Substance use in pregnancy is an increasingly common problem and has become an important public health issue. Postpartum depression has a high prevalence (10%) of women in Spanish population.

To study the impact of perinatal tobacco use in postpartum depression.

A cohort study of 1804 puerperal Spanish Caucasian women of general population. Variables collected: socio-demographic, obstetric, personal and family psychiatric history, substance use during pregnancy and 6 months postpartum, depressive symptoms (EPDS) and anxiety traits (STAI) at 2–3 days, 8 weeks and 32 weeks postpartum. Major postpartum depression (MPD) (EPDS>9) were confirmed through a structured interview (DIGS-DSM-IV). The sample was divided in four groups:

The mean (SD) age was 31.8 (4.6), 46% were primiparous, 96.5% were married and 68% had at least secondary school. Thirty-one per cent had family and 17% personal psychiatric history. Twenty one percent reported tobacco use during pregnancy and 28.2% use tobacco in postpartum. Tobacco use in the four groups and MPD at 8 weeks (x²=17.872;df=3;p<0.001) and at 32 weeks postpartum (x²=15.582;df=3;p=0.001) were different. Only smoking postpartum group had a risk four times higher of having MPD at 8 weeks postpartum (OR=4.3; 95%CI=1.91–9.66). Others independent variables: personal psychiatry history (OR=2.53; 95%CI=1.55–4.22), family psychiatry history (OR=1.87; 95%CI=1.15–3.06) and anxiety traits (OR=1.12, 95%CI=1.08–1.16). The results at 32 weeks showed the same risk factors.

The use of tobacco in postpartum had a considerable impact on mother’s psychiatric health.