregnancy (Allen et al., 2008, Euro-Peristat Project, 2008). The prevalence rate of alcohol consumption shows a wider range and is estimated to vary between 6% and 50% in western countries (Alvik et al., 2006, Blondel and Kermarrec, 2011, Centers for Disease Control and Prevention, 2004, Cheng et al., 2011, Health Council of the Netherlands, 2005, Nilsen et al., 2008). Quitting rates during pregnancy are between 23% and 47% for smoking (Schneider, Huy, Schütz, & Diehl, 2010) and vary between 27% and 80% for alcohol consumption (Krans et al., 2013, Ockene et al., 2002, Palma et al., 2007).
Risk factors associated with smoking and alcohol consumption during pregnancy include the level of education, being multiparae, being single, and experiencing anxiety or depressive symptoms (Powers et al., 2013, Schneider et al., 2010, Skagerström et al., 2011). General population studies have shown that personality traits predict both health behavior and risky health behavior (e.g. excessive drug and alcohol consumption) (Bogg and Roberts, 2004, Hampson et al., 2006). In pregnancy, continued smoking and alcohol consumption can be considered as a form of risky health behavior and therefore personality traits are likely predictors of these behaviors. The well-known Five Factor Model explains personality as consisting of five domains or traits, each accompanied by six facets, that describe individual differences between people (Table 1) (Costa & McCrae, 1992). Neuroticism is characterized by a tendency to experience negative affects. Extraversion is characterized by being social, energetic, and adventurous. Openness to experience relates to curiosity, intellect and creativity. Conscientiousness is related to responsibility, carefulness, and conforming to societal norms. Agreeableness refers to avoiding conflict, being sensitive to social cues, and being considerate (Costa & McCrae, 1992).
As far as we know, personality has been related to continued smoking and alcohol consumption during pregnancy in only two studies. Maxson and colleagues found an association between lower levels of agreeableness and continued smoking, compared to smoking cessation, using the NEO-Five Factor Inventory (Costa and McCrae, 1992, Maxson et al., 2012). Another study, using the Big Five Inventory (John & Srivastava, 1999), did not find an association between personality and continued smoking, but found that higher levels of extraversion and lower levels of conscientiousness increased the risk for continued alcohol consumption (Ystrom, Vollrath, & Nordeng, 2011). However, the latter study included non-smokers and non-drinkers as reference groups which provide little information if one is particularly interested in how continued users differ from quitters during pregnancy. To our knowledge, no study has investigated personality associated with continued alcohol consumption compared to discontinued consumption during pregnancy. Furthermore, the association of personality with the amount of smoking and alcohol consumption among continued users during pregnancy has not been investigated to date.
Smoking and alcohol consumption are, particularly in women, considered to be a strategy to regulate or cope with feelings of negative affect (Abbey et al., 1993, Locke and Newcomb, 2001, Zuckerman et al., 1990). Therefore, we propose that anxiety and depressive symptoms may explain part of the association of personality with continued smoking and alcohol consumption during pregnancy.
The present study investigated the relationships of personality traits with continued smoking and continued alcohol consumption during early pregnancy. Based on the characteristics of the traits and previous research, we expected to find an association of continued smoking and alcohol consumption with higher levels of neuroticism and extraversion and with lower levels of conscientiousness, agreeableness, and openness to experience. Furthermore, we assumed that some proportion of the associations would be explained by anxiety or depressive symptoms. Finally, we explored the associations between personality and the amount of smoking and alcohol consumption among continued users.
Section snippets
Setting and participants
Data from the ongoing ‘Pregnancy, Anxiety and Depression’ (PAD) study was used. This population-based prospective cohort study investigates psychological, medical and social factors during pregnancy and the postnatal period. Participants in the PAD study are enrolled at primary midwifery practices (n = 102) and obstetric and gynecology departments of hospitals (n = 9) throughout the Netherlands. Women who provide written informed consent enter the study before 16 weeks of gestation and complete
Descriptives
Characteristics of the study participants after imputation of missing data are presented in Table 2. Women who continued smoking reported a lower educational level compared to women who quit smoking (p < 0.001). Women who continued alcohol consumption differed from those who quit regarding the personality traits openness to experience and conscientiousness (p = 0.012 and p = 0.038, respectively). Furthermore, women who continued alcohol consumption had somewhat higher levels of anxiety and depressive
Discussion
This study investigated the associations of personality traits with continued smoking and alcohol consumption during early pregnancy. Our results showed that continued alcohol consumption is associated with higher levels of openness to experience and lower levels of conscientiousness, compared to women who quit. Moreover, the association between conscientiousness and continued alcohol consumption was partly explained by both anxiety and depressive symptoms. Conversely, continued smoking was not
Role of funding sources
Funding for this study was provided by a grant from the Netherlands Organization for Health Care Research and Development #120520013. The Netherlands Organization for Health Care Research and Development had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Huibert Burger, Hans Ormel, and Claudi Bockting designed the study. Chantal Beijers and Tjitte Verbeek collected the data. Chantal Beijers performed the data analyses. Chantal Beijers wrote the first draft of the manuscript and all authors contributed to and have approved the final version of this manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgments
The authors would like to thank all midwifes and gynecologists for the screening of participants, and all women for their participation.
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