About one in 14 U.S. women who gave birth in 2016 smoked cigarettes during their pregnancies, according to a report by CDC's National Center for Health Statistics (NCHS) released Wednesday.
According to NCHS, researchers have linked tobacco use during pregnancy to several adverse infant and child outcomes, such as low birthweight, preterm birth, and other birth defects.
For the report, researchers reviewed 2016 data from the National Vital Statistics System's natality data file. The report is the first to present new national data on maternal smoking before and during pregnancy since the U.S. Standard Certificate of Live Birth was revised in 2003 to ask for the number of cigarettes or packs of cigarettes women smoked during the three months before pregnancy and during each trimester of pregnancy.
Overall, the researchers found 7.2% of U.S. women who gave birth in 2016 smoked during their pregnancies. According to the researchers, the prevalence of smoking during pregnancy varied significantly across age groups, educational attainment, race and Hispanic origin, and states.
Variations by age
For instance, the researchers found that the prevalence of smoking among pregnant women was the highest among those ages 20 to 24, at 10.7%, and the lowest among those ages 45 and over, at 2%.
The researchers also found the prevalence of smoking among pregnant teens was high among those ages 15 to 19, at 8.5%, but was low among those under age 15, at 2.5%.
Variations by educational attainment
The researchers also found that smoking levels varied among pregnant women depending on their levels of education. For instance, the researchers found the prevalence of smoking during pregnancy was highest among women with a high school diploma or GED at 12.2%, followed by women with:
- Less than a high school diploma at 11.7%;
- Some college or an associate's degree at 7.9%; and
- A bachelor's degree or higher, at less than 1%.
Variations by race and Hispanic origin
In terms of race and Hispanic origin, the researchers found the prevalence of smoking during pregnancy ranged from 0.6% among non-Hispanic Asian women to 16.7% among non-Hispanic American Indian or Alaska Native (AIAN) women. The researchers found non-Hispanic AIAN women were 1.6 times more likely to smoke during pregnancy when compared with non-Hispanic white women, who had the second-highest smoking prevalence rate at 10.5%.
According to the report, pregnant non-Hispanic black women had a smoking prevalence of 6%, and pregnant Hispanic women had a smoking prevalence of 1.8%.
Variations by state
According to the report, rates of smoking during pregnancy were lower in 19 states and the District of Columbia when compared with the national average, and higher in 31 states when compared with the national average.
Specifically, the researchers found nine states and the District of Columbia had a prevalence of smoking during pregnancy lower than 5%:
- New Jersey;
- New York;
- Texas; and
The researchers found the prevalence of smoking during pregnancy was the highest in West Virginia, at 25.1%. According to the report, other states with comparatively high rates of smoking during pregnancy included:
- Kentucky, at 18.4%;
- Missouri, at 15.3%;
- Montana, at 16.5%; and
- Vermont, at 15.5%.
Patrick Drake, a senior author on the report and a demographer at NCHS, said, "Despite the well-understood risk to mother and child, still, about one of every 14 women in the United States smoked during pregnancy." He continued, "These levels do vary widely by state, maternal age, race and Hispanic origin, and education, but any amount of smoking during pregnancy is too much."
Robyn Horsager-Boehrer, professor and chief of obstetrics and gynecology at the University of Texas Southwestern's William P. Clements Jr. University Hospital, said the prevalence of smoking during pregnancy could be underreported, because women might be less inclined to admit they smoked while they were pregnant.
Haywood Brown, professor of obstetrics and gynecology at Duke University School of Medicine, said, "We still need very aggressive education campaigns in high-smoking-prevalence states, particularly in where there's rural access-to-care issues." Brown added, "We still have a serious issue with infant mortality—prematurity and infant mortality are clearly linked to cigarette smoking, as is low birth weight—and when you begin to explain these things to patients, it really does appear to make a difference to them" (May, USA Today, 2/28; Howard, CNN, 2/28; Pirani, Atlanta Journal-Constitution, 3/1; NCHS Data Brief, February 2018).
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