Tobacco Use and Pregnancy: CDC Activities

What Is CDC Doing To Eliminate Tobacco Use and Exposure During the Reproductive Years?

CDC strives to help women around the world to be tobacco-free before, during, and after pregnancy to improve reproductive and overall health outcomes through—

• Evaluating and promoting evidence-based interventions for prevention and cessation of tobacco use among women.
• Analyzing and disseminating population-based surveillance and survey data.
• Conducting and synthesizing epidemiologic studies on health effects of combustible and smokeless tobacco on reproductive and infant health.
• Serving as subject matter experts and providing technical assistance to public health organizations.
• Promoting collaboration with internal and external partners.

The CDC's Division of Reproductive Health (DRH), Office on Smoking and Health (OSH), National Center for Birth Defects and Developmental Disabilities, and National Center for Environmental Health collaborate on projects to address this public health problem.

The following are some of CDC’s highlights:

Pregnancy Risk Assessment and Monitoring System

The Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of the CDC and state health departments. PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. Currently, PRAMS is conducted in 37 states and New York City and covers 75% of all U.S. live births. The PRAMS questionnaire collects information on smoking before, during, and after pregnancy, as part of the core questionnaire that is used by all states. States may also add optional questions to their surveys, and these questions cover tobacco-related topics such as use of smokeless tobacco, receipt of prenatal care provider advice about quitting smoking, use of interventions to quit smoking, and smoking rules used in the home. For more topic information see the PRAMS questionnaire.

Smoking Cessation for Pregnancy and Beyond: A Virtual Clinic
This is an interactive Web-based program designed for health care professionals to hone their skills in assisting pregnant women to quit smoking. Up to 4 hours of continuing education credits can be earned by completing the practicum that was developed by the Interactive Media Laboratory, Dartmouth Medical School in collaboration with the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention. The cost is $25.00 per user.  

Evaluation of State Tobacco Quitlines To Help Pregnant and Postpartum Smokers Quit

Telephone-based counseling using tobacco quitlines has proven to be an effective method for delivering cessation counseling among the general adult population. Because quitlines are now available in all 50 states, quitlines have the potential of reaching diverse populations. In FY 2009, CDC's Division of Reproductive Health (DRH) and CDC's Office on Smoking and Heath (OSH) co-funded three states to evaluate the referral patterns and use of quitlines among pregnant women and their health care providers. The evaluation results may improve promotion of and referrals to quitlines among pregnant and postpartum smokers.

Health and Economic Consequences of Prenatal Smoking

The health effects of prenatal smoking on the mother and infant are well known. Maternal and Child Health SAMMEC (Smoking Attributable Mortality, Morbidity, and Economic Costs) can be used to estimate the disease impact of smoking among pregnant women in the United States, individual states, and other large populations. The disease impact of smoking refers to the health and health-related economic consequences of smoking, including smoking-attributable infant deaths, and excess health care expenditures. These measures help public health researchers and policy makers quantify the adverse effects of cigarette smoking. CDC updated the smoking attributable costs based on 2001/2002 Pregnancy Risk Assessment Monitoring System (PRAMS) data and 2003 state birth certificates using 2004 costs.

Smokeless Tobacco

Smokeless tobacco use is common among women in some parts of Alaska. In collaboration with the local medical center, CDC is studying the effects of maternal smokeless tobacco use on pregnancy outcomes in Alaska Native women.

Tobacco Eexposure During Pregnancy in Low and Middle Income Countries

In many countries, particularly low and middle income countries, the burden from tobacco is growing, and little is known about pregnant women's use of cigarettes and non-cigarette tobacco products, and prevalence of exposure to environmental tobacco smoke (ETS). CDC's Division of Reproductive Health (DRH), in collaboration with the Global Network for Perinatal and Reproductive Health (GNPRH) and the Tobacco Control Research Branch of the U.S. National Cancer Institute, convened an expert meeting to develop a research agenda focused on helping reduce tobacco use and environmental tobacco exposure by pregnant women around the world. A special journal issue was developed and includes an invited guest editorial, commentaries, review papers, and manuscripts submitted to an international call for papers. 

Prenatal Smoking Cessation in Argentina and Uruguay

CDC is funding a 4-year project to evaluate the adaptation and implementation of a brief smoking cessation counseling intervention (5A’s) with nurse midwives and system reminders (e.g., chart stickers, vital sign stamps, medical record flow sheets, and checklists) in prenatal clinics in Buenos Aires, Argentina, and Montevideo, Uruguay. Prenatal smoking rates in these countries are among the highest in the world, 15% and 20%, respectively; however, pregnancy-specific smoking cessation interventions are not systematically integrated into prenatal clinics.  The project objectives are to increase the frequency of women receiving the 5 A’s, decrease the frequency of women who smoke at the end of pregnancy, and increase the frequency of positive attitudes and readiness to provide smoking cessation counseling. Research is being led by Tulane University in collaboration with the Institute for Clinical Effectiveness and Health Policy and Montevideo Clinical and Epidemiological Research Unit. 

WHO Guidelines for the Treatment of Tobacco, Alcohol, and Illicit Drug Dependence

World Health Organization (WHO) in collaboration with CDC and other agencies will develop clinical guidelines for treating tobacco, alcohol, and illicit drug dependence during pregnancy. The process will include conducting systematic reviews, meta-analyses, and consultation with a technical panel. These WHO guidelines will provide support to member states for the treating substance abuse during pregnancy.

National Tobacco Control Program

CDC’s Office on Smoking and Health (OSH) created the National Tobacco Control Program (NCTP) in 1999 to encourage coordinated, national efforts to reduce tobacco-related diseases and deaths. The program provides funding and technical support to state and territorial health departments. All 50 states and the District of Columbia, eight U.S. territories or jurisdictions, six national networks, and eight tribal support centers.