In the United States, the prevalence of smoking in pregnant women has declined; however, according to data gathered from 29 states by the Pregnancy Risk Assessment Monitoring System (PRAMS), about 13% of women smoked during the last 3 months of pregnancy.  The prevalence varied according to state, with the highest rates reported in West Virginia (28.7%), Arkansas (24.0%),Tennessee (19.7%), and Maine (19.5%).

Certain groups of women were more likely to smoke during pregnancy. These high risk groups included women aged 20–24 years (19.3% smoked during pregnancy), Alaska Native women (30.4%), women with < 12 years of education (22.5%), and women who were Medicaid-insured (22.1%).

Smoking during pregnancy carries many risks.  Smoking may make it more difficult to conceive, and women smokers are at greater risk for miscarriage and stillbirth.  Women who smoke during pregnancy are at greater risk for certain complications, including placental previa, placental abruption, and premature delivery.  Furthermore, infants of mothers who smoke during pregnancy are more likely to be small for gestational age and are at greater risk of sudden infant death syndrome (SIDS).

A recent study from researchers at Columbia University has focused on the longer term effects of maternal smoking on the offspring.  This analysis included 238 offspring from a family study of depression where data on prenatal histories had been collected over 30 years (beginning in pregnancy) and where the adult children were available for at least one clinical interview in order to document the prevalence of psychiatric illness in the adult offspring.  In this study, prenatal exposure to tobacco was defined as maternal smoking of ?10 cigarettes per day, or nearly every day.

After adjusting for potential confounders, prenatal tobacco exposure was associated with, on average, a 0.7 pound (9%) reduction in birth weight.  In addition, prenatal tobacco exposure was associated with increased rates of disruptive behavior disorders in males (OR=2.66) and substance use disorders in females (OR=2.23).  Interestingly, children with prenatal tobacco exposure had decreased rates of mood disorders (OR=0.42). Birth weight did not appear to mediate the association between prenatal tobacco exposure and risk for psychopathology.

Ruta Nonacs, MD PhD


Prenatal tobacco exposure, birthweight, and offspring psychopathologyTalati A, Wickramaratne PJ, Wesselhoeft R, Weissman MM.  Psychiatry Res. 2017 Mar 8;252:346-352.

PRAMS and Smoking. (2013, August). Retrieved from


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