Pregnancy and Smoking

What's the Problem?

Women who smoke while pregnant may have premature and/or low birth-weight infants, pregnancy complications, or stillbirth. Moreover, infant mortality is higher among mothers who smoke during pregnancy.

A pregnant woman who smokes puts a baby at risk for Sudden Infant Death Syndrome (SIDS), poor lung development, asthma, and respiratory infections.

Who's at Risk?

About 12% of women reported smoking during pregnancy in 2000. Although smoking during pregnancy dropped 3 percent from 1999 and 37 percent from 1989, for women of all ages, smoking rates are highest for older teenagers 18 to 19 years, and followed by women 20 to 24 years. With their failure to gain adequate weight during pregnancy and their lower rates of prenatal care, pregnant teens who smoke face real hazards that can lead to immediate adverse effects and lifelong implications for themselves and their unborn children.

Smoking during pregnancy is highest among American Indian, non-Hispanic Caucasian, and Hawaiian mothers. Smoking rates are relatively low for 18 to 19 year old Mexican mothers (3.2%), while 31 percent of non-Hispanic Caucasian teens, aged 18 to 19, smoke during pregnancy—the highest rate of any group.

Can It Be Prevented?

Yes, but many factors prevent women from quitting at this important time in their lives. For some women, it's information overload. They hear and must respond to so many health messages during their pregnancy – diet, alcohol use, appropriate weight gain – that smoking is just one more thing on a list. Also, once smoking begins in the teen years, quitting is hard. Most teens expect not to be smoking in the future, but the drug effects of nicotine make quitting difficult. Over 80% have tried to quit and failed.

Teens are heavily influenced by their friends and role models to start smoking, but family has a major influence, too. Pervasive and targeted cigarette advertising and promotion also influence initiation.

The Bottom Line

• Smoking during pregnancy is a serious public health problem for both a mother and her unborn child, particularly when other risky health behaviors are also present.
• Teens are especially vulnerable because smoking rates are highest for this group and the possibility of unplanned pregnancy may be great.
• A woman receives so much healthcare information when she is pregnant that it's important for her physician to make sure that she is not overwhelmed by it.

Case Example

A 17-year-old teen is smoking at the mall with her friends. She says she might be pregnant and is worried about her parents' reactions. The next day, she confides in a school nurse who urges her to tell her parents and start prenatal care. The nurse gives her advice on health and diet, telling her to eat more fruits and vegetables and to think about how harmful smoking is to her baby. She follows this advice and sees a doctor, but doesn't stop smoking because it calms her and she thinks it helps control her weight. The doctor urges her to stop.

After many discussions with friends and failed attempts to quit, she does succeed in cutting back some. The pregnancy progresses well, but the baby is born early with low birth weight. The mother goes home after several days and the frail infant stays in the hospital, struggling for several weeks in intensive care. Mom visits every day for hours on end and hates that she is unable to care for her child and take it home with her when she leaves each night. Finally, the baby stabilizes and gains enough weight to be discharged. The teen mom decides to stop smoking and never take a chance on her own health or her baby's health again. Her family rallies around to help with the new baby and its recovery.