Each year smoking takes a tremendous toll on our nation's health in terms of lives lost or diminished by illness. Although the focus is often on the long-term effects of smoking, smoking can have immediate effects on the health of mothers and infants during pregnancy and at delivery.

Smoking during pregnancy increases the risk for sudden infant death syndrome (SIDS) and reduces infant birth weight by as much as 200 grams.¹ Smoking during pregnancy costs our nation over $350 million annually for neonatal care and results in additonal indirect costs due to infant lives lost.² Accurately assessing the prevalence of smoking during pregnancy and initiating efforts to further reduce it are critical public health priorities.

Tobacco use among pregnant women has declined in recent years, but there is still a long way to go to reach the Healthy People 2010 goals of reducing the prevalence of smoking to 12% among adults and to no more than 2% among pregnant women and of increasing smoking cessation during pregnancy by 30%.³ Analysis of birth certificate data presented in this databook shows that the prevalence of smoking among pregnant women has declined 35.4% nationally, from 19.5% in 1989 to 12.6% in 1999. However, national data also indicate that between 3.8% and 26.1% of pregnant women in the 50 states and the District of Columbia still smoked during pregnancy in 1999.⁴

Underlying the overall decreased national trend are some troubling patterns. First, the prevalence of smoking during pregnancy is highest among the youngest, those who become pregnant in their teenage years. In 1999, the prevalence of smoking was 18.0% among pregnant women younger than 20 years old and 9.8% among pregnant women aged 35 or older. Second, smoking among pregnant teenagers has increased recently.⁴ These girls are likely to continue to smoke for much of their adult lives: almost all adult tobacco users begin smoking during adolescence.5 Reducing the use of tobacco among our nation's youngest mothers is an important public health priority.

The national picture also shows that smoking during pregnancy is strongly related to the educational and racial/ethnic background of the mother. Although 5.1% of pregnant women with more than a high school education smoke during pregnancy, four times as many (20.9%) of those with less than a high school education smoke during pregnancy. In general, smoking during pregnancy is highest among white and American Indian/Alaska Native women and lowest among Hispanic and Asian or Pacific Islander women. White women with less than a high school education have the highest rates of smoking during pregnancy.

A lot of new activity is focused on reducing tobacco use among pregnant women. Researchers are attempting to find more effective smoking cessation programs to reduce the prevalence of smoking among pregnant women. Public and private organizations, including the Centers for Disease Control and Prevention (CDC), the Robert Wood Johnson Foundation's Smoke-Free Families program, the American College of Obstetricians and Gynecologists, the Health Resources and Services Administration, the Association of Maternal and Child Health Programs, the American Association of Health Plans, and the Agency for Healthcare Research and Quality, are disseminating clinical guidelines and best practice interventions to help pregnant women quit smoking. Nationally, the tobacco settlement funds provide a source of revenue that could be used to promote media and other campaigns to discourage tobacco use among pregnant women. Together with existing maternal and child health state programs, these efforts can bring us closer to our goals.

One of CDC's main responsibilities in the area of tobacco use is to educate the American public about the health hazards of using tobacco. Although earlier CDC reports have presented data on smoking prevalence^4,6 and overall smoking-attributable health outcomes,⁷ they have not included data on the prevalence and health effects of smoking among pregnant women. The purpose of this publication is to fill this gap by providing national and state data on the prevalence of smoking during pregnancy, its effects on infant health and health care costs, and states' efforts to reduce smoking among pregnant women. This databook provides the following information for each state:

• Prevalence of smoking during pregnancy by the mother's race/ethnicity, age, and education and her child's birth weight.
• Smoking-attributable infant deaths due to sudden infant death syndrome (SIDS).
• Neonatal illness and health care costs attributable to smoking.
• Summary birth statistics.
• Medicaid programs for pregnant women.
• Regulation of day care centers.
• Federal/state grant programs to reduce smoking-related adverse outcomes during pregnancy.
• State cigarette tax and regulatory policies.
• Maternal and Child Health smoking cessation programs.

Although the public health community often describes the consequences of tobacco use in terms of the chronic conditions that it causes, this data-book provides an opportunity to analyze the effects of tobacco use on pregnancy and delivery. It also brings the issue to the state level by presenting a two-page summary of data for each state. As such, this databook serves as a companion to Investment in Tobacco Control: State Highlights, published by CDC's Office on Smoking and Health. State data, although not always available for all states, are comparable within each topic area.

State policy makers often request information on how their state data compare with national data or with data from other states. The state-specific data presented here have been collected and analyzed in a consistent manner. State data on smoking prevalence are also aggregated to provide a picture at the national level. Together, these data provide states with new or updated information and allow national and state comparisons to be made.

Providing these data on a state-by-state basis should help states better define the prenatal smoking issue at the state level. Because a large proportion of each state's births are financed by state Medicaid programs, finding ways to better manage the health of mothers and infants is a major state issue. This information can be used to encourage mothers, providers, and policy makers to join together to improve the nation's health by reducing tobacco use among pregnant women.

The data in this hard copy edition vary by year across topic areas but are largely for 1999. This report, as well as future updates, will be made available on CDC's Division of Reproductive Health's Web site: http://www.cdc.gov/nccdphp/drh. Future updates of the text and data will be available only on the Web.

Date last reviewed: 03/29/2006
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion