Smoking and Pregnancy: Still a Bad Idea

Tobacco use during pregnancy is associated to a plethora of harmful outcomes for infants and children, including preterm birth, low birthweight, numerous birth defects and learning and cognitive problems. In 2016, changes in CDC’s natality assessment (implemented in 2003) was the first time that the modified questions and assessment items were compiled and analyzed from all states and the District of Columbia. This new and improved report presented the prevalence of cigarette smoking at any time during pregnancy among women who gave birth in 2016 in the United States, by state of residence, as well as demographic descriptors including maternal race, age and educational attainment.

The Results

  • One in 14 women who gave birth in the United States in 2016 (7.2%) reported smoking during pregnancy
  • Compared with the nation overall, smoking during pregnancy was lower in 19 states and D.C., and higher in 31 states
  • The prevalence of smoking during pregnancy was highest in West Virginia (25.1%), followed by Kentucky (18.4%), Montana (16.5%), Vermont (15.5%), and Missouri (15.3%)
  • The prevalence of smoking during pregnancy was lowest in Arizona, California, Connecticut, Hawaii, New Jersey, New York, Nevada, Texas, Utah, and D.C.; of which, each had a prevalence of less than 5.0%
  • Non-Hispanic American Indian or Alaska Native women had the highest prevalence of smoking during pregnancy (16.7%); non-Hispanic Asian women had the lowest (0.6%)
  • The prevalence of smoking during pregnancy was highest among women with a completed high school education (12.2%), and second highest among women with less than a high school education (11.7)
  • Prevalence of smoking was highest among women aged 20–24 (10.7%), followed by women aged 15–19 (8.5%) and 25–29 (8.2%) (Figure 2)
  • The prevalence of smoking during pregnancy increased for mothers under age 15 through those aged 20–24, and then declined with increasing maternal age
  • Smoking during pregnancy was least prevalent among those aged 45 and over (2.0%) and those under age 15 (2.5%)


Why Does This Matter?Ask the Expert

It is well established that smoking is harmful to one’s health and extremely toxic to the unborn during pregnancy. Nearly everyone knows this, yet these data would lead some to feel otherwise. But when you see smoking as an addiction, you can see how addiction overrides basic survival drives, or as my friend and colleague Dr. Nora Volkow wrote, “addiction highjacks the brain”. What she means is the salience of smoking is interpreted by the reward and survival centers of the brain as “important”. So why does a competent intelligent woman inhale smoke that she knows is harmful to her and to her baby? Answer—addiction has usurped her maternal instincts and rewards her as if smoking is vitally important to her survival. Although cigarette smoking is not associated with loss of behavioral control as observed in alcohol and other drugs, the withdrawal is protracted and for most, wrought with mood swings, burst of norepinephrine, intense anxiety, agitation, mood swings and depression.

Clearly another prevention movement is needed. Yet for the millions of addicted women of child bearing age, whose smoking can be a life sentence of disability to her child – finding effective treatment is equally important, because the cost of failure for both the woman and her child is simply too high.


Drake P, Driscoll AK, Mathews TJ.. National Center for Health Statistics, Division of Vital Statistics, Reproductive Statistics Branch. NCHS Data Brief No. 3, Feb. 2018