A CDC report shows only modest decreases in smoking during and after pregnancy during a 10-year period, despite evidence linking smoking to higher risk of complications and infant death.
In 2002, 5%-8% of preterm deliveries, 13%-19% of term infants with growth restriction, 5%-7% of preterm-related deaths and 23%-34% of deaths from SIDS could be attributed to prenatal smoking in the U.S., according to a study published in 2010. Three Healthy People 2020 objectives call for reducing the prevalence of smoking to 14% before pregnancy and 1.4% during pregnancy, while increasing the percentage of expectant mothers who quit smoking during pregnancy to 30%.
To measure progress toward these goals, the CDC examined data from the Pregnancy Risk Assessment Monitoring System questionnaire from 2000-10. PRAMS is an ongoing collaboration between the CDC and health departments in 40 states. Data from the 27 PRAMS sites with data from 2010 represents about 52% of live births nationwide.
A past report showed smoking before pregnancy was unchanged from 2000-05 and smoking during and after pregnancy decreased slightly. The CDCs new findings appear in the Nov. 8 Morbidity and Mortality Weekly Report.
The analysis found moderate but significant decreases in the prevalence of women smoking while pregnant (from 13.3% to 12.3%) and after delivery (from 18.6% to 17.2%) in a subgroup of 10 PRAMS sites (Alaska, Arkansas, Colorado, Hawaii, Maine, Nebraska, Oklahoma, Utah, Washington and West Virginia) during 2000-10.
However, the prevalence of smoking before pregnancy was unchanged, with approximately one in five women smoking during 2000-10. For that time period, the prevalence of smoking before, during and after pregnancy decreased at three sites (Minnesota, New York and Utah). Eight sites (Colorado, Illinois, New Jersey, New Mexico, New York City, Washington, Wisconsin and Wyoming), recorded a decrease in prevalence of one or two of the measures (before, during or after pregnancy).
However, none of the PRAMS sites in 2010 reached the Healthy People 2020 goal of reducing prenatal smoking prevalence to 1.4%. According to the CDC report, if the prevalence of smoking during pregnancy continues to decrease at the current pace an estimated tenth of a percentage point per year it could take 100 years for the U.S. to reach that goal.
Researchers also found only two sites (New York City and Utah) met the Healthy People 2020 goal of reducing smoking prevalence before pregnancy to 14%. Most of the PRAMS sites did not show a change over time for any of the three measures, and three sites (Louisiana, Mississippi and West Virginia) showed an increase in smoking prevalence before, during and after pregnancy. In Oklahoma, smoking increased before pregnancy, according to the report, and in Maine smoking prevalence increased during and after pregnancy. All of the 27 PRAMS sites with 2010 data available met the goal of increasing smoking cessation during pregnancy to 30%, according to the report.
In the conclusion, the CDC researchers call for instituting comprehensive tobacco-control plans such as awareness campaigns, price increases and 100% smoke-free policies to further reduce smoking among pregnant women.
The report suggests strong state tobacco-control policies help greatly reduce smoking prevalence before, during and after pregnancy. Of the five PRAMS states showing increases in smoking before, during and after pregnancy, three had cigarette excise taxes that were less than $1 per pack and three had no state smoke-free policy. Of the 11 sites with reductions in smoking, 10 had a state smoke-free policy and nine sites had taxes ranging from $1.23 to $4.35 per pack.
Although tobacco-control policies are likely to have the most public health impact in reducing smoking prevalence, continued efforts are needed to develop more effective clinical interventions and to deliver these interventions to female smokers who need help quitting, researchers wrote. The current best practice for prenatal smoking cessation entails psychosocial counseling delivered in the prenatal care setting.
The report also notes promising studies of interventions in which quitting is reinforced with financial incentives, with a quit rate of as much as 34% in the intervention group (compared with 7.1% in the standard-of-care group) and infant birth weight improvements.
Reducing costs for treatments has also been effective for increasing the number of people who quit smoking. Starting in 2014, the Affordable Care Act mandates tobacco-use screening and cessation interventions must be covered without cost sharing for beneficiaries in the Medicaid expansion population. The law also requires states to cover tobacco-cessation drugs for traditional Medicaid enrollees.