Trends in smoking before, during, and after pregnancy - Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 sites, 2000-2005

Van T Tong, Jaime R Jones, Patricia M Dietz, Denise D'Angelo, Jennifer M Bombard
MMWR Surveillance Summaries 2009 May 29, 58 (4): 1-29

PROBLEM: Smoking among nonpregnant women contributes to reduced fertility, and smoking during pregnancy is associated with delivery of preterm infants, low infant birthweight, and increased infant mortality. After delivery, exposure to secondhand smoke can increase an infant's risk for respiratory tract infections and for dying of sudden infant death syndrome. During 2000-2004, an estimated 174,000 women in the United States died annually from smoking-attributable causes, and an estimated 776 infants died annually from causes attributed to maternal smoking during pregnancy.


DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) was initiated in 1987 and is an ongoing state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants in the United States. Self-reported questionnaire data are linked to selected birth certificate data and are weighted to represent all women delivering live infants in the state. Self-reported smoking data were obtained from the PRAMS questionnaire and birth certificates. This report provides data on trends (aggregated and site-specific estimates) of smoking before, during, and after pregnancy and describes characteristics of female smokers during these periods.

RESULTS: For the study period 2000-2005, data from 31 PRAMS sites (Alabama, Alaska, Arkansas, Colorado, Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, New York, New York City, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Washington, and West Virginia) were included in this report. All 31 sites have met the Healthy People 2010 (HP 2010) objective of increasing the percentage of pregnant smokers who stop smoking during pregnancy to 30%; site-specific quit rates in 2005 ranged from 30.2% to 61.0%. However, none of the sites achieved the HP 2010 objective of reducing the prevalence of prenatal smoking to 1%; site-specific prevalence of smoking during pregnancy in 2005 ranged from 5.2% to 35.7%. During 2000--2005, two sites (New Mexico and Utah) experienced decreasing rates for smoking before, during, and after pregnancy, and two sites (Illinois and New Jersey) experienced decreasing rates during pregnancy only. Three sites (Louisiana, Ohio, and West Virginia) had increases in the rates for smoking before, during, and after pregnancy, and Arkansas had increases in rates before pregnancy only. For the majority of sites, smoking rates did not change over time before, during, or after pregnancy. For 16 sites (Alaska, Arkansas, Colorado, Florida, Hawaii, Illinois, Maine, Nebraska, New Mexico, New York [excluding New York City], North Carolina, Oklahoma, South Carolina, Utah, Washington, and West Virginia) for which data were available for the entire 6-year study period, the prevalence of smoking before pregnancy remained unchanged, with approximately one in five women (from 22.3% in 2000 to 21.5% in 2005) reporting smoking before pregnancy. The prevalence of smoking during pregnancy declined (p = 0.01) from 15.2% in 2000 to 13.8% in 2005, and the prevalence of smoking after delivery declined (p = 0.04) from 18.1% in 2000 to 16.4% in 2005.

INTERPRETATION: The results indicate that efforts to reduce smoking prevalence among female smokers before pregnancy have not been effective; however, efforts targeting pregnant women have met some success as rates have declined during pregnancy and after delivery. Current tobacco-control efforts and smoking-cessation efforts targeting pregnant women are not sufficient to reach the HP 2010 objective of reducing prevalence of smoking during pregnancy.

PUBLIC HEALTH ACTION: The data provided in this report are important for developing, monitoring, and evaluating state tobacco-control policies and programs to reduce smoking among female and pregnant smokers. States can reduce smoking before, during, and after pregnancy through sustained and comprehensive tobacco-control efforts (e.g., smoke-free policies and tobacco excise taxes). Health-care providers should increase efforts to assess the smoking status of their patients and offer effective smoking-cessation interventions to every female or pregnant smoker to whom they provide health-care services.

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