The Reality

Smoking before and during pregnancy is the single 

most preventable cause of illness and death among 

mothers and infants. Women who quit smoking 

before or early in pregnancy significantly reduce the 

risk for several adverse outcomes. 

• Compared with women who do not smoke,

- Women who smoke prior to pregnancy are 

about twice as likely to experience a delay 

in conception and have approximately 30% 

higher odds of being infertile,

- Women who smoke during pregnancy are 

about twice as likely to experience premature 

rupture of membranes, placental abruption, 

and placenta previa during pregnancy.

• Babies born to women who smoke during 

pregnancy, 

- Have about 30% higher odds of being born 

prematurely.

- Are more likely to be born with low birth 

weight (less than 2500 grams or 5.5 pounds), 

increasing their risk for illness or death. 

- Weigh an average of 200 grams less than 

infants born to women who do not smoke. 

- Are 1.4 to 3.0 times more likely to die of 

Sudden Infant Death Syndrome (SIDS). 

Prevalence of Smoking During The 

Last 3 Months of Pregnancy

According to 2004 Pregnancy Risk Assessment 

Monitoring System (PRAMS) data from 26 states,1

• Approximately 13% of women reported smoking 

during the last 3 months of pregnancy. 

• Younger, less educated, non-Hispanic white, and 

American Indian women are more likely to

smoke during pregnancy compared with their 

older, more educated counterparts (Figure 1).

• Women on Medicaid are more than three times 

as likely to smoke during the last 3 months of 

pregnancy as women with private insurance, 

and smoking rates are higher among women 

who enter into prenatal care later in pregnancy 

(Figure 2).

• Of women who smoked during the last 3 months 

of pregnancy, 52% reported smoking 5 or fewer 

cigarettes per day, 27% reported smoking 6 to 10 

cigarettes per day, and 21% reported smoking 11 

or more cigarettes per day. 

• Of women who smoked 3 months before 

pregnancy, 45% quit during pregnancy. Among 

quitters during pregnancy, 52% relapsed within 

6 months after delivery.

	 PRAMS 2004 representing 26 states. Division of Reproductive Health,

National Center for Chronic Disease Prevention and Health Promotion,

Centers for Disease Control and Prevention.

Preventing Smoking and Exposure 

to Secondhand Smoke Before, 

During, and After Pregnancy

July 2007

Figure 1. Prevalance of Smoking During the Last Three Months of Pregnancy

by Demographic Characteristics as reported by 26 PRAMS States, 2004

0%

5%

10%

15%

20%

25%

> 35 years

25 to 34 years

20 to 24 years

< 20 years

> 12 years

12 years

< 12 years

Other/Mixed

Asian/Pacific Islander

American Indian

Hispanic

Black, non-Hispanic

White, non-Hispanic

Race/Ethnicity Education Age

16%

10%

5%

20%

4%

13%

21%

18%

6%

17%

19%

10% 9%

Figure 2. Prevalance of Smoking During the Last Three Months of Pregnancy

by Access to Health Care as reported by 26 PRAMS States, 2004

0%

5%

10%

15%

20%

25%

Entry into 

Prenatal Care 

Second 

Trimester or Later

Entry into 

Prenatal Care 

First Trimester

No 

Insurance

Private Medicaid

Insurance

7%

24%

18%

11%

18%
Secondhand Smoke

Exposure to secondhand smoke causes premature 

death and disease in children and adults who do 

not smoke.

• From 1988 through 

2002, cotinine levels 

(a biological indicator 

of tobacco smoke 

exposure) declined by 

approximately 70% 

among children and 

nonsmoking adults. 

Despite this positive 

trend, in 2002 nearly 

half of all children and 

nonsmoking adults 

still had detectable 

levels of cotinine. 

• Pregnant women who are exposed to 

secondhand smoke have a 20% higher odds 

of giving birth to a low-birth weight baby than 

women who are not exposed to secondhand 

smoke during pregnancy. 

• Children are at greater risk of being exposed to 

secondhand smoke than adults.

- During the period 1999–2002, almost 40 

million children aged 3 to 19, or about 58% 

of children in this age group, were exposed 

to secondhand smoke. 

- Infants who are exposed to secondhand 

smoke are more likely to die of SIDS 

compared with infants who are not exposed.

- Children who are exposed to secondhand 

smoke are at increased risk for bronchitis, 

pneumonia, ear infections, severe asthma, 

respiratory symptoms, and slowed lung 

growth.

Recommended Strategies & 

Policies

Prevent smoking initiation among young people.

• Increasing the unit price for tobacco products 

and conducting mass media campaigns in 

combination with other interventions (such 

as school-based education and community 

education) effectively prevents young people 

from initiating smoking. 

Help pregnant women quit and prevent relapse.

• Because pregnant women who have received 

brief smoking cessation counseling are more 

likely to quit smoking, clinicians should offer 

effective smoking cessation interventions to 

pregnant smokers at the first prenatal visit and 

throughout the pregnancy. 

• Medicaid coverage of smoking cessation 

counseling services and medications is 

associated with lower smoking rates among 

women.

• Increasing the unit price for tobacco products 

can reduce rates of smoking during pregnancy 

and relapse after delivery.

Take Action

The Surgeon General has concluded that the only 

way to fully protect yourself and your loved ones 

from the dangers of tobacco smoke is to live in and 

visit only 100% smoke-free environments. 

- Access a quitline serving your area by calling 

1-800-QUIT-NOW (1-800-784-8669) or 

visiting www.1800quitnow.org.

- Find tips on quitting smoking at www.

smokefree.gov.

- Learn more online about the harmful 

effects of smoking and secondhand smoke 

and receive expert advice on how to keep 

children tobacco-free at www.cdc.gov/

tobacco. 

- Make the Smoke-free Home Pledge by calling 

1-866-SMOKE-FREE (1-866-766-5337) or 

visiting www.epa.gov/smokefree.

- Read The Health Consequences of 

Involuntary Exposure to Tobacco Smoke 

– 2006 Surgeon General’s Report, available 

at http://www.cdc.gov/tobacco/data_

statistics/sgr/sgr_2006/.

For more information or updates, visit www.cdc.gov/

nccdphp or email cdcinfo@cdc.gov.

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