Psychosocial and pharmacological factors associated with prenatal smoking in women with psychiatric disorders

Psychosocial and pharmacological factors associated with prenatal smoking in women with psychiatric disorders | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychosocial and pharmacological factors associated with prenatal smoking in women with psychiatric disorders Ayumi Kuramitsu, Kazutaka Ohi, Shunsuke Sugiyama, Tomomi Shiga, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8234382/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Cigarette smoking during pregnancy increases risks for adverse maternal and child outcomes. Individuals with psychiatric disorders—particularly schizophrenia spectrum disorders (SSD)—have higher smoking prevalence than the general population. However, it remains unclear whether, during pregnancy, SSDs exhibit higher smoking rates than those with other psychiatric disorders (non-SSD), and how psychosocial and pharmacological characteristics influence smoking in SSDs. Methods A total of 174 pregnant individuals with psychiatric disorders (SSD, n = 33; non-SSD, n = 141), identified from medical records at a single institution between 2006 and 2024, were evaluated. Smoking status, individual characteristics, and psychotropic use at the third trimester were assessed. Differences in smoking status between SSDs and non-SSDs, and factors associated with smoking during pregnancy were examined. Results In the third trimester, current smoking was more prevalent in SSDs (90.0%, n = 10) than in non-SSDs (10.3%, n = 39) (χ²=26.0, p = 3.47×10⁻ 7 ), and cigarettes smoked per day (CPD) was higher in SSDs ( beta = 0.36, p = 3.03×10 − 6 ). Among SSDs, current smokers had lower educational attainment, used a greater number of psychotropic drugs, including antipsychotics, had higher antipsychotic chlorpromazine-equivalent dose (CPZeq), and had a higher prevalence of having no intention to breastfeed than non-current smokers. Logistic regression demonstrated significant associations between smoking and lower education, higher CPZeq, multiple psychotropics, and no intention to breastfeed ( p < 0.05). CPD correlated significantly with the number of antipsychotics used (B = 0.5, p = 6.42×10⁻⁴). Conclusion Smoking during late pregnancy was more prevalent in SSDs, and smoking was associated with both psychosocial and pharmacological characteristics. Targeted interventions to promote breastfeeding and the implementation of antipsychotic monotherapy may help reduce smoking during pregnancy and improve maternal–child outcomes. smoking schizophrenia spectrum disorders pregnancy antipsychotics breastfeeding Figures Figure 1 Figure 2 Introduction Cigarette smoking during pregnancy is a well-established risk factor for adverse outcomes in both the mother and child, including placental abruption [ 1 ], intrauterine growth retardation [ 2 ], sudden fetal and infant death [ 3 ], and long-term impact such as reduced offspring academic achievement [ 4 ]. Maternal smoking restricted to the first trimester is not associated with adverse birth outcomes, whereas continued smoking increases risks of preterm birth, small size for gestational age, and childhood overweight [ 5 ]. Third-trimester smoking is also linked to higher risk of atopic eczema/dermatitis syndrome in infants compared with smoking at earlier stages of pregnancy [ 6 ]. Adverse fetal risk rises with the number of cigarettes smoked [ 5 , 7 , 8 ]. Despite known risks, smoking during pregnancy remains common. Globally, cigarette smoking prevalence is 5.4% before pregnancy, and 1.7% during pregnancy [ 9 , 10 ]. Several psychosocial factors have been associated with smoking during pregnancy, including younger age, lower socioeconomic status, lower educational attainment, lower occupational status, being unmarried, obesity (BMI, body mass index ≥ 30), and lack of breastfeeding intentions [ 11 – 15 ]. Pregnant individuals with psychiatric disorders—including schizophrenia spectrum disorders (SSD), bipolar disorders, depressive disorders, anxiety and stress related disorders, and personality disorders—tend to be younger with lower educational attainment and socioeconomic status compared with those without psychiatric disorders [ 16 , 17 ]. The prevalence of smoking among individuals with psychiatric disorders is markedly higher than in the general population [ 18 – 20 ]. Among individuals with SSD, smoking prevalence ranges from 66% to 88%, substantially higher than in other psychiatric disorders [ 21 – 23 ]. The self-medication hypothesis proposes that individuals with SSD may smoke to alleviate extrapyramidal symptoms (EPS) induced by antipsychotics [ 24 ]. Nicotine may counteract antipsychotic effects by partially restoring drug-induced dopamine receptor blockade [ 25 , 26 ] and can increase hepatic metabolism via CYP450 activation, thereby reducing serum antipsychotic levels [ 27 ]. However, other studies have reported no association between smoking in SSDs and antipsychotic chlorpromazine-equivalent dose (CPZeq) or adverse effects such as EPS [ 28 , 29 ], resulting in inconsistent evidence regarding associations between psychotropic drugs and smoking. Among individuals with SSD, women tend to smoke more than men [ 30 ], and even during pregnancy, smoking rates remain higher in those with SSD compared with the general population [ 31 , 32 ]. However, it is not yet established whether individuals with SSD have higher smoking rates than those with other psychiatric disorders specifically during pregnancy. Guidelines recommend continuation of antipsychotics during pregnancy for individuals with SSD to prevent relapse and maintain maternal stability [ 33 ]. Pregnant individuals who used psychotropic drugs were more likely to smoke than those who did not [ 16 , 34 ], although the relationship between psychotropic drug type, number, or dosage during pregnancy and smoking remains unclear. To mitigate adverse birth outcomes in pregnant individuals with psychiatric disorders—including SSD—understanding the associations between psychotropic drug use and smoking during pregnancy is therefore important. In this retrospective study, we compared smoking behaviors during pregnancy between individuals with SSD and those with other psychiatric disorders, and identified factors influencing smoking during pregnancy. We hypothesized that pregnant individuals with SSD would have higher smoking rates than those with other psychiatric disorders, mirroring findings in non-pregnant populations [ 21 – 23 ]. We further considered that this pattern may be related to the greater psychosocial difficulties (e.g., lower educational attainment) and pharmacological characteristics (e.g., higher antipsychotic doses and greater psychotropic polypharmacy) reported in SSDs relative to other psychiatric disorders [ 35 ]. Methods Study design and participants This study included individuals who gave birth between April 1, 2006, and March 31, 2024, at Gifu University Hospital in Japan and had comorbid psychiatric disorders documented in their medical records. Individuals who delivered preterm (< 36 weeks) were excluded. Primary psychiatric diagnoses at the third trimester (≥ 36 weeks) were identified from medical records and determined according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) [36]. If a psychiatric diagnosis was later revised, the final diagnosis was used. A total of 174 deliveries from individuals with psychiatric disorders were included. When individuals delivered more than once (i.e., had multiple childbirths), each delivery was counted as a separate observation. All participants were Japanese, except four (two Chinese, one Filipino, and one Brazilian) residing in the Chubu region of Japan. The SSD group included individuals with schizophrenia ( n =30), schizoaffective disorder ( n =1), and brief psychotic disorder ( n =2). The non-SSD group included individuals with bipolar I disorder ( n =6), bipolar II disorder ( n =18), major depressive disorder ( n =29), persistent depressive disorder ( n =4), premenstrual dysphoric disorder ( n =1), panic disorder ( n =29), generalized anxiety disorder ( n =10), specific phobia ( n =1), obsessive-compulsive disorder ( n =5), adjustment disorder ( n =12), dissociative disorders ( n =7), conversion disorder ( n =1), somatic symptom disorder ( n =1), eating disorder ( n =3), insomnia ( n =2), intellectual developmental disorder ( n =4), autism spectrum disorder ( n =2), tic disorder ( n =1), and borderline personality disorder ( n =5). Information on education and comorbid physical disorders was extracted from medical records. Neonatal data, including multiple gestation status and neonatal intensive care unit (NICU) admission, were also extracted. Demographics of the SSD ( n =33) and non-SSD ( n =141) groups are summarized in Table 1. This retrospective study complied with the World Medical Association’s Declaration of Helsinki and was approved by the Research Ethics Committees of Gifu University (2024-050). The need for written informed consent was waived due to the retrospective design, with the option to decline participation via opt-out. Smoking status and history Information on participants’ smoking status defined as the use of combustible cigarettes was extracted from medical records, including whether participants were currently smoking ≥ 36 weeks of pregnancy, had never smoked, or were smokers before 36 weeks of pregnancy. For current smokers, the number of cigarettes smoked per day (CPD) was recorded and grouped into four categories: 0, 1–10, 11–20, and ≥21. Psychotropic drug information Regular psychotropic drug use (antipsychotics, antidepressants, benzodiazepines, mood stabilizers, and anticholinergics) at ≥ 36 weeks of pregnancy was identified from medical records. Regular use was defined as uninterrupted use for ≥ 4 consecutive weeks, as confirmed by the medical records. The presence and number of regular use of antipsychotics, antidepressants, benzodiazepines, mood stabilizers, and anticholinergic drugs at the third trimester were recorded, respectively. The list of psychotropic drugs has been provided previously [37]. As-needed medications were not assessed. Psychotropic doses were converted to CPZeq, imipramine equivalent (IMIeq), diazepam equivalent (DZPeq), and biperiden equivalent (BPDeq) according to established equivalence tables [38]. Statistical analysis Statistical analyses were performed using IBM SPSS Statistics version 30.0 (IBM Japan, Tokyo, Japan). Differences in participant and newborn information related to pregnancy between the SSD and non-SSD groups were analyzed using chi-square tests for categorical variables (e.g., comorbidity of physical disorders and regular antipsychotic use at the third trimester) and Mann–Whitney U tests for continuous variables (e.g., number of antipsychotics used during the third trimester and BMI at the third trimester). Differences in smoking history between groups were examined using logistic regression: (a) ever versus never smoking (dependent variable: ever smoking; independent variable: SSD diagnosis), and (b) among ever-smokers (SSD, n =10; non-SSD, n =39), current versus former smoking (dependent variable: current smoking; independent variable: SSD diagnosis). To investigate whether the number of CPD differed between the SSD ( n =33) and non-SSD ( n =141) groups, a linear regression analysis was conducted using CPD category (0; 1–10; 11–20; and ≥ 21) as the dependent variable and SSD diagnosis as the independent variable. Age and childbirth year were covariates in all logistic and linear regression models. Next, we focused on the SSD group ( n =33) and evaluated differences in clinical characteristics between current and non-current smokers at the third trimester using Fisher’s exact and the Mann–Whitney U tests. To identify the possible effects of current smoking during pregnancy on clinical factors in the SSD group ( n =33), logistic regression analyses were conducted (dependent variable: current smoking status at the third trimester; independent variables: clinical factors; covariates: age and childbirth year); the use and number of antipsychotics and mood stabilizers were excluded due to complete separation. To examine the possible effects of CPD category (0; 1–10; 11–20; and ≥ 21) at the third trimester of pregnancy on clinical factors in the SSD group ( n =33), a linear regression was conducted (dependent variable: CPD category; independent variables: clinical factors; covariates: age and childbirth year). The nominal two-tailed significance level was p <0.05, and Bonferroni correction yielded a final alpha of p <2.17×10 −3 ( α =0.05/23 characteristics), avoiding type I error. Results Individuals’ characteristics at the third trimester and their newborns’ outcomes at birth Demographic information at the third trimester in the SSD and non-SSD groups is shown in Table 1. The SSD group had lower education (z=−3.1, p =2.22×10⁻ 3 ), lower prevalence of comorbid physical disorders ( χ 2 =4.6, p =0.032), higher BMI (z=5.0, p =6.83×10⁻ 7 ), higher prevalence of non-breastfeeding intentions ( χ 2 =4.1, p =0.044), higher age at childbirth (z=2.0, p =0.049), and higher prevalence of cesarean section ( χ 2 =6.1, p =0.046) than those in the non-SSD group. Regarding psychotropic drug information, the SSD group exhibited higher prevalence of regular antipsychotic use ( χ 2 =74.1, p =7.40×10⁻ 18 ), greater number of antipsychotics (z=8.8, p =1.66×10⁻ 18 ), higher CPZeq (z=9.1, p =8.91×10⁻ 20 ), higher prevalence of regular anticholinergic use ( χ 2 =74.1, p =7.40×10⁻ 18 ), greater number of anticholinergics (z=2.9, p =3.93×10⁻ 3 ), higher BPDeq (z=2.9, p =4.02×10⁻ 3 ), and greater number of psychotropics (z=4.4, p =1.13×10⁻ 5 ) than those in the non-SSD group. Regarding newborn outcomes, the SSD group had a higher prevalence of multiple gestation ( χ 2 =4.5, p =0.034) and neonatal intensive care unit (NICU) admission ( χ 2 =6.8, p =8.97×10⁻ 3 ) than those in the non-SSD group. Differences in smoking history at the third trimester of pregnancy between the SSD and non-SSD groups We examined differences in smoking history— (a) ever vs. never, (b) current vs. former among ever-smokers, and (c) CPD category—at the third trimester of pregnancy between the SSD ( n =33) and non-SSD ( n =141) groups (Fig. 1). Among those with ever-smoking history, the proportion of current smokers was significantly higher in the SSD group (90.0%, n =10) than in the non-SSD group (10.3%, n =39) (χ²=26.0, p =3.47×10⁻ 7 ) (Fig. 1b). CPD category was also higher in the SSD group than in the non-SSD group ( beta =0.36, p =3.03×10 −6 ). In contrast, no significant differences were observed in the proportion of ever-smokers between the SSD (30.3%) and non-SSD (27.7%; p >0.05) groups (Fig. 1a). Possible factors influencing current smoking status at the third trimester of pregnancy in the SSD group Given the higher smoking rate in the SSD group at third trimester than in the non-SSD group, we next focused on the SSD group ( n =33, Table 2). Current smokers at the third trimester ( n =9) had lower education (z=−3.2, p =2.49×10 −3 ), greater number of psychotropics (z=2.7, p =9.62×10 −3 ), higher CPZeq (z=2.5, p =0.012), greater number of antipsychotics (z=3.1, p =0.018), and higher prevalence of non-breastfeeding intentions (χ²=7.7, p =0.010) than non-current smokers. Then, we examined the possible effects of current smoking during pregnancy on clinical factors, including individual characteristics and the use of psychotropics (Fig. 2a). Logistic regression analyses adjusting for age and childbirth year indicated that the current smoking at the third trimester was nominally associated with higher prevalence of non-breastfeeding intentions (OR=14.3 , 95%CI [1.8, 112.1], p =0.011), lower education (OR=0.06 , 95% CI [0.007, 0.63], p =0.018), higher CPZeq (OR=2.5 , 95% CI [1.1, 6.1], p =0.036), and greater number of psychotropics (OR=2.8 , 95% CI [1.0, 7.7], p =0.040), with no significant associations for other factors ( p >0.05). Possible factors influencing CPD number at the third trimester of pregnancy in the SSD group We examined the possible effects of the CPD categories (0, n =24; 1–10, n =6; 11–20, n =2; and ≥ 21, n =1) at the third trimester on clinical factors, including individual characteristics and psychotropic use, in the SSD group (Fig. 2b). A higher CPD category correlated significantly with a greater number of antipsychotics (B=0.5, 95% CI [0.2, 0.7], p =6.42×10⁻⁴), and nominally correlated with greater number of psychotropics (B=0.3, 95% CI [0.1, 0.6], p =6.81×10⁻ 3 ), higher prevalence of non-breastfeeding intentions (B=0.8, 95% CI [0.2, 1.3], p =8.33×10⁻ 3 ), higher BPDeq (B=0.2, 95% CI [0.02, 0.3], p =0.027), and greater number of benzodiazepines (B=0.3, 95% CI [0.003, 0.5], p =0.048) (Fig. 2b); no significant correlations were observed for other factors ( p >0.05). Possible factors influencing current smoking at the third trimester in the non-SSD group To compare with the findings from the SSD group, we evaluated clinical correlates of current smoking at the third trimester in the non-SSD group (Supplementary Fig. 1). No clinical factors were associated with current smoking status ( p >0.05, Supplementary Fig. 1a). In contrast, a higher CPD category correlated significantly with regular anticholinergic use (B=0.9, 95% CI [0.5, 1.4], p =1.45×10⁻ 5 ), greater number of anticholinergics (B=0.1, 95%CI [0.08, 0.2], p =1.45×10⁻ 5 ), higher BPDeq (B=0.1, 95%CI [0.07, 0.2], p =1.45×10⁻ 5 ), and non-breastfeeding intentions (B=0.1, 95% CI [0.04, 0.2], p =8.62×10⁻ 4 ), and was nominally correlated with regular benzodiazepine (B=0.1, 95%CI [0.03, 0.2], p =9.40×10⁻ 3 ) and antidepressant (B=0.1, 95% CI [0.02, 0.2], p =0.046) use, greater number of benzodiazepines (B=0.04, 95% CI [0.005, 0.08], p =0.026), antidepressants (B=0.04, 95% CI [0.0004, 0.07], p =0.047), and psychotropics (B=0.05, 95%CI [0.007, 0.09], p =0.022), and non-first pregnancy (B=−0.09, 95%CI [−0.2, −0.01], p =0.027) (Supplementary Fig. 1b). Discussion In this study, we investigated the differences in smoking status during pregnancy between individuals with SSD and those with other psychiatric disorders. We found that current smoking at the third trimester of pregnancy was significantly more prevalent in the SSD group than in the non-SSD group, despite similar lifetime smoking histories, and the SSD group smoked more CPD. In the SSD group, current smoking at the third trimester was nominally associated with non-breastfeeding intentions, lower educational attainment, greater number of antipsychotics, higher CPZeq, and greater number of psychotropics. CPD category was significantly associated with the number of antipsychotics and nominally associated with non-breastfeeding intentions, greater number of psychotropics and benzodiazepines, and higher BPDeq. These findings suggest that smoking at the third trimester in individuals with SSD may be influenced by both psychosocial and pharmacological factors. The higher prevalence of smoking in the SSD group may partly reflect lower smoking cessation rates documented in non-pregnant SSD cohorts [ 39 ]. Associations between smoking, non-breastfeeding intentions, and lower educational attainment are consistent with findings from previous studies in the general population [ 12 , 15 , 40 ]. SSD populations have lower breastfeed intentions and educational attainment than the general population [ 17 , 41 , 42 ]. This study showed that these psychosocial factors were significantly more prevalent in the SSDs compared with other psychiatric disorders, and may contribute to the higher third-trimester smoking prevalence. Consistent with previous studies [ 35 ], individuals with SSD received higher CPZeq doses and more frequent psychotropic polypharmacy during pregnancy than those with other psychiatric disorders. Current smoking at the third trimester was nominally associated with higher CPZeq use and psychotropic polypharmacy. High-dose antipsychotic treatment and psychotropic polypharmacy increase the risk of adverse effects, including EPS [ 43 , 44 ]. Additionally, among individuals treated with antipsychotics and other psychotropics, smokers have shown more pronounced reductions in antipsychotic blood concentrations compared with non-smokers [ 27 ]. These findings support the possibility that smoking may alleviate antipsychotic side effects, consistent with the self-medication hypothesis [ 27 ]. Reportedly, CPD number correlates positively with CPZeq [ 45 ] in SSDs, whereas the relationship with the number of antipsychotics is unclear. Our results indicate that the number of antipsychotics was the strongest factor associated with CPD category. SSD is a chronic disorder, and continued antipsychotic treatment throughout life, including during pregnancy, is recommended [ 33 ]. Antipsychotic monotherapy is also recommended [ 46 ]. An increased CPD number reportedly enhances the activity of drug-metabolizing enzymes, thereby reducing antipsychotic plasma concentrations [ 27 , 47 ], potentially necessitating higher dosages. These findings suggest that optimizing antipsychotic treatment through the promotion of monotherapy during pregnancy may reduce cigarette consumption in SSDs and mitigate adverse outcomes for both the individual and the newborn. The smoking rate during pregnancy in the general population is 1.7% [ 9 ], whereas it was higher at 2.8% even in the non-SSD group. To compare with the SSD group, we explored clinical correlates of smoking status at the third trimester in the non-SSD group; none was significantly associated with current smoking at the third trimester in the non-SSDs. However, the use, dosage, and number of anticholinergics, the absence of breastfeeding intention, and nominal associations with benzodiazepines and antidepressants were significantly associated with CPD number at the third trimester. These findings suggest that smoking behavior among pregnant individuals with psychiatric disorders other than SSD may also be related to maternal behavioral intentions and pharmacological treatment. Similar to SSDs, targeted breastfeeding interventions and careful assessment of antipsychotic side effects may help reduce smoking during pregnancy even among non-SSD individuals. Limitations This study has several limitations. First, our participants’ data were obtained from a single university hospital, and unlike individuals treated in general obstetric clinics and hospitals, those treated in university hospitals may present with more severe psychiatric complications. Although psychiatric symptoms and medication side effects may be associated with smoking [ 24 , 48 ], we could not assess them. Therefore, a causal relationship between adverse effects and smoking has not been demonstrated. In the SSD group, newborns were more likely to require NICU admission compared with those in the non-SSD group; however, the relationship between newborn outcomes and maternal smoking behavior remains unclear. Future studies should collect data on psychiatric symptoms and adverse effects to clarify these relationships. Conclusion In conclusion, smoking during the third trimester of pregnancy was more common among individuals with SSD than among those with other psychiatric disorders. Compared with the non-SSD group, the SSD group showed distinctive psychosocial and pharmacological characteristics, including lower educational attainment, lack of breastfeeding intention, higher doses and numbers of antipsychotics, and greater number of psychotropics. Notably, CPD number correlated significantly with the number of antipsychotics used. In SSDs, targeted breastfeeding interventions and the implementation of antipsychotic monotherapy, including preconception care, may help reduce smoking during pregnancy and improve outcomes for both mothers and their newborn. Declarations Acknowledgements We would like to thank all individuals who participated in this study. Authors’ contributions A. Kuramitsu collected the data, performed the analyses, interpreted the results, and drafted the manuscript. K. Ohi was critically involved in the study design and contributed to writing the manuscript. A. Kuramitsu was also responsible for conducting the literature review. A. Kuramitsu, K. Ohi, S. Sugiyama, T. Shiga, T. Furui, and T. Shioiri were extensively involved in data collection and made substantial intellectual contributions to data interpretation. All authors contributed to and approved the final version of the manuscript. Funding This work was supported by a grant from the Smoking Research Foundation. The supporters had no role in the design, analysis, interpretation, or publication of this study. This work was also supported by JSPS KAKENHI (Grant No. 23K14797 [to SS]). Availability of data and materials The datasets analyzed during the current study are not publicly available because they contain information that could compromise participant privacy. Ethics approval and consent to participate Approved by the Research Ethics Committee of Gifu University (2024-050). The requirement for written informed consent was waived due to the retrospective design, with an opt-out option available. Consent for publication All the authors have gone through the final version of this manuscript and have given their consent for the publication. Competing interests The authors declare no competing interests. References Chen D, Gao X, Yang T, Xin X, Wang G, Wang H, et al. Independent risk factors for placental abruption: a systematic review and meta-analysis. 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Differences in infant feeding methods at one month postpartum among women with psychiatric disorders and factors influencing exclusive breastfeeding. Child and Adolescent Psychiatry and Mental Health. 2025;19(1). Inada T, Inagaki A. Psychotropic dose equivalence in Japan. Psychiatry Clin Neurosci. 2015;69(8):440-7. de Leon J, Diaz FJ. A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res. 2005;76(2-3):135-57. O'Campo P, Faden RR, Brown H, Gielen AC. The impact of pregnancy on women's prenatal and postpartum smoking behavior. Am J Prev Med. 1992;8(1):8-13. Dickson H, Hedges EP, Ma SY, Cullen AE, MacCabe JH, Kempton MJ, et al. Academic achievement and schizophrenia: a systematic meta-analysis. Psychol Med. 2020;50(12):1949-65. Crossley NA, Alliende LM, Czepielewski LS, Aceituno D, Castañeda CP, Diaz C, et al. The enduring gap in educational attainment in schizophrenia according to the past 50 years of published research: a systematic review and meta-analysis. Lancet Psychiatry. 2022;9(7):565-73. Sim K, Su A, Leong JY, Yip K, Chong MY, Fujii S, et al. High dose antipsychotic use in schizophrenia: findings of the REAP (research on east Asia psychotropic prescriptions) study. Pharmacopsychiatry. 2004;37(4):175-9. Højlund M, Köhler-Forsberg O, Gregersen AT, Rohde C, Mellentin AI, Anhøj SJ, et al. Prevalence, correlates, tolerability-related outcomes, and efficacy-related outcomes of antipsychotic polypharmacy: a systematic review and meta-analysis. Lancet Psychiatry. 2024;11(12):975-89. Ohi K, Shimada T, Kuwata A, Kataoka Y, Okubo H, Kimura K, et al. Smoking Rates and Number of Cigarettes Smoked per Day in Schizophrenia: A Large Cohort Meta-Analysis in a Japanese Population. Int J Neuropsychopharmacol. 2019;22(1):19-27. NICE. Psychosis and schizophrenia in adults: prevention and management. 2014. https://www.nice.org.uk/guidance/cg178/chapter/recommendations#how-to-use-antipsychotic-medication. Accessed 8 August 2025. Plowchalk DR, Rowland Yeo K. Prediction of drug clearance in a smoking population: modeling the impact of variable cigarette consumption on the induction of CYP1A2. Eur J Clin Pharmacol. 2012;68(6):951-60. Mu X, Wu W, Wang S, Su X, Guan H, Guan X, et al. Smoking affects symptom improvement in schizophrenia: a prospective longitudinal study of male patients with first-episode schizophrenia. Schizophrenia. 2024;10(1):34. Tables Table 1. Differences in subjects’ characteristics at the third trimester and their newborns’ outcomes at birth between those with schizophrenia spectrum disorders (SSDs) and those without (non-SSDs). SSDs non-SSDs ( n =33) ( n =141) χ 2 or Z value p value Individual information at the third trimester Education (years) 12.0±1.5 13.6±2.3 -3.1 2.22×10 -3 Comorbid physical disorders (+/-) 4/29 43/98 4.6 a 0.032 First pregnancy (+/-) 18/15 84/57 0.3 a 0.60 BMI (kg/m 2 ) 29.5±5.1 24.8±4.1 5.0 6.83×10 -7 Occupation (+/-) 3/30 33/108 3.1 a 0.078 Unmarried (+/-) 4/29 8/133 1.7 a 0.19 Non-breastfeeding intentions (+/-) 10/23 19/107 4.1 a 0.044 No baby supplies prepared (+/-) 4/27 18/103 0.1 a 0.78 Physical complications related to pregnancy (+/-) 20/13 57/84 <0.1 a 0.83 Age at childbirth (years) 33.6±5.7 31.6±5.3 2.0 0.049 Delivery methods (Vaginal delivery/ Elective CS/Emergency CS) 19/8/6 109/22/10 6.1 a 0.046 Psychotropic drugs information at the third trimester Regular use of antipsychotics (+/-) 29/4 19/122 74.1 a 7.40×10 -18 Regular use of antidepressants (+/-) 2/31 27/114 3.3 a 0.069 Regular use of benzodiazepines (+/-) 8/25 29/112 0.2 a 0.64 Regular use of mood stabilizers (+/-) 2/31 9/132 <0.1 a 0.95 Regular use of anticholinergic drugs (+/-) 3/30 1/140 8.4 a 3.82×10 -3 CPZeq (mg/day) 284.1±207.5 25.7±105.7 9.1 8.91×10 -20 IMIeq (mg/day) 5.3±21.4 18.8±48.4 -1.8 0.07 DZPeq (mg/day) 2.0±4.7 2.8±8.7 -0.4 0.70 BPDeq (mg/day) 0.2±0.7 0.02±0.3 2.9 4.02×10 -3 Number of psychotropic drugs 1.7±1.5 0.8±1.3 4.4 1.13×10 -5 Number of antipsychotics 1.0±0.5 0.1±0.4 8.8 1.66×10 -18 Number of antidepressants 0.09±0.4 0.2±0.5 -1.8 0.08 Number of benzodiazepines 0.3±0.7 0.3±0.7 0.4 0.68 Number of mood stabilizers 0.06±0.2 0.06±0.2 -0.1 0.95 Number of anticholinergic drugs 0.09±0.3 0.007±0.08 2.9 3.93×10 -3 Their newborn information at birth Gestational age at birth (weeks) 38.5±1.4 38.6±1.4 -0.7 0.48 Multiple gestation status (+/-) 2/31 1/140 4.5 a 0.034 Sex of the newborn (male/female) 20/15 79/63 0.1 a 0.78 Birth weight of the newborn (g) 3038.5±571.3 2933.5±417.6 0.9 0.36 Admission to the NICU (+/-) 28/7 78/64 6.8 a 8.97×10 -3 At 1 minute: Apgar score at 1 minute 8.1±1.0 8.2±1.2 -0.6 0.53 At 5 minutes: Apgar score at 5 minutes 9.1±0.8 9.2±1.0 -1.0 0.30 The means and standard deviations (SDs) of patients with SSD and non-SSD, and their newborns are presented. Complete demographic information was not obtained for all participants (Education, SSD, n =28, non-SSD, n =88; Breastfeeding intentions during pregnancy, non-SSD, n =126; No baby supplies prepared at the third trimester, SSD, n =31, non-SSD, n =121). BMI, body mass index; CS, Cesarean section; CPZeq, chlorpromazine equivalent; IMIeq, imipramine equivalent; DZPeq, diazepam equivalent; BPDeq, biperiden equivalent; NICU, neonatal intensive care unit. a χ 2 test. P <0.05 is shown in bold. Table 2. Differences in subjects’ characteristics between current-smoker and non-smoker at the third trimester in schizophrenia spectrum disorders. Current-smoker Non-current smoker ( n =9) ( n =24) χ 2 or Z value p value Individual information at the third trimester Education (years) 10.1±1.5 12.6±1.5 -3.2 2.49×10 -3 Comorbid physical disorders (+/-) 3/6 1/23 5.2 a 0.052 First pregnancy (+/-) 5/4 13/11 0.99 BMI (kg/m 2 ) 32.1±6.4 28.5±4.1 1.4 0.18 Occupation (+/-) 2/7 1/22 2.4 a 0.18 Unmarried (+/-) 2/7 2/22 1.2 a 0.30 Non-breastfeeding intentions (+/-) 6/3 4/20 7.7 a 0.010 No baby supplies prepared (+/-) 2/6 2/21 1.4 a 0.26 Physical complications related to pregnancy (+/-) 3/6 11/13 <0.1 a 0.70 Age at childbirth (years) 31.5±4.8 34.4±5.8 -1.6 0.11 Psychotropic drugs information at the third trimester Regular use of antipsychotics (+/-) 9/0 20/4 1.7 a 0.55 Regular use of antidepressants (+/-) 1/8 1/23 0.6 a 0.48 Regular use of benzodiazepines (+/-) 4/5 4/20 2.8 a 0.17 Regular use of mood stabilizers (+/-) 0/9 2/22 0.8 a >0.99 Regular use of anticholinergic drugs (+/-) 1/8 2/22 0.99 CPZeq (mg/day) 442.2±194.4 224.9±178.0 2.5 0.012 IMIeq (mg/day) 11.1±31.4 3.1±15.3 0.8 0.77 DZPeq (mg/day) 3.7±6.9 1.3±3.1 1.5 0.29 BPDeq (mg/day) 0.3±0.9 0.2±0.6 0.3 0.89 Number of psychotropic drugs 2.7±1.8 1.3±1.2 2.7 9.62×10 -3 Number of antipsychotics 1.4±0.5 0.8±0.4 3.1 0.018 Number of antidepressants 0.2±0.6 0.04±0.2 0.8 0.77 Number of benzodiazepines 0.7±0.9 0.2±0.5 1.6 0.22 Number of mood stabilizers 0.0±0.0 0.08±0.3 -0.9 0.74 Number of anticholinergic drugs 0.1±0.3 0.08±0.3 0.2 0.92 The means and standard deviations (SDs) of patients with SSD and non-SSD are presented. Complete demographic information was not obtained for all participants (Education, n =28; No baby supplies prepared at the third trimester, n =31). BMI, body mass index; CPZeq, chlorpromazine equivalent; IMIeq, imipramine equivalent; DZPeq, diazepam equivalent; BPDeq, biperiden equivalent. a Fisher’s exact test. P <0.05 is shown in bold. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":153803,"visible":true,"origin":"","legend":"\u003cp\u003eSmoking status and cigarette consumption at the third trimester of pregnancy in individuals with schizophrenia spectrum disorders (SSD) and other psychiatric disorders (non-SSD). The proportion of ever smokers (dark blue) and never smokers (light blue) among individuals with SSD (\u003cem\u003en\u003c/em\u003e= 33, top) and non-SSD (\u003cem\u003en\u003c/em\u003e = 141, bottom) \u003cstrong\u003e(a)\u003c/strong\u003e, the proportions of current (dark pink) and former smokers (light pink) among ever smokers \u003cstrong\u003e(b) \u003c/strong\u003eare shown. The distribution of the number of cigarettes smoked per day among current smokers, categorized as 1-10 (green), 11-20 (orange), and more than 20 (yellow) is shown\u003cstrong\u003e (c)\u003c/strong\u003e.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8234382/v1/ff94860f138f0d23487e91f1.png"},{"id":100070044,"identity":"63d3c697-2959-4cb1-951b-e2085c1c4a52","added_by":"auto","created_at":"2026-01-12 16:16:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":92533,"visible":true,"origin":"","legend":"\u003cp\u003ePossible factors influencing current smoking status\u003cstrong\u003e \u003c/strong\u003eat the third trimester in the schizophrenia spectrum disorders group (SSD)\u003cstrong\u003e (a)\u003c/strong\u003e.\u003cstrong\u003e \u003c/strong\u003eOdds ratios (ORs) with 95% confidence intervals (CIs) are shown for each clinical and demographic variable. Bars indicate ORs, with error bars representing 95% CIs. An OR greater than 1.0 indicates a positive association with current smoking, whereas an OR less than 1.0 indicates a negative association. Possible factors influencing the number of cigarettes smoked per day among current smokers, categorized as 0 cigarette, 1-10, 11-20, and over 21 per day at the third trimester in the SSD \u003cstrong\u003e(b)\u003c/strong\u003e.\u003cstrong\u003e \u003c/strong\u003eEffect sizes (unstandardized Beta values) are represented, and error bars represent the 95% confidence intervals of the unstandardized Beta values. BPDeq, biperiden equivalent; BMI, body mass index; CPZeq, chlorpromazine equivalent; IMIeq, imipramine equivalent, DZPeq, diazepam equivalent. *\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003e p\u003c/em\u003e \u0026lt;0.01, *** \u003cem\u003ep\u003c/em\u003e \u0026lt;2.17×10\u003csup\u003e-3\u003c/sup\u003e.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8234382/v1/20c8e9cbf4af5aeaba93c730.png"},{"id":100070944,"identity":"eb9fc66f-1b93-4ad3-83c6-944d91b80590","added_by":"auto","created_at":"2026-01-12 16:18:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1508582,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8234382/v1/cd12f07d-331e-44e6-99cc-d7ae11a5acbb.pdf"},{"id":100070056,"identity":"deb5f8ef-0160-4a89-b3c5-56746fe800a4","added_by":"auto","created_at":"2026-01-12 16:16:12","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":171188,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-8234382/v1/3a57707b92131e20fbb61228.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychosocial and pharmacological factors associated with prenatal smoking in women with psychiatric disorders","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCigarette smoking during pregnancy is a well-established risk factor for adverse outcomes in both the mother and child, including placental abruption [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], intrauterine growth retardation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], sudden fetal and infant death [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and long-term impact such as reduced offspring academic achievement [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Maternal smoking restricted to the first trimester is not associated with adverse birth outcomes, whereas continued smoking increases risks of preterm birth, small size for gestational age, and childhood overweight [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Third-trimester smoking is also linked to higher risk of atopic eczema/dermatitis syndrome in infants compared with smoking at earlier stages of pregnancy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Adverse fetal risk rises with the number of cigarettes smoked [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite known risks, smoking during pregnancy remains common. Globally, cigarette smoking prevalence is 5.4% before pregnancy, and 1.7% during pregnancy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral psychosocial factors have been associated with smoking during pregnancy, including younger age, lower socioeconomic status, lower educational attainment, lower occupational status, being unmarried, obesity (BMI, body mass index\u0026thinsp;\u0026ge;\u0026thinsp;30), and lack of breastfeeding intentions [\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Pregnant individuals with psychiatric disorders\u0026mdash;including schizophrenia spectrum disorders (SSD), bipolar disorders, depressive disorders, anxiety and stress related disorders, and personality disorders\u0026mdash;tend to be younger with lower educational attainment and socioeconomic status compared with those without psychiatric disorders [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The prevalence of smoking among individuals with psychiatric disorders is markedly higher than in the general population [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Among individuals with SSD, smoking prevalence ranges from 66% to 88%, substantially higher than in other psychiatric disorders [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe self-medication hypothesis proposes that individuals with SSD may smoke to alleviate extrapyramidal symptoms (EPS) induced by antipsychotics [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Nicotine may counteract antipsychotic effects by partially restoring drug-induced dopamine receptor blockade [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and can increase hepatic metabolism via CYP450 activation, thereby reducing serum antipsychotic levels [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, other studies have reported no association between smoking in SSDs and antipsychotic chlorpromazine-equivalent dose (CPZeq) or adverse effects such as EPS [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], resulting in inconsistent evidence regarding associations between psychotropic drugs and smoking.\u003c/p\u003e \u003cp\u003eAmong individuals with SSD, women tend to smoke more than men [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and even during pregnancy, smoking rates remain higher in those with SSD compared with the general population [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, it is not yet established whether individuals with SSD have higher smoking rates than those with other psychiatric disorders specifically during pregnancy. Guidelines recommend continuation of antipsychotics during pregnancy for individuals with SSD to prevent relapse and maintain maternal stability [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Pregnant individuals who used psychotropic drugs were more likely to smoke than those who did not [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], although the relationship between psychotropic drug type, number, or dosage during pregnancy and smoking remains unclear. To mitigate adverse birth outcomes in pregnant individuals with psychiatric disorders\u0026mdash;including SSD\u0026mdash;understanding the associations between psychotropic drug use and smoking during pregnancy is therefore important.\u003c/p\u003e \u003cp\u003eIn this retrospective study, we compared smoking behaviors during pregnancy between individuals with SSD and those with other psychiatric disorders, and identified factors influencing smoking during pregnancy. We hypothesized that pregnant individuals with SSD would have higher smoking rates than those with other psychiatric disorders, mirroring findings in non-pregnant populations [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. We further considered that this pattern may be related to the greater psychosocial difficulties (e.g., lower educational attainment) and pharmacological characteristics (e.g., higher antipsychotic doses and greater psychotropic polypharmacy) reported in SSDs relative to other psychiatric disorders [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included individuals who gave birth between April 1, 2006, and March 31, 2024, at Gifu University Hospital in Japan and had comorbid psychiatric disorders documented in their medical records. Individuals who delivered preterm (\u0026lt; 36 weeks) were excluded. Primary psychiatric diagnoses at the third trimester (\u0026ge; 36 weeks) were identified from medical records and determined according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) [36]. If a psychiatric diagnosis was later revised, the final diagnosis was used. A total of 174 deliveries from individuals with psychiatric disorders were included. When individuals delivered more than once (i.e., had multiple childbirths), each delivery was counted as a separate observation. All participants were Japanese, except four (two Chinese, one Filipino, and one Brazilian) residing in the Chubu region of Japan.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe SSD group included individuals with schizophrenia (\u003cem\u003en\u003c/em\u003e=30), schizoaffective disorder (\u003cem\u003en\u003c/em\u003e=1), and brief psychotic disorder (\u003cem\u003en\u003c/em\u003e=2). The non-SSD group included individuals with bipolar I disorder (\u003cem\u003en\u003c/em\u003e=6), bipolar II disorder (\u003cem\u003en\u003c/em\u003e=18), major depressive disorder (\u003cem\u003en\u003c/em\u003e=29), persistent depressive disorder (\u003cem\u003en\u003c/em\u003e=4), premenstrual dysphoric disorder (\u003cem\u003en\u003c/em\u003e=1), panic disorder (\u003cem\u003en\u003c/em\u003e=29), generalized anxiety disorder (\u003cem\u003en\u003c/em\u003e=10), specific phobia (\u003cem\u003en\u003c/em\u003e=1), obsessive-compulsive disorder (\u003cem\u003en\u003c/em\u003e=5), adjustment disorder (\u003cem\u003en\u003c/em\u003e=12), dissociative disorders (\u003cem\u003en\u003c/em\u003e=7), conversion disorder (\u003cem\u003en\u003c/em\u003e=1), somatic symptom disorder (\u003cem\u003en\u003c/em\u003e=1), eating disorder (\u003cem\u003en\u003c/em\u003e=3), insomnia (\u003cem\u003en\u003c/em\u003e=2), intellectual developmental disorder (\u003cem\u003en\u003c/em\u003e=4), autism spectrum disorder (\u003cem\u003en\u003c/em\u003e=2), tic disorder (\u003cem\u003en\u003c/em\u003e=1), and borderline personality disorder (\u003cem\u003en\u003c/em\u003e=5). Information on education and comorbid physical disorders was extracted from medical records. Neonatal data, including multiple gestation status and neonatal intensive care unit (NICU) admission, were also extracted. Demographics of the SSD (\u003cem\u003en\u003c/em\u003e=33) and non-SSD (\u003cem\u003en\u003c/em\u003e=141) groups are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003eThis retrospective study complied with the World Medical Association\u0026rsquo;s Declaration of Helsinki and was approved by the Research Ethics Committees of Gifu University (2024-050). The need for written informed consent was waived due to the retrospective design, with the option to decline participation via opt-out.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSmoking status and history\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformation on participants\u0026rsquo; smoking status defined as the use of combustible cigarettes was extracted from medical records, including whether participants were currently smoking \u0026ge; 36 weeks of pregnancy, had never smoked, or were smokers before 36 weeks of pregnancy. For current smokers, the number of cigarettes smoked per day (CPD) was recorded and grouped into four categories: 0, 1\u0026ndash;10, 11\u0026ndash;20, and \u0026ge;21.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychotropic drug information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegular psychotropic drug use (antipsychotics, antidepressants, benzodiazepines, mood stabilizers, and anticholinergics) at \u0026ge; 36 weeks of pregnancy was identified from medical records. Regular use was defined as uninterrupted use for \u0026ge; 4 consecutive weeks, as confirmed by the medical records. The presence and number of regular use of antipsychotics, antidepressants, benzodiazepines, mood stabilizers, and anticholinergic drugs at the third trimester were recorded, respectively. The list of psychotropic drugs has been provided previously [37]. As-needed medications were not assessed. Psychotropic doses were converted to CPZeq, imipramine equivalent (IMIeq), diazepam equivalent (DZPeq), and biperiden equivalent (BPDeq) according to established equivalence tables [38]. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics version 30.0 (IBM Japan, Tokyo, Japan). Differences in participant and newborn information related to pregnancy between the SSD and non-SSD groups were analyzed using chi-square tests for categorical variables (e.g., comorbidity of physical disorders and regular antipsychotic use at the third trimester) and Mann\u0026ndash;Whitney \u003cem\u003eU\u003c/em\u003e tests for continuous variables (e.g., number of antipsychotics used during the third trimester and BMI at the third trimester).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDifferences in smoking history between groups were examined using logistic regression:\u003cstrong\u003e\u0026nbsp;(a)\u003c/strong\u003e ever versus never smoking (dependent variable: ever smoking; independent variable: SSD diagnosis), and \u003cstrong\u003e(b)\u003c/strong\u003e among ever-smokers (SSD, \u003cem\u003en\u003c/em\u003e=10; non-SSD, \u003cem\u003en\u003c/em\u003e=39), current versus former smoking (dependent variable: current smoking; independent variable: SSD diagnosis). To investigate whether the number of CPD differed between the SSD (\u003cem\u003en\u003c/em\u003e=33) and non-SSD (\u003cem\u003en\u003c/em\u003e=141) groups, a linear regression analysis was conducted using CPD category (0; 1\u0026ndash;10; 11\u0026ndash;20; and \u0026ge; 21) as the dependent variable and SSD diagnosis as the independent variable. Age and childbirth year were covariates in all logistic and linear regression models.\u003c/p\u003e\n\u003cp\u003eNext, we focused on the SSD group (\u003cem\u003en\u003c/em\u003e=33) and evaluated differences in clinical characteristics between current and non-current smokers at the third trimester using Fisher\u0026rsquo;s exact and the Mann\u0026ndash;Whitney\u003cem\u003e\u0026nbsp;U\u003c/em\u003e tests. To identify the possible effects of current smoking during pregnancy on clinical factors in the SSD group (\u003cem\u003en\u003c/em\u003e=33), logistic regression analyses were conducted (dependent variable: current smoking status at the third trimester; independent variables: clinical factors; covariates: age and childbirth year); the use and number of antipsychotics and mood stabilizers were excluded due to complete separation. To examine the possible effects of CPD category (0; 1\u0026ndash;10; 11\u0026ndash;20; and \u0026ge; 21) at the third trimester of pregnancy on clinical factors in the SSD group (\u003cem\u003en\u003c/em\u003e=33), a linear regression was conducted (dependent variable: CPD category; independent variables: clinical factors; covariates: age and childbirth year).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe nominal two-tailed significance level was \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, and Bonferroni correction yielded a final alpha of \u003cem\u003ep\u003c/em\u003e\u0026lt;2.17\u0026times;10\u003csup\u003e\u0026minus;3\u003c/sup\u003e (\u003cem\u003e\u0026alpha;\u003c/em\u003e=0.05/23 characteristics), avoiding type I error.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eIndividuals\u0026rsquo; characteristics at the third trimester and their newborns\u0026rsquo; outcomes at birth\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic information at the third trimester in the SSD and non-SSD groups is shown in Table 1. The SSD group had lower education (z=\u0026minus;3.1,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=2.22\u0026times;10⁻\u003csup\u003e3\u003c/sup\u003e), lower prevalence of comorbid physical disorders (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=4.6, \u003cem\u003ep\u003c/em\u003e=0.032), higher BMI (z=5.0,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=6.83\u0026times;10⁻\u003csup\u003e7\u003c/sup\u003e), higher prevalence of non-breastfeeding intentions (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=4.1,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.044), higher age at childbirth (z=2.0,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.049), and higher prevalence of cesarean section (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=6.1,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.046) than those in the non-SSD group. Regarding psychotropic drug information, the SSD group exhibited higher prevalence of regular antipsychotic use (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=74.1,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=7.40\u0026times;10⁻\u003csup\u003e18\u003c/sup\u003e), greater number of antipsychotics (z=8.8,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=1.66\u0026times;10⁻\u003csup\u003e18\u003c/sup\u003e), higher CPZeq (z=9.1,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=8.91\u0026times;10⁻\u003csup\u003e20\u003c/sup\u003e), higher prevalence of regular anticholinergic use (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=74.1,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=7.40\u0026times;10⁻\u003csup\u003e18\u003c/sup\u003e), greater number of anticholinergics (z=2.9,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=3.93\u0026times;10⁻\u003csup\u003e3\u003c/sup\u003e), higher BPDeq (z=2.9,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=4.02\u0026times;10⁻\u003csup\u003e3\u003c/sup\u003e), and greater number of psychotropics (z=4.4,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=1.13\u0026times;10⁻\u003csup\u003e5\u003c/sup\u003e) than those in the non-SSD group. Regarding newborn outcomes, the SSD group had a higher prevalence of multiple gestation (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=4.5,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.034) and neonatal intensive care unit (NICU) admission (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=6.8,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=8.97\u0026times;10⁻\u003csup\u003e3\u003c/sup\u003e) than those in the non-SSD group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifferences in\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;smoking history\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eat the third trimester of pregnancy between the SSD and non-SSD groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe examined differences in smoking history\u0026mdash;\u003cstrong\u003e(a)\u003c/strong\u003e ever vs. never, \u003cstrong\u003e(b)\u003c/strong\u003e current vs. former among ever-smokers, and \u003cstrong\u003e(c)\u003c/strong\u003e CPD category\u0026mdash;at the third trimester of pregnancy between the SSD (\u003cem\u003en\u003c/em\u003e=33) and non-SSD (\u003cem\u003en\u003c/em\u003e=141) groups (Fig. 1). Among those with ever-smoking history, the proportion of current smokers was significantly higher in the SSD group (90.0%, \u003cem\u003en\u003c/em\u003e=10) than in the non-SSD group (10.3%, \u003cem\u003en\u003c/em\u003e=39) (\u0026chi;\u0026sup2;=26.0,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=3.47\u0026times;10⁻\u003csup\u003e7\u003c/sup\u003e) (Fig. 1b). CPD category was also higher in the SSD group than in the non-SSD group (\u003cem\u003ebeta\u003c/em\u003e=0.36, \u003cem\u003ep\u003c/em\u003e=3.03\u0026times;10\u003csup\u003e\u0026minus;6\u003c/sup\u003e). In contrast, no significant differences were observed in the proportion of ever-smokers between the SSD (30.3%) and non-SSD (27.7%; \u003cem\u003ep\u003c/em\u003e\u0026gt;0.05) groups (Fig. 1a).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePossible factors influencing current smoking status at the third trimester of pregnancy in the SSD group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGiven the higher smoking rate in the SSD group at third trimester than in the non-SSD group, we next focused on the SSD group (\u003cem\u003en\u003c/em\u003e=33, Table 2). Current smokers at the third trimester (\u003cem\u003en\u003c/em\u003e=9) had lower education (z=\u0026minus;3.2, \u003cem\u003ep\u003c/em\u003e=2.49\u0026times;10\u003csup\u003e\u0026minus;3\u003c/sup\u003e), greater number of psychotropics (z=2.7, \u003cem\u003ep\u003c/em\u003e=9.62\u0026times;10\u003csup\u003e\u0026minus;3\u003c/sup\u003e), higher CPZeq (z=2.5, \u003cem\u003ep\u003c/em\u003e=0.012), greater number of antipsychotics (z=3.1, \u003cem\u003ep\u003c/em\u003e=0.018), and higher prevalence of non-breastfeeding intentions (\u0026chi;\u0026sup2;=7.7, \u003cem\u003ep\u003c/em\u003e=0.010) than non-current smokers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThen, we examined the possible effects of current smoking during pregnancy on clinical factors, including individual characteristics and the use of psychotropics (Fig. 2a). Logistic regression analyses adjusting for age and childbirth year indicated that the current smoking at\u0026nbsp;the third trimester was nominally associated with higher prevalence of non-breastfeeding intentions (OR=14.3\u003cem\u003e,\u003c/em\u003e 95%CI [1.8, 112.1], \u003cem\u003ep\u003c/em\u003e=0.011), lower education (OR=0.06\u003cem\u003e,\u003c/em\u003e 95% CI [0.007, 0.63], \u003cem\u003ep\u003c/em\u003e=0.018), higher CPZeq (OR=2.5\u003cem\u003e,\u003c/em\u003e 95% CI [1.1, 6.1], \u003cem\u003ep\u003c/em\u003e=0.036), and greater number of psychotropics (OR=2.8\u003cem\u003e,\u003c/em\u003e 95% CI [1.0, 7.7], \u003cem\u003ep\u003c/em\u003e=0.040), with no significant associations for other factors (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePossible factors influencing CPD number at the third trimester of pregnancy in the SSD group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe examined the possible effects of the CPD categories (0, \u003cem\u003en\u003c/em\u003e=24; 1\u0026ndash;10,\u003cem\u003e\u0026nbsp;n\u003c/em\u003e=6; 11\u0026ndash;20, \u003cem\u003en\u003c/em\u003e=2; and \u0026ge; 21, \u003cem\u003en\u003c/em\u003e=1) at the third trimester on clinical factors, including individual characteristics and psychotropic use, in the SSD group (Fig. 2b). A higher CPD category correlated significantly with a greater number of antipsychotics (B=0.5, 95% CI [0.2, 0.7], \u003cem\u003ep\u003c/em\u003e=6.42\u0026times;10⁻⁴), and nominally correlated with greater number of psychotropics (B=0.3, 95% CI [0.1, 0.6], \u003cem\u003ep\u003c/em\u003e=6.81\u0026times;10⁻\u003csup\u003e3\u003c/sup\u003e), higher prevalence of non-breastfeeding intentions (B=0.8, 95% CI [0.2, 1.3], \u003cem\u003ep\u003c/em\u003e=8.33\u0026times;10⁻\u003csup\u003e3\u003c/sup\u003e), higher BPDeq (B=0.2, 95% CI [0.02, 0.3], \u003cem\u003ep\u003c/em\u003e=0.027), and greater number of benzodiazepines (B=0.3, 95% CI [0.003, 0.5], \u003cem\u003ep\u003c/em\u003e=0.048)\u0026nbsp;(Fig. 2b); no significant correlations were observed for other factors (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePossible factors influencing current smoking\u003c/strong\u003e \u003cstrong\u003eat the third trimester\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ein the non-SSD group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo compare with the findings from the SSD group, we evaluated clinical correlates of current smoking at the third trimester in the non-SSD group (Supplementary Fig. 1). No clinical factors were associated with current smoking status (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05, Supplementary Fig. 1a). In contrast, a higher CPD category correlated significantly with regular anticholinergic use (B=0.9, 95% CI [0.5, 1.4], \u003cem\u003ep\u003c/em\u003e=1.45\u0026times;10⁻\u003csup\u003e5\u003c/sup\u003e),\u0026nbsp;greater number of anticholinergics\u0026nbsp;(B=0.1, 95%CI [0.08, 0.2], \u003cem\u003ep\u003c/em\u003e=1.45\u0026times;10⁻\u003csup\u003e5\u003c/sup\u003e), higher BPDeq\u0026nbsp;(B=0.1, 95%CI [0.07, 0.2], \u003cem\u003ep\u003c/em\u003e=1.45\u0026times;10⁻\u003csup\u003e5\u003c/sup\u003e),\u0026nbsp;and\u0026nbsp;non-breastfeeding intentions (B=0.1, 95% CI [0.04, 0.2], \u003cem\u003ep\u003c/em\u003e=8.62\u0026times;10⁻\u003csup\u003e4\u003c/sup\u003e), and was nominally correlated with regular benzodiazepine (B=0.1, 95%CI [0.03, 0.2], \u003cem\u003ep\u003c/em\u003e=9.40\u0026times;10⁻\u003csup\u003e3\u003c/sup\u003e) and antidepressant (B=0.1, 95% CI [0.02, 0.2], \u003cem\u003ep\u003c/em\u003e=0.046) use, greater number of benzodiazepines (B=0.04, 95% CI [0.005, 0.08], \u003cem\u003ep\u003c/em\u003e=0.026), antidepressants (B=0.04, 95% CI [0.0004, 0.07], \u003cem\u003ep\u003c/em\u003e=0.047), and psychotropics (B=0.05, 95%CI [0.007, 0.09], \u003cem\u003ep\u003c/em\u003e=0.022), and non-first pregnancy (B=\u0026minus;0.09, 95%CI [\u0026minus;0.2, \u0026minus;0.01], \u003cem\u003ep\u003c/em\u003e=0.027) (Supplementary Fig. 1b).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we investigated the differences in smoking status during pregnancy between individuals with SSD and those with other psychiatric disorders. We found that current smoking at the third trimester of pregnancy was significantly more prevalent in the SSD group than in the non-SSD group, despite similar lifetime smoking histories, and the SSD group smoked more CPD. In the SSD group, current smoking at the third trimester was nominally associated with non-breastfeeding intentions, lower educational attainment, greater number of antipsychotics, higher CPZeq, and greater number of psychotropics. CPD category was significantly associated with the number of antipsychotics and nominally associated with non-breastfeeding intentions, greater number of psychotropics and benzodiazepines, and higher BPDeq.\u0026nbsp;These findings suggest that smoking at the third trimester in individuals with SSD may be influenced by both psychosocial and pharmacological factors.\u003c/p\u003e \u003cp\u003eThe higher prevalence of smoking in the SSD group may partly reflect lower smoking cessation rates documented in non-pregnant SSD cohorts [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Associations between smoking, non-breastfeeding intentions, and lower educational attainment are consistent with findings from previous studies in the general population [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. SSD populations have lower breastfeed intentions and educational attainment than the general population [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This study showed that these psychosocial factors were significantly more prevalent in the SSDs compared with other psychiatric disorders, and may contribute to the higher third-trimester smoking prevalence.\u003c/p\u003e \u003cp\u003eConsistent with previous studies [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], individuals with SSD received higher CPZeq doses and more frequent psychotropic polypharmacy during pregnancy than those with other psychiatric disorders. Current smoking at the third trimester was nominally associated with higher CPZeq use and psychotropic polypharmacy. High-dose antipsychotic treatment and psychotropic polypharmacy increase the risk of adverse effects, including EPS [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Additionally, among individuals treated with antipsychotics and other psychotropics, smokers have shown more pronounced reductions in antipsychotic blood concentrations compared with non-smokers [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These findings support the possibility that smoking may alleviate antipsychotic side effects, consistent with the self-medication hypothesis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eReportedly, CPD number correlates positively with CPZeq [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] in SSDs, whereas the relationship with the number of antipsychotics is unclear. Our results indicate that the number of antipsychotics was the strongest factor associated with CPD category. SSD is a chronic disorder, and continued antipsychotic treatment throughout life, including during pregnancy, is recommended [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Antipsychotic monotherapy is also recommended [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. An increased CPD number reportedly enhances the activity of drug-metabolizing enzymes, thereby reducing antipsychotic plasma concentrations [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], potentially necessitating higher dosages. These findings suggest that optimizing antipsychotic treatment through the promotion of monotherapy during pregnancy may reduce cigarette consumption in SSDs and mitigate adverse outcomes for both the individual and the newborn.\u003c/p\u003e \u003cp\u003eThe smoking rate during pregnancy in the general population is 1.7% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], whereas it was higher at 2.8% even in the non-SSD group. To compare with the SSD group, we explored clinical correlates of smoking status at the third trimester in the non-SSD group; none was significantly associated with current smoking at the third trimester in the non-SSDs. However, the use, dosage, and number of anticholinergics, the absence of breastfeeding intention, and nominal associations with benzodiazepines and antidepressants were significantly associated with CPD number at the third trimester. These findings suggest that smoking behavior among pregnant individuals with psychiatric disorders other than SSD may also be related to maternal behavioral intentions and pharmacological treatment. Similar to SSDs, targeted breastfeeding interventions and careful assessment of antipsychotic side effects may help reduce smoking during pregnancy even among non-SSD individuals.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, our participants\u0026rsquo; data were obtained from a single university hospital, and unlike individuals treated in general obstetric clinics and hospitals, those treated in university hospitals may present with more severe psychiatric complications. Although psychiatric symptoms and medication side effects may be associated with smoking [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], we could not assess them. Therefore, a causal relationship between adverse effects and smoking has not been demonstrated. In the SSD group, newborns were more likely to require NICU admission compared with those in the non-SSD group; however, the relationship between newborn outcomes and maternal smoking behavior remains unclear. Future studies should collect data on psychiatric symptoms and adverse effects to clarify these relationships.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, smoking during the third trimester of pregnancy was more common among individuals with SSD than among those with other psychiatric disorders. Compared with the non-SSD group, the SSD group showed distinctive psychosocial and pharmacological characteristics, including lower educational attainment, lack of breastfeeding intention, higher doses and numbers of antipsychotics, and greater number of psychotropics. Notably, CPD number correlated significantly with the number of antipsychotics used. In SSDs, targeted breastfeeding interventions and the implementation of antipsychotic monotherapy, including preconception care, may help reduce smoking during pregnancy and improve outcomes for both mothers and their newborn.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all individuals who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA. Kuramitsu collected the data, performed the analyses, interpreted the results, and drafted the manuscript. K. Ohi was critically involved in the study design and contributed to writing the manuscript. A. Kuramitsu was also responsible for conducting the literature review. A. Kuramitsu, K. Ohi, S. Sugiyama, T. Shiga, T. Furui, and T. Shioiri were extensively involved in data collection and made substantial intellectual contributions to data interpretation. All authors contributed to and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by a grant from the Smoking Research Foundation. The supporters had no role in the design, analysis, interpretation, or publication of this study. This work was also supported by JSPS KAKENHI (Grant No. 23K14797 [to SS]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are not publicly available because they contain information that could compromise participant privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproved by the Research Ethics Committee of Gifu University (2024-050). The requirement for written informed consent was waived due to the retrospective design, with an opt-out option available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors have gone through the final version of this manuscript and have given their consent for the publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChen D, Gao X, Yang T, Xin X, Wang G, Wang H, et al. Independent risk factors for placental abruption: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2025;25(1):351.\u003c/li\u003e\n\u003cli\u003eHorta BL, Victora CG, Menezes AM, Halpern R, Barros FC. Low birthweight, preterm births and intrauterine growth retardation in relation to maternal smoking. 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Am J Prev Med. 1992;8(1):8-13.\u003c/li\u003e\n\u003cli\u003eDickson H, Hedges EP, Ma SY, Cullen AE, MacCabe JH, Kempton MJ, et al. Academic achievement and schizophrenia: a systematic meta-analysis. Psychol Med. 2020;50(12):1949-65.\u003c/li\u003e\n\u003cli\u003eCrossley NA, Alliende LM, Czepielewski LS, Aceituno D, Casta\u0026ntilde;eda CP, Diaz C, et al. The enduring gap in educational attainment in schizophrenia according to the past 50 years of published research: a systematic review and meta-analysis. Lancet Psychiatry. 2022;9(7):565-73.\u003c/li\u003e\n\u003cli\u003eSim K, Su A, Leong JY, Yip K, Chong MY, Fujii S, et al. High dose antipsychotic use in schizophrenia: findings of the REAP (research on east Asia psychotropic prescriptions) study. Pharmacopsychiatry. 2004;37(4):175-9.\u003c/li\u003e\n\u003cli\u003eH\u0026oslash;jlund M, K\u0026ouml;hler-Forsberg O, Gregersen AT, Rohde C, Mellentin AI, Anh\u0026oslash;j SJ, et al. Prevalence, correlates, tolerability-related outcomes, and efficacy-related outcomes of antipsychotic polypharmacy: a systematic review and meta-analysis. Lancet Psychiatry. 2024;11(12):975-89.\u003c/li\u003e\n\u003cli\u003eOhi K, Shimada T, Kuwata A, Kataoka Y, Okubo H, Kimura K, et al. Smoking Rates and Number of Cigarettes Smoked per Day in Schizophrenia: A Large Cohort Meta-Analysis in a Japanese Population. Int J Neuropsychopharmacol. 2019;22(1):19-27.\u003c/li\u003e\n\u003cli\u003eNICE. Psychosis and schizophrenia in adults: prevention and management. 2014. https://www.nice.org.uk/guidance/cg178/chapter/recommendations#how-to-use-antipsychotic-medication. Accessed 8 August 2025.\u003c/li\u003e\n\u003cli\u003ePlowchalk DR, Rowland Yeo K. Prediction of drug clearance in a smoking population: modeling the impact of variable cigarette consumption on the induction of CYP1A2. Eur J Clin Pharmacol. 2012;68(6):951-60.\u003c/li\u003e\n\u003cli\u003eMu X, Wu W, Wang S, Su X, Guan H, Guan X, et al. Smoking affects symptom improvement in schizophrenia: a prospective longitudinal study of male patients with first-episode schizophrenia. Schizophrenia. 2024;10(1):34.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Differences in subjects\u0026rsquo; characteristics at the third trimester and their newborns\u0026rsquo; outcomes at birth between those with schizophrenia spectrum disorders (SSDs) and those without (non-SSDs).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"701\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSSDs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u003cstrong\u003enon-SSDs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e=33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e=141)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e or \u003cem\u003eZ\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndividual information at the third trimester\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eEducation (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e12.0\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e13.6\u0026plusmn;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.22\u0026times;10\u003csup\u003e-3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eComorbid physical disorders (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e4/29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e43/98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e4.6\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eFirst pregnancy (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e18/15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e84/57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.3\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e29.5\u0026plusmn;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e24.8\u0026plusmn;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.83\u0026times;10\u003csup\u003e-7\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eOccupation (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e3/30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e33/108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e3.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eUnmarried (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e4/29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e8/133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e1.7\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNon-breastfeeding intentions (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e10/23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e19/107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e4.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.044\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNo baby supplies prepared (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e4/27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e18/103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003ePhysical complications related to pregnancy (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e20/13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e57/84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eAge at childbirth (years)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e33.6\u0026plusmn;5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e31.6\u0026plusmn;5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eDelivery methods (Vaginal delivery/\u003c/p\u003e\n \u003cp\u003eElective CS/Emergency CS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e19/8/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e109/22/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e6.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 61.9658%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychotropic drugs information at the third trimester\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3932%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.8262%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of antipsychotics (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e29/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e19/122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e74.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.40\u0026times;10\u003csup\u003e-18\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of antidepressants (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e27/114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e3.3\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of benzodiazepines\u0026nbsp;(+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e8/25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e29/112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.2\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of mood stabilizers (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e9/132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of anticholinergic drugs (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e3/30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1/140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e8.4\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.82\u0026times;10\u003csup\u003e-3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eCPZeq (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e284.1\u0026plusmn;207.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e25.7\u0026plusmn;105.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.91\u0026times;10\u003csup\u003e-20\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eIMIeq (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e5.3\u0026plusmn;21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e18.8\u0026plusmn;48.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eDZPeq\u0026nbsp;(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2.0\u0026plusmn;4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2.8\u0026plusmn;8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eBPDeq\u0026nbsp;(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.2\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.02\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.02\u0026times;10\u003csup\u003e-3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of psychotropic drugs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.7\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.8\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.13\u0026times;10\u003csup\u003e-5\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of antipsychotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.0\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.1\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.66\u0026times;10\u003csup\u003e-18\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of antidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.09\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.2\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of benzodiazepines\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.3\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.3\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of mood stabilizers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.06\u0026plusmn;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.06\u0026plusmn;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of anticholinergic drugs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.09\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.007\u0026plusmn;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.93\u0026times;10\u003csup\u003e-3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheir newborn information at birth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eGestational age at birth (weeks)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e38.5\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e38.6\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eMultiple gestation status (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1/140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e4.5\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eSex of the newborn (male/female)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e20/15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e79/63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eBirth weight of the newborn (g)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e3038.5\u0026plusmn;571.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2933.5\u0026plusmn;417.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eAdmission to the NICU (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e28/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e78/64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e6.8\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.97\u0026times;10\u003csup\u003e-3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eAt 1 minute: Apgar score at 1 minute\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e8.1\u0026plusmn;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e8.2\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eAt 5 minutes: Apgar score at 5 minutes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e9.1\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e9.2\u0026plusmn;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe means and standard deviations (SDs) of patients with SSD and non-SSD, and their newborns are presented. Complete demographic information was not obtained for all participants (Education, SSD, \u003cem\u003en\u003c/em\u003e=28, non-SSD, \u003cem\u003en\u003c/em\u003e=88; Breastfeeding intentions during pregnancy, non-SSD, \u003cem\u003en\u003c/em\u003e=126; No baby supplies prepared at the third trimester, SSD, \u003cem\u003en\u003c/em\u003e=31, non-SSD, \u003cem\u003en\u003c/em\u003e=121). BMI, body mass index; CS, Cesarean section; CPZeq, chlorpromazine equivalent; IMIeq, imipramine equivalent; DZPeq, diazepam equivalent; BPDeq, biperiden equivalent; NICU, neonatal intensive care unit. \u003csup\u003ea\u003c/sup\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e test. \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 is shown in bold.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Differences in subjects\u0026rsquo; characteristics between current-smoker and non-smoker at the third trimester in schizophrenia spectrum disorders.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"701\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent-smoker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-current smoker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e=9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e=24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e or \u003cem\u003eZ\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndividual information at the third trimester\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eEducation (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e10.1\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e12.6\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.49\u0026times;10\u003csup\u003e-3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eComorbid physical disorders (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e3/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1/23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e5.2\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eFirst pregnancy (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e5/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e13/11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e32.1\u0026plusmn;6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e28.5\u0026plusmn;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eOccupation (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e2.4\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eUnmarried (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e1.2\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNon-breastfeeding intentions (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e6/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e4/20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e7.7\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNo baby supplies prepared (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e1.4\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003ePhysical complications related to pregnancy (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e3/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e11/13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eAge at childbirth (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e31.5\u0026plusmn;4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e34.4\u0026plusmn;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 61.9658%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychotropic drugs information at the third trimester\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of antipsychotics (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e9/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e20/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e1.7\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of antidepressants (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1/23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.6\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of benzodiazepines\u0026nbsp;(+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e4/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e4/20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e2.8\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of mood stabilizers (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.8\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eRegular use of anticholinergic drugs (+/-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eCPZeq (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e442.2\u0026plusmn;194.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e224.9\u0026plusmn;178.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eIMIeq (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e11.1\u0026plusmn;31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e3.1\u0026plusmn;15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eDZPeq\u0026nbsp;(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e3.7\u0026plusmn;6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.3\u0026plusmn;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eBPDeq\u0026nbsp;(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.3\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.2\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of psychotropic drugs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2.7\u0026plusmn;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.3\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.62\u0026times;10\u003csup\u003e-3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of antipsychotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.4\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.8\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of antidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.2\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.04\u0026plusmn;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of benzodiazepines\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.7\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.2\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of mood stabilizers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.0\u0026plusmn;0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.08\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e-0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.151%;\"\u003e\n \u003cp\u003eNumber of anticholinergic drugs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.1\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.08\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3932%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8262%;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe means and standard deviations (SDs) of patients with SSD and non-SSD are presented. Complete demographic information was not obtained for all participants (Education, \u003cem\u003en\u003c/em\u003e=28;\u0026nbsp;No baby supplies prepared at the third trimester,\u003cem\u003e\u0026nbsp;n\u003c/em\u003e=31).\u0026nbsp;BMI, body mass index; CPZeq, chlorpromazine equivalent; IMIeq, imipramine equivalent; DZPeq, diazepam equivalent; BPDeq, biperiden equivalent. \u003csup\u003ea\u003c/sup\u003e Fisher\u0026rsquo;s exact test. \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 is shown in bold.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"smoking, schizophrenia spectrum disorders, pregnancy, antipsychotics, breastfeeding","lastPublishedDoi":"10.21203/rs.3.rs-8234382/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8234382/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCigarette smoking during pregnancy increases risks for adverse maternal and child outcomes. Individuals with psychiatric disorders\u0026mdash;particularly schizophrenia spectrum disorders (SSD)\u0026mdash;have higher smoking prevalence than the general population. However, it remains unclear whether, during pregnancy, SSDs exhibit higher smoking rates than those with other psychiatric disorders (non-SSD), and how psychosocial and pharmacological characteristics influence smoking in SSDs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 174 pregnant individuals with psychiatric disorders (SSD, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;33; non-SSD, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;141), identified from medical records at a single institution between 2006 and 2024, were evaluated. Smoking status, individual characteristics, and psychotropic use at the third trimester were assessed. Differences in smoking status between SSDs and non-SSDs, and factors associated with smoking during pregnancy were examined.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the third trimester, current smoking was more prevalent in SSDs (90.0%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10) than in non-SSDs (10.3%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;39) (χ\u0026sup2;=26.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.47\u0026times;10⁻\u003csup\u003e7\u003c/sup\u003e), and cigarettes smoked per day (CPD) was higher in SSDs (\u003cem\u003ebeta\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.36, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.03\u0026times;10\u003csup\u003e\u0026minus;\u0026thinsp;6\u003c/sup\u003e). Among SSDs, current smokers had lower educational attainment, used a greater number of psychotropic drugs, including antipsychotics, had higher antipsychotic chlorpromazine-equivalent dose (CPZeq), and had a higher prevalence of having no intention to breastfeed than non-current smokers. Logistic regression demonstrated significant associations between smoking and lower education, higher CPZeq, multiple psychotropics, and no intention to breastfeed (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05). CPD correlated significantly with the number of antipsychotics used (B\u0026thinsp;=\u0026thinsp;0.5, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.42\u0026times;10⁻⁴).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSmoking during late pregnancy was more prevalent in SSDs, and smoking was associated with both psychosocial and pharmacological characteristics. Targeted interventions to promote breastfeeding and the implementation of antipsychotic monotherapy may help reduce smoking during pregnancy and improve maternal\u0026ndash;child outcomes.\u003c/p\u003e","manuscriptTitle":"Psychosocial and pharmacological factors associated with prenatal smoking in women with psychiatric disorders","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 16:01:10","doi":"10.21203/rs.3.rs-8234382/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-12T10:04:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277030291646879855043232359915866100464","date":"2026-01-07T16:38:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-06T12:20:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-02T11:35:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-01T03:32:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-01T03:31:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-11-29T05:01:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9284651c-85dd-43c9-9e18-d4f376e6b458","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:01:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 16:01:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8234382","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8234382","identity":"rs-8234382","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}