NCHS Data Brief ■ No. 305 ■ February 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Cigarette Smoking During Pregnancy: United States, 2016

Patrick Drake, M.S., Anne K. Driscoll, Ph.D., and T.J. Mathews, M.S.

Key findings 

Data from the National 

Vital Statistics System

● In 2016, 7.2% of women

who gave birth smoked

cigarettes during pregnancy.

● Prevalence of smoking

during pregnancy was highest

for women aged 20–24

(10.7%), followed by women

aged 15–19 (8.5%) and 25–29

(8.2%).

● 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 secondhighest among women with less

than a high school education

(11.7%).

Maternal tobacco use during pregnancy has been linked to a host of negative 

infant and child outcomes, including low birthweight, preterm birth, and 

various birth defects (1–5). The 2003 revision of the U.S. Standard Certificate 

of Live Birth included new and modified items on maternal cigarette smoking 

before and during pregnancy. The 2016 natality data file is the first for which 

this information is available for all states and the District of Columbia (D.C.). 

This report presents 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 maternal race and Hispanic origin, age, and educational 

attainment.

Keywords: prenatal • tobacco • National Vital Statistics System (NVSS)

Prevalence of cigarette smoking during pregnancy varied by 

state.

 

 

 

 

 

Figure 1. Prevalence of maternal smoking at any time during pregnancy, by state:

United States, 2016

NOTE: Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db305_table.pdf#1.

SOURCE: NCHS National Vital Statistics System, Natality.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 305 ■ February 2018

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● One in 14 women who gave birth in the United States in 2016 (7.2%) reported smoking 

during pregnancy (Figure 1). 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.; each had a 

prevalence of less than 5.0%.

Women aged 20–24 were most likely to smoke cigarettes during pregnancy.

● 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%). 

 

Figure 2. Prevalence of maternal smoking at any time during pregnancy, by age of mother: United States, 2016

1

Significant differences among all age groups except between women under age 15 and women aged 45 and over (p < 0.05). 2

Significant decreasing trend from women aged 20–24 to women aged 45 and over (p < 0.05).

NOTE: Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db305_table.pdf#2.

SOURCE: NCHS, National Vital Statistics System, Natality.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 305 ■ February 2018

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Hispanic and non-Hispanic Asian women were least likely to smoke 

tobacco during pregnancy.

● By race and Hispanic origin, the prevalence of smoking during pregnancy ranged from less 

than 1% among non-Hispanic Asian women (0.6%) to 16.7% of non-Hispanic American 

Indian or Alaska Native (AIAN) women (Figure 3). 

● Non-Hispanic AIAN women were 1.6 times as likely to smoke during pregnancy as

non-Hispanic white women (10.5%), the group with the second-highest rate.

● Among the three largest race and Hispanic-origin groups, non-Hispanic white women had 

the highest prevalence of smoking during pregnancy, followed by non-Hispanic black 

women (6.0%) and Hispanic women (1.8%). 

 

Figure 3. Prevalence of maternal smoking at any time during pregnancy, by race and Hispanic origin of mother:

United States, 2016

1

Significant differences among all race and Hispanic-origin groups (p < 0.05).

NOTE: Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db305_table.pdf#3.

SOURCE: NCHS, National Vital Statistics System, Natality.

 
NCHS Data Brief ■ No. 305 ■ February 2018

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Smoking during pregnancy was least prevalent among women with a 

master’s degree or higher.

● Prevalence of smoking during pregnancy was highest for women with a high school 

diploma or GED (12.2%), followed by women with less than a high school diploma (11.7%) 

and women with some college or an associate’s degree (7.9%) (Figure 4). 

● The prevalence of smoking decreased with increasing education among women with a 

completed high school education or higher.

● Women with a bachelor’s degree or higher had a prevalence of smoking during pregnancy 

of 1.0% or less.

 

Figure 4. Prevalence of maternal smoking at any time during pregnancy, by educational attainment of mother:

United States, 2016

1

Significant differences among all groups (p < 0.05). 2

Significant decreasing trend from high school diploma or GED to master’s degree or higher (p < 0.05). 

NOTES: Data include only women aged 25 and over. Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db305_table.pdf#4.

SOURCE: NCHS, National Vital Statistics System, Natality.

 
NCHS Data Brief ■ No. 305 ■ February 2018

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Summary

This report presents the first national data on maternal smoking during pregnancy based on the 

2003 birth certificate revision. Cigarette smoking during pregnancy was shown to differ across 

states, as well as by maternal age, race and Hispanic origin, and educational attainment. Smoking 

during pregnancy was most common among women aged 20–24, non-Hispanic AIAN mothers, 

and women with a high school education or less. Identifying maternal characteristics linked with 

smoking during pregnancy can help inform the development of strategies to reduce the prevalence 

of maternal smoking and increase smoking cessation during pregnancy in the United States.

Definitions

Prevalence of smoking during pregnancy: Number of births to women who reported smoking 

cigarettes at any point during pregnancy per 100 births in the given category. The question from 

the 2003 revised birth certificate asks for the number of cigarettes (or packs) smoked in the 

3 months before pregnancy and in each trimester. If the mother reported smoking in any of the 

3 trimesters of pregnancy, she was classified as a smoker (smoked anytime during pregnancy). 

Women with unknown smoking status for any trimester were classified as “Unknown smoking 

status” and excluded from this analysis.

Race and Hispanic origin: Race and Hispanic origin are reported independently on the U.S. 

Standard Certificate of Live Birth. This report presents data for single-race non-Hispanic white, 

single-race non-Hispanic black, single-race non-Hispanic Asian, single-race non-Hispanic 

American Indian or Alaska Native, single-race Native Hawaiian or Other Pacific Islander, and 

Hispanic births. 
NCHS Data Brief ■ No. 305 ■ February 2018

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Data source and methods

This report is based on data from the 2016 natality data file of the National Vital Statistics 

System. The natality file is based on information derived from birth certificates and includes 

information for all births occurring in the United States. Publicly available birth data files are 

available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm.

Maternal education analyses are restricted to women aged 25 and over to allow for completion 

of education. The items regarding maternal smoking on the 2003 birth certificate include the 

average number of cigarettes or packs smoked per day during four periods: over the 3 months 

before pregnancy and in each of the 3 trimesters of pregnancy. This report does not include data 

on the reporting of smoking during the 3 months before pregnancy. The information on maternal 

smoking is recommended to be asked of the mother on the mother’s worksheet in the hospital 

around the time of delivery. The total percentage of records with missing information on smoking 

during any trimester of pregnancy for the United States was 0.5%. By state, rates of missing data 

for this measure ranged from 0.1% (New York) to 4.4% (West Virginia).

The difference between any percentages is noted in the text only if it is statistically significant. 

References to decreasing linear trends are statistically significant at the 0.05 level and assessed 

using the Cochran–Armitage test for trends, a modified chi-squared test.
NCHS Data Brief ■ No. 305 ■ February 2018

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About the authors

Patrick Drake, Anne K. Driscoll, and T.J. Mathews are with the National Center for Health 

Statistics, Division of Vital Statistics, Reproductive Statistics Branch. 

References

1. Bernstein IM, Mongeon JA, Badger GJ, Solomon L, Heil SH, Higgins ST. Maternal smoking 

and its association with birth weight. Obstet Gynecol 106(5 Pt 1):986–91. 2005.

2. McCowan LM, Dekker GA, Chan E, Stewart A, Chappell LC, Hunter M, et al. Spontaneous 

preterm birth and small for gestational age infants in women who stop smoking early in 

pregnancy: Prospective cohort study. BMJ 338:b1081. 2009.

3. Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: A 

systematic review based on 173,687 malformed cases and 11.7 million controls. Hum Reprod 

Update 17(5):589–604. 2011. 

4. Jaddoe VW, Troe EJ, Hofman A, Mackenbach JP, Moll HA, Steegers EA, Witteman JC. 

Active and passive maternal smoking duing pregnancy and the risks of low birthweight and 

preterm birth: The Generation R Study. Paediatr Perinat Epidmiol 22(2):162–71. 2008.

5. Voigt M, Hermanussen M, Wittwer-Backofen U, Fusch C, Hesse V. Sex-specific differences 

in birth weight due to maternal smoking during pregnancy. Eur J Pediatr 165(11):757–61. 2006.
NCHS Data Brief ■ No. 305 ■ February 2018

Suggested citation

Drake P, Driscoll AK, Mathews TJ. 

Cigarette smoking during pregnancy: United 

States, 2016. NCHS Data Brief, no 305. 

Hyattsville, MD: National Center for Health 

Statistics. 2018.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Vital Statistics

Delton Atkinson, M.P.H., M.P.H., P.M.P., 

Director

Hanyu Ni, Ph.D., M.P.H., Associate Director 

for Science

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