Background - Feelings of depression may contribute to persistent smoking during pregnancy. Relationships between feelings of depression, smoking behavior and educational level during pregnancy have been documented. So far, however, there have been no longitudinal studies assessing feelings of depression in women with different smoking patterns antepartum and postpartum. Objectives – The aim of this study was to determine relationships between depressive symptoms, socio-demographic characteristics and smoking pattern during and after pregnancy. Methods – We conducted an observational, prospective, non-interventional study. Data were collected during two stages of pregnancy (T0: < 16 weeks and T1: 32-34 weeks) and postpartum (T2: > 6 weeks) in 523 respondents. Feelings of depression (according to the Beck Depression Inventory - BDI), smoking behavior and socio-demographic variables were registered and analyzed using generalized linear mixed models (SAS 9.2). Results - At all sampling points smokers and initial smokers reported significantly more depressive symptoms compared to recent ex-smokers, non-smokers and initial non-smokers (F(4,486) = 12.06; p < .001). The three-way interaction between time point, smoking pattern and educational level (F(8,619) = 2.29; p = 0.02) was significant. The evolution of the mean BDI over time differed between the educational level classes of the smokers. Within respondents with a secondary school certificate or less differences were observed between smokers and non-smokers, recent ex-smokers and initial non-smokers, and non-smokers and initial non-smokers. Within the respondents with a college or university degree no differences were observed. Discussion – Paying attention to depressive symptoms and offering adapted stop-smoking
advice to lower educated pregnant women and their smoking partners might reduce the prevalence of smoking among pregnant and postpartum women.