A Pathway to Improved Reproductive, Maternal, Newborn and Child Health

This research examines the association between hookah use and postpartum depression symptoms. Using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) collected between 2016 and 2020, a national survey administered by the Centers for Disease Control and Prevention in cooperation with state health departments, Haile and collaborators analyzed information from more than 206,000 women across 47 states. The team restricted their analysis to nearly 107,000 women who had given birth and had no prior history of pre-pregnancy or prenatal depression in order to isolate new onset postpartum depressive symptoms. In this sample, 4.1 percent of women who had recently given birth reported using a hookah in the previous two years. Hookahs—water pipes used to smoke flavored or sweetened tobacco, marijuana, or hashish—are often perceived as less harmful than cigarettes, but their smoke contains tar, heavy metals, carbon monoxide, and other harmful toxins.

Prior work found that women with a history of hookah use were less likely to breastfeed their infants for at least three months compared to those who had not used hookah in the past two years. Building on that research, the current study found that women who had used a hookah in the past two years had considerably higher chances of experiencing postpartum depression symptoms, a result consistent with prior findings relating cigarette smoking to postpartum depression. The analysis also revealed that depressive symptoms were most likely to occur in mothers from historically marginalized racial or ethnic groups, underscoring existing disparities in maternal mental health outcomes.

Investigators draw attention to the importance of recognizing non-cigarette tobacco products, such as hookahs and e-cigarettes, as potential contributors to adverse maternal and infant health outcomes.  The findings emphasize generating evidence to support policymakers in creating guidelines, interventions, and policies grounded in evidence-based practice. Researchers advocate for educating pregnant women about the adverse health outcomes associated with hookahs and counseling them on abstaining from these products. The researchers note the need for understanding continued associations between non-cigarette tobacco products and maternal, infant and child health outcomes to inform prenatal and postpartum health care and policy. The research highlights preventable risks associated with non-cigarette tobacco use during the perinatal period and suggests a foundation for further studies using varied designs and populations to help policymakers address infant mortality, racial and ethnic disparities and other adverse outcomes in the United States.