Part I - Smoking Among Women of Reproductive Age

Smoking kills over 174,000 women and 776 infants each year[1]. It is a primary cause of lung cancer, which surpassed breast cancer as the leading cancer killer of women, and is a primary cause of cardiovascular disease. However, cardiovascular disease is the leading overall killer of women[2].

For women of reproductive age, smoking presents unique risks to pregnancy-related health outcomes. For example, women who smoke are at increased risk for difficulty conceiving, infertility, spontaneous abortion. Women who smoke during pregnancy are increased risk of premature rupture of membranes, placenta previa, and placental abruption. Risk to the infant includes low birth weight, neonatal mortality, stillbirth, preterm delivery, and sudden infant death syndrome (SIDS).

Data from the 2006 Behavioral Risk Factor Surveillance System show the median prevalence of smoking among women of reproductive age at 22.4 percent[3]. And, according to 2005 Pregnancy Risk Assessment Monitoring System data combined with birth certificate data from 26 states, 14 percent of women reported smoking during pregnancy [4].

Among women of reproductive age, smoking is highest among those who are:

• 18-24 years of age (20.7%)
• American Indians or Alaska Natives (26.8%), white non-Hispanic (20.0%)
• General Educational Development (GED) diploma (38.8%)
• Living below the poverty level (26.9%)[5]

These same groups of women report higher rates of smoking during pregnancy than their counterparts. According to 2005 data from 26 PRAMS states, smoking during pregnancy is highest among the following groups of women:

• < 20 years of age (20%) or 20-24 years of age (21%)
• Alaska Natives (36%), American Indians (23%), white non-Hispanic (18%)
• < 12 years of education (24%)
• Medicaid for health insurance (24%)
• Enter prenatal care after the first trimester (18-20%)[6]

Comprehensive and sustained tobacco control programs and policies have been shown to reduce initiation of smoking and increase smoking cessation[7]. The health care system plays an integral role in this overall tobacco control strategy. Health care providers, by conducting brief clinical interventions as recommended by ACOG[8] and US Public Health Service Guidelines[9], can increase the chances of a successful cessation attempt. Counseling and behavioral therapies can also contribute to cessation success. Pharmacological therapies, including nicotine replacement products and non-nicotine mediations, have also been found to be effective in treating tobacco dependence among non-pregnant women. However, further research is needed to determine the safety and efficacy of pharmacological therapies for pregnant women.

[1] Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses --- United States, 2000—2004.MMWR Morb Mortal Wkly Rep 2008 Nov, 14;57(45):1226-1228. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm. 

[2] Ibid.

[3] Smoking Prevalence Among Women of Reproductive Age, United States- 2006. MMWR Morb Mortal Wkly Rep. 2008 August 8;57(31):849-852. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5731a2.htm.  

[4] Tong VT, Jones JR, Dietz PM, D’Angelo D, Bombard JM. Trends in Smoking Before, During, and After Pregnancy – Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 Sites, 2000-2005. MMWR Surveill Summ. 2009 May 29;58(4):1-29.

[5] Tobacco Use Among Adults—United States, 2005. MMWR Morb Mortal Wkly Rep. 2006 November 6;55(42):1145–1148. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a1.htm.

[6] CDC Fact Sheet–Preventing Smoking and Exposure to Secondhand Smoke Before, During, and After Pregnancy (July 2007). Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Available online at: http://www.cdc.gov/NCCdphp/publications/factsheets/Prevention/smoking.htm.

[7] Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2007. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; October 2007.http://www.cdc.gov/tobacco/tobacco_control_programs/stateandcommunity/best_practices/pdfs/2007/BestPractices_Complete.pdf

[8] Smoking cessation during pregnancy. ACOG Committee Opinion No. 316. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;106:883-8.

[9] U.S. Department of Health and Human Services. Treating Tobacco Use and Dependence: Clinical Practice Guidline 2008 Update. USDHHS, Rockville, MD. 2008.pgs 37-62.