Researchers find correlation between hookah use and postpartum depression

Symptoms of postpartum depression are higher among women who used hookahs before or during pregnancy, according to a study led by Zelalem Haile, Ph.D., Ohio University Heritage College of Osteopathic Medicine associate professor of epidemiology. Hookahs are water pipes used to smoke flavored or sweetened tobacco, marijuana, and hashish. Many people mistakenly believe that smoking from a hookah is safer than cigarettes.

However, hookah smoke contains high levels of unhealthy toxins and chemicals, such as tar, heavy metals, and carbon monoxide.

In recent years, hookah use has increased among young adults in the United States because it is seen as being less addictive and easier to quit. The Centers for Disease Control and Prevention reports that one in eight young adults has used a hookah.

Pregnant women who use a hookah also feel it is less harmful than cigarettes, but there is evidence showing that hookah use is associated with infant mortality, preterm birth, and low birth weight. A study led by Haile and published in 2022 found that women with a history of hookah use were less likely to breastfeed their infants for at least three months compared to those who had not used hookah in the past two years.

Despite these findings, Haile's most recent study published in the International Journal of Gynecology and Obstetrics, found 4.1 percent of women who had recently given birth said they used a hookah in the previous two years.

Haile, along with collaborators Sabrina Karim from the University of South Carolina, Mohammad Rifat Haider from the University of Georgia, and Heritage College students Kasey Murton and Sravya Patibandla, examined data collected in the Pregnancy Risk Assessment and Monitoring System 2016-2020.

This national survey, administered by the CDC in cooperation with state health departments, contains information from more than 206,000 women from 47 states. Haile's team limited their study to data from the nearly 107,000 women who had given birth but had no prior history of prepregnancy or prenatal depression.

Their study found that the chances of having postpartum depression symptoms were considerably higher for women who had used a hookah in the past two years, which is similar to previous research showing an association between smoking cigarettes and postpartum depression. The study also found that depressive symptoms were most likely to occur in mothers from historically marginalized racial or ethnic groups.

"My goal is to generate as much evidence as possible to assist policymakers in building and making a case for developing guidelines, interventions, and policies for evidence-based practice," said Haile. "Pregnant women should be educated about the adverse health outcomes associated with these products. We should be giving them advice on abstaining from them and counsel them on the detrimental health effects."

Going forward, Haile plans to continue investigating the association between non-cigarette tobacco products, such as hookahs and e-cigarettes, and maternal, infant, and child health outcomes in order to inform prenatal and postpartum health care and policy.

"We see a lot of infant mortality and disparities by race, ethnicity, and other factors, and there are many easily preventable issues that we still see a lot of people dying from here in the U.S.," said Haile. "This can be a foundation for further study to take a look into this issue with other study designs and populations and generate some evidence to help policymakers make better decisions and guidelines."