Data Highlights | References | Tables

Background

Pregnant women can enhance birth outcomes and infant health by engaging in healthy behaviors and avoiding risky ones around the time of pregnancy. About 84% of pregnant women initiate prenatal care in their first trimester,¹ placing prenatal care providers in a unique position to screen for risky behaviors and to promote healthy ones early in pregnancy. The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that providers screen all women at the first prenatal care visit for smoking and counsel all smokers about the impact of smoking during pregnancy.² Further, national Healthy People 2010 objectives have been set to reduce the prevalence of smoking during pregnancy from 13% (1998) to 1% (Objective 16 –17c), and to increase smoking cessation during the first trimester from 14% (1998) to 30% (Objective 27–6).³

Smoking is the most important known preventable risk factor for low birthweight and small size for gestational age, both of which are leading contributors of fetal and neonatal deaths.^4–8 The incidence of low birthweight among mothers who smoke is estimated to be about double that for non-smokers.⁵ Cigarette smoking during pregnancy is also associated with premature rupture of membranes, abruption placentae, placenta previa, and preterm delivery.^9–11

Studies have shown that counseling has a positive effect on rates of smoking cessation.^12–15 The National Partnership to Help Pregnant Smokers Quit, a collaboration among more than 50 public and private organizations and agencies, has been formed to provide proven clinical and community-based interventions to every pregnant smoker.¹⁶

Despite the documented risks and the national campaign to stop smoking, during 2003 an estimated 11% of mothers in the United States continued to smoke during pregnancy.¹⁷ However, this rate has steadily declined from 19.5% in 1989. Although a high proportion of health care providers reported advising their pregnant smokers to quit, full implementation of the recommendations and interventions is not widespread among professionals providing prenatal care.¹⁸ Furthermore, racial disparities have been found among pregnant women who received prenatal care advice on smoking from health care providers.¹⁹ White women were more likely than African American women to receive advice from their health care provider. In addition, women who were younger or less educated received more advice than older or more educated women did, and women who obtained prenatal care at hospital clinics and other sites were more likely to receive advice than those obtaining prenatal care in private physician offices.

PRAMS collects data from women on whether any health care provider or worker talked to them about the effects of smoking during pregnancy on the baby during a prenatal care visit. States and professional organizations can use these data to monitor counseling practices and to improve the quality of prenatal care counseling on maternal smoking during pregnancy.

Data Highlights

• In 2002, the proportion of women who reported that their prenatal care counseling included a discussion of the effects of smoking during pregnancy ranged from 49.5% (Utah) to 79.4% (South Carolina).

References

1. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. National Vital Statistics Reports 2003;52(10):1–113.
   
   
2. American Academy of Pediatrics (AAP) Committee on the Fetus and Newborn and American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. Guidelines for Perinatal Care. Elk Grove Village, IL and Washington, DC: AAP and ACOG; 2002.
   
   
3. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd Edition. Washington, DC: U.S. Government Printing Office; 2000.
   
   
4. Salihu HM, Aliyu MH, Pierre-Louis BJ, Alexander GR. Levels of excess infant deaths attributable to maternal smoking during pregnancy in the United States. Maternal and Child Health Journal 2003;7(4):219–227.
   
   
5. Ventura SJ, Hamilton BE, Mathews TJ, Chandra A. Trends and variations in smoking during pregnancy and low birth weight: evidence from the birth certificate, 1990–2000. Pediatrics 2003;111(5 Pt 2):1176–1180.
   
   
6. Visscher WA, Feder M, Burns AM, Brady TM, Bray RM. The impact of smoking and other substance use by urban women on the birthweight of their infants. Substance Use and Misuse 2003;38(8):1063–1093.
   
   
7. Mitchell EA, Thompson JM, Robinson E, Wild CJ, Becroft DM, Clark PM, et al. Smoking, nicotine and tar and risk of small for gestational age babies. Acta Paediatrica 2002;91(3):323–328.
   
   
8. Chomitz VR, Cheung LW, Lieberman E. The role of lifestyle in preventing low birth weight. Future Child 1995;5(1):121–138.
   
   
9. Castles A, Adams EK, Melvin CL, Kelsch C, Boulton ML. Effects of smoking during pregnancy. Five meta-analyses. American Journal of Preventive Medicine 1999;16(3):208–215.
   
   
10. Shah NR, Bracken MB. A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery. American Journal of Obstetrics and Gynecology 2000;182(2):465–472.
    
    
11. Andres RL, Day MC. Perinatal complications associated with maternal tobacco use. Seminars in Neonatology 2000;5(3):231–241.
    
    
12. Dolan-Mullen P, Ramirez G, Groff JY. A meta-analysis of randomized trials of prenatal smoking cessation interventions. American Journal of Obstetrics and Gynecology 1994;171(5):1328–1334.
    
    
13. Melvin CL, Dolan-Mullen P, Windsor RA, Whiteside HP Jr, Goldenberg RL. Recommended cessation counselling for pregnant women who smoke: a review of the evidence. Tobacco Control 2000;9(Supplement 3):III80–84.
    
    
14. Windsor RA, Woodby LL, Miller TM, Hardin JM, Crawford MA, DiClemente CC. Effectiveness of Agency for Health Care Policy and Research clinical practice guideline and patient education methods for pregnant smokers in Medicaid maternity care. American Journal of Obstetrics and Gynecology. 2000;182(1 Pt 1):68–75.
    
    
15. Albrecht SA, Maloni JA, Thomas KK, Jones R, Halleran J, Osborne J. Smoking cessation counseling for pregnant women who smoke: scientific basis for practice for AWHONN's SUCCESS project. Journal of Obstetric, Gynecologic, and Neonatal Nursing 2004;33(3):298–305.
    
    
16. Orleans T, Melvin C, Marx J, Maibach E, Vose KK. National action plan to reduce smoking during pregnancy: the National Partnership to Help Pregnant Smokers Quit. Nicotine and Tobacco Research 2004;6(Supplement 2):S269–S277.
    
    
17. Hamilton BE, Martin JA, Sutton PD. Births: preliminary data for 2003. National Vital Statistics Reports 2004;53(9):1–17.
    
    
18. Chapin J, Root W. Improving obstetrician-gynecologist implementation of smoking cessation guidelines for pregnant women: an interim report of the American College of Obstetricians and Gynecologists. Nicotine and Tobacco Research 2004;6(Supplement 2):S253–S257.
    
    
19. Kogan MD, Kotelchuck M, Alexander GR, Johnson WE. Racial disparities in reported prenatal care advice from health care providers. American Journal of Public Health 1994;84(1):82–88.

 

Prevalence of Prenatal Care Discussion of Effects of Smoking During Pregnancy, 2002

State	Respondents	Percent†	Standard Error	95% CI‡
Alabama	1,508	73.5	1.4	70.7–76.2
Alaska	1,587	76.3	1.3	73.7–78.6
Arkansas	1,904	70.3	1.5	67.3–73.0
Colorado	2,230	68.0	1.3	65.4–70.5
Florida	1,972	70.5	1.6	67.3–73.5
Hawaii	1,771	74.1	1.3	71.5–76.5
Illinois	1,891	74.4	1.1	72.3–76.5
Louisiana	1,641	77.3	1.1	74.9–79.4
Maine	1,123	78.0	1.4	75.1–80.6
Maryland	1,437	68.0	1.8	64.3–71.4
Michigan	1,522	72.4	1.3	69.8–74.9
Minnesotaa	1,107	73.6	1.7	70.2–76.7
Montana	1,024	70.8	1.5	67.8–73.5
Nebraska	1,839	72.9	1.3	70.4–75.3
New Jerseyb	910	63.2	1.9	59.5–66.8
New Mexico	1,510	74.3	1.2	71.9–76.5
New Yorkc	1,182	67.1	1.7	63.6–70.4
North Carolina	1,508	75.6	1.4	72.8–78.2
North Dakota	890	67.7	1.5	64.7–70.7
Ohio	1,352	69.1	1.6	65.8–72.2
Oklahoma	1,816	73.1	1.6	69.8–76.1
Rhode Island	1,376	70.9	1.4	68.0–73.6
South Carolina	1,343	79.4	1.7	75.8–82.6
Utah	1,535	49.5	1.6	46.2–52.7
Vermont	1,085	74.8	1.3	72.2–77.3
Washington	1,490	69.7	1.7	66.2–73.0
West Virginia	1,655	75.9	1.5	72.9–78.8
All PRAMS states§	40,208	71.0	0.4	70.3–71.8
† 2002 state range is 49.5–79.4%. ‡ Confidence interval. § Aggregate of the 27 PRAMS states. a Data represent Minnesota births from May–December 2002. b Data represent New Jersey births from July–December 2002. c Data exclude New York City.

 

Prevalence of Prenatal Care Discussion of Effects of Smoking During Pregnancy, 2002

 

Prevalence of Prenatal Care Discussion of Effects of Smoking During Pregnancy, 2000–2002

State	2000 (%)	2001 (%)	2002 (%)	P value for trend#
Alabama	75.1	74.0	73.5	0.413
Alaska	75.6	73.8	76.3	0.714
Arkansas	69.6	68.2	70.3	0.782
Colorado	69.1	70.5	68.0	0.547
Florida	68.5	72.4	70.5	0.380
Hawaii	72.8	73.3	74.1	0.434
Illinois	76.0	74.9	74.4	0.300
Louisiana	75.7	77.5	77.3	0.327
Maine	77.7	77.1	78.0	0.907
Maryland	—	69.2d	68.0	# #
Michigan	—	74.2e	72.4	# #
Minnesota	—	—	73.6a	# #
Montana	—	—	70.8	# #
Nebraska	70.1	70.1	72.9	0.113
New Jersey	—	—	63.2b	# #
New Mexico	71.7	71.8	74.3	0.122
New Yorkc	70.0	70.9	67.1	0.218
North Carolina	78.7	76.5	75.6	0.094
North Dakota	—	—	67.7	# #
Ohio	68.7	70.4	69.1	0.850
Oklahoma	74.0	73.7	73.1	0.705
Rhode Island	—	—	70.9	# #
South Carolina	76.8	78.1	79.4	0.280
Utah	50.0	51.2	49.5	0.799
Vermont	—f	72.1f	74.8	# #
Washington	70.4	71.8	69.7	0.771
West Virginia	76.2	77.9	75.9	0.914
# Based on a test for linear trend using logistic regression. # # < 3 years of data available; test for linear trend not applicable. a Data represent Minnesota births from May–December 2002. b Data represent New Jersey births from July–December 2002. c Data exclude New York City. d Data represent Maryland births from February–December 2001. e Data represent Michigan births from July–December 2001. f Data represent Vermont births from October 2000–December 2001.