Date of Award

Summer 8-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program/Concentration

Health Services Research

Committee Director

Qi (Harry) Zhang

Committee Member

Denise McKinney

Committee Member

George Saade

Abstract

Postpartum Depression (PPD) is the most common mental health complication of childbirth with 17% of women globally and 13% in the US experience PPD. The pathophysiology of PPD is not yet fully understood, with psycho-social, biological, and environmental factors, interplaying together and predisposing to PPD. One key modifiable risk factor is prenatal exposure to nicotine (PEN) including Active Tobacco Smoking (ATS), Secondhand Smoking (SHS), and Electronic Nicotine Products (ENPs). Several studies investigated the association between prenatal ATS or SHS and PPD, however the findings were inconclusive. There is a lack of studies that assessed the overall PEN, and none of the previous studies were conducted in Virginia. Additionally, there are three systematic reviews that assessed this association (two about ATS&PPD, and one about SHS&PPD), but no systematic review summarized the effect of ENPs or PEN on PPD. Furthermore, most of the previous studies were conducted prior to the COVID-19 pandemic, and the recent ones were conducted at the early phase of the pandemic. There is a lack of data about how pandemic-related factors affected PEN or PPD and whether COVID-19 pandemic influenced their association.

Therefore, the aim of this project is to integrate evidence across all forms of PEN and investigate its association with PPD by conducting systematic review and meta-analysis to summarize and evaluate current evidence; conduct analysis of PRAMS data (2012-2022) from Virginia to provide a comprehensive understanding of the association between PEN and PPD and assess the influence of the COVID-19 pandemic on this association.

The meta-analysis and the PRAMS data findings suggested significant association between PEN and PPD, particularly driven by prenatal ATS. No significant association was found between SHS or ENP and PPD in both meta-analysis and PRAMS findings, this could be due to small number of studies in the meta-analysis, and small sample sizes for ENP and SHS in PRAMS data.

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DOI

10.25777/mdet-5413

ISBN

9798193216902

ORCID

0000-0002-2297-9235

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