Mothers Who Smoke While Pregnant
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The percentage of births to women who reported smoking during pregnancy dropped substantially during the 1990s, from 19.5 percent in 1989 to 10.2 percent in 2004 (preliminary estimate). (See Figure 1) However, over one-quarter of those with a low level of education (nine to eleven years of education) reported smoking during pregnancy in 2003, the most recent year for which those data are available.

Importance

Smoking during pregnancy is associated with many adverse outcomes for children, such as premature birth, low birthweight, intrauterine growth retardation, stillbirth and infant mortality, as well as negative consequences for child health and development.^1,2 Infants whose mothers smoke during pregnancy are three times more likely to die from Sudden Infant Death Syndrome as are babies whose mothers do not smoke during pregnancy.³ Children born to mothers who smoked while pregnant, and possibly children whose grandmothers smoked while pregnant, have a higher risk of developing childhood asthma.^4,5,6In addition, maternal smoking during pregnancy is a risk factor for early childhood overweight.⁷

Smoking during pregnancy may indicate that a woman is not taking a healthy approach to childbearing and, thus, may be associated with later problem behaviors for the child. For example, smoking by the mother during pregnancy has been found associated with substance abuse and criminal behavior in both male and female children when they reach adulthood.⁸

Trends

Between 1989 and 2004, the percentage of births to mothers who smoked during pregnancy decreased by about a half, from 19.5 percent to 10.2 percent (preliminary estimate for 2004). Among teen mothers ages 15 to 19, the percentage who smoked during pregnancy increased modestly between 1994 and 1999 but then declined in to a new low of 15.4 percent in 2003, the most recent year for which data are available for this group. (See Figure 1)

Differences by Race and Ethnicity

American Indian/Alaska Native women were the most likely to smoke during pregnancy, followed by non-Hispanic white women and non-Hispanic black women. In 2004, 18.2 percent of American Indian or Alaska Native births, 13.8 percent of non-Hispanic white births, and 8.4 percent of non-Hispanic black births were to women who smoked during pregnancy (based on preliminary estimates). (See Figure 2) In contrast, very few Hispanic or Asian or Pacific Islander women smoked during pregnancy. In 2004, 2.2 percent of Asian or Pacific Islander births and 2.6 percent of Hispanic births were to women who smoked during pregnancy.

There were substantial variations in smoking rates among subgroups within both the Hispanic and Asian or Pacific Islander categories. Among Hispanics, the percentage of women who smoked during pregnancy ranged from 1.1 percent for Central and South American mothers to 7.9 percent for Puerto Rican mothers in 2003, the most recent year for which estimates are available. Similarly, among Asian or Pacific Islanders, the percentages ranged from 0.5 percent for Chinese mothers to 13.7 percent for Hawaiian and part-Hawaiian mothers in 2002, the latest year in which these estimates are available. (See Table 1)

Differences by Age

Young women ages 15 to 24 were much more likely than older women to smoke during pregnancy. In 2003, the most recent year for which estimates are available, 15.4 percent of births to teens ages 15 to 19 and 16.1 percent of births to women ages 20 to 24 were to women who smoked during pregnancy, compared with less than 10 percent of births to women ages 25 and older. (See Figure 3)

Differences by Mother's Education

Among women ages 20 and older, those with a college degree were the least likely to smoke during pregnancy. In 2003, the most recent year for which estimates are available, less than two percent of births to college graduates were to women who smoked during pregnancy. In contrast, 25.5 percent of women with 9 to 11 years of education smoked during pregnancy. Women with fewer than nine years of education were also relatively unlikely to smoke (6.2 percent). (See Figure 4) In part, this is because Hispanic women, many of whom are immigrants, and who have low rates of smoking during pregnancy, account for a high percentage of women with less than nine years of education.

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Related Indicators

Low and Very Low Birthweight Infants, Late or No Prenatal Care, Parental Smoking

State and Local Estimates

2002 state estimates of the percentage of births to mothers who smoked during pregnancy are available at http://www.aecf.org/kidscount/sld/compare_results.jsp?i=45

Estimates of the percentage of births to mothers who smoked during pregnancy for 1990-2003 are available for all states and the 50 largest cities in the U.S. from The Right Start for America's Newborns: City and State Trends. http://www.aecf.org/kidscount/sld/rightstart.jsp

International Estimates

None available

National Goals

Healthy People 2010 has set a goal to increase the percent of pregnant women who do not smoke during pregnancy from 87 percent in 1998 to 99 percent by 2010.

More information is available at: http://www.health.gov/healthypeople/document/html/objectives/16-17.htm(Goal 16-17-c)

What Works: Programs and Interventions that May Influence this Indicator

Click here to view examples of programs and interventions that research has evaluated for this indicator. View programs

Research References

¹Mathews, T.J. "Smoking During Pregnancy, 1990-96," National Vital Statistics Reports, Vol 47, No. 10. Hyattsville, MD: National Center for Health Statistics, 1998. http://www.cdc.gov/nchs/data/nvsr/nvsr47/nvs47_10.pdf

²US Department of Health and Human Services. The 2004 Surgeon General's Report: The Health Consequences of Smoking. http://www.cdc.gov/tobacco/sgr/sgr_2004/consumerpiece/SGR2004_Whatitmeanstoyou.pdf

³Ibid.

⁴Jakakkola, Jouni J. K. and Gissler, Mika. (2004). "Maternal Smoking in Pregnancy, Fetal Development, and Childhood Asthma." American Journal of Public Health, 94(1):136-140.

⁵Lee, William and Galant, Stanley. (2002). "Effects of Maternal Smoking During Pregnancy and Environmental Tobacco Smoke on Asthma and Wheezing in Children." Pediatrics,110(2):445-446.

⁶LI, Y.F., Langholz, B., Salam, M.T., and Gilliland, F.T. (2005). "Maternal and grandmaternal smoking patterns are associated with early childhood asthma." Chest, 127(4):1232-41.

⁷Salsberry, Pamela J. and Reagan, Patricia B. (2005). "Dynamics of Early Childhood Overweight". Pediatrics, 116(4): 1329-1338. Abstract available at:http://pediatrics.aappublications.org/cgi/content/abstract/116/6/1329.

⁸Brennan, P.A., Grekin, E.R., Mortensen, E.L., Mednick, S.A, "Relationship of Maternal Smoking During Pregnancy with Criminal Arrest and Hospitalization for Substance Abuse in Male and Female Adult Offspring," American Journal of Psychiatry, Vol. 159, No. 1, pp. 48-54, 2002.

⁸Estimates for mothers who smoke while pregnant by maternal education only include mothers aged 20 or older.

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Definition

Women were considered to be smokers if they reported smoking at least one cigarette daily during pregnancy.

Data Source

Data for 1970-1999: Eberhardt MS, Ingram DD, Makuc DM, et al. Urban and Rural Health Chartbook. Health, United States, 2001. Hyattsville, Maryland: National Center for Health Statistics. http://www.cdc.gov/nchs/data/hus/hus01.pdf (Table 11)

Data for 2000-2001: National Center for Health Statistics. Health United States 2003 with Chartbook on Trends in the Health of Americans. Hyattsville, Maryland: 2003. Table 11. http://www.cdc.gov/nchs/data/hus/tables/2003/03hus011.pdf

Data for education of mother 2002: National Center for Health Statistics. (2005). "Health, United States, 2004 With Chartbook on Trends in the Health of Americans." Hyattsville, Maryland: Table 11. http://www.cdc.gov/nchs/data/hus/hus01.pdf

All other data for 2002: Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: Final data for 2002. National vital statistics reports; vol 52 no 10. Hyattsville, Maryland: National Center for Health Statistics. 2003. Table 31. http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_10.pdf

Data for 2003: Martin JA, Hamilton BE, Sutton PD, et al. (2005). "Births: Final data for 2003." National Vital Statistics Reports, 54(2). Hyattsville, MD: National Center for Health Statistics. Tables 24 and 30. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf

Data for education of mother 2003: National Center for Health Statistics. (2005). "Health, United States, 2005 With Chartbook on Trends in the Health of Americans." Hyattsville, Maryland: Table 12. http://www.cdc.gov/nchs/data/hus/hus05.pdf.

Preliminary data for 2004: Hamilton, BE, Martin, JA, Ventura, SJ, Sutton, PD, and Menacker, F. (2006). "Births: Preliminary Data for 2004". National Vital Statistics Reports, 54(8). Hyattsville, MD: National Center for Health Statistics. Table D. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_08.pdf.

Raw Data Source

Birth Data, National Vital Statistics System
http://www.cdc.gov/nchs/nvss.htm

Approximate Date of Next Update

Winter 2007

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