Smoking: Effects on Mothers and Babies in West Virginia

Smoking by women during pregnancy is widely recognized to increase the risks of several adverse health outcomes (1). In fact, the following warning appears on some tobacco products: "SURGEON GENERAL'S WARNING: Smoking by pregnant women may result in fetal injury, premature birth, or low birth weight."

BIRTH CERTIFICATE DATA. Beginning with 1989, the Health Statistics Center of the West Virginia Bureau for Public Health has tracked smoking rates of mothers who smoked during pregnancy. These data have been derived from the West Virginia certificate of live birth, which includes a question regarding the mother's smoking habits during pregnancy. The data have been tabulated for the 10-year period 1989-1998, with tobacco use being related to other items on the birth certificate.

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With smoking rates among the general U.S. population gradually declining during the period, the figure among women giving birth in West Virginia also showed a modest downward trend. Among white women who had babies during this ten-year period, 26.8% smoked in 1989 with
a gradual decrease to 25.4% by 1998. Black mothers showed a drop from 25.2% in 1989 to 23.9% by 1998; however, their rate has been gradually increasing since a low of 19.0% in 1995. It should be pointed out, however, that these are self-reported data, causing the rates to be somewhat lower.

Smoking rates among mothers as reported on the birth certificate are less than those reported by the Behavioral Risk Factor Surveillance System (a monthly telephone survey conducted by the West Virginia Bureau for Public Health) for all women of ages 15-44 in West Virginia. These data show that, in 1998, approximately 33% of all women of childbearing age were smokers in the state. For 1998 in the U.S. as a whole, the Centers for Disease Control and Prevention reported that approximately 26% of all women of childbearing age smoked.

Smoking is most common among less educated mothers of all races. The highest smoking rates were among mothers with fewer than 12 years of schooling -- 50% of white mothers and 40.0% o f nonwhite mothers smoked in 1998. The lowest smoking rates for all races were among women with one or more years of college. White mothers with less than a high school education were almost twice as likely to smoke as were high school graduates (50% compared to 26.8%) and were more than five times as likely to smoke than those with some college. Nonwhite mothers with less than a high school education were more than twice as likely to smoke as those with some college. Interestingly, although nonwhites reported a lower rate of smoking than whites in the two lesser education categories, those with some college reported a higher rate of smoking than their white counterparts.

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White mothers aged 10-17 and 18-24 were more likely to report smoking than other adolescent and early adult mothers. There was a general pattern of decline of smoking with age among both white and nonwhite mothers aged 25-34, but there was an increase in smoking reported by nonwhite mothers in later adulthood (aged 35+).

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Babies born with low birth weights require more medical care, have more health problems, and are more likely to die in infancy than are babies of normal or higher birth weights (2). White mothers who smoke during pregnancy are nearly twice as likely to have a low birth weight baby, and nonwhite mothers are almost 60% more likely than are mothers who do not smoke. Reducing the percentage of babies born at low birth weights has been a relatively intractable public health problem. In West Virginia, little progress has been made in reducing the percentage of low birth weight babies.

Babies of mothers who smoke weigh less on average than those born to mothers who do not smoke (3). In addition to low birth weight, smoking has also been linked to premature birth. White mothers who are smokers are nearly19% more likely to have a premature birth than are nonsmoking white mothers. Nonwhite mothers who smoke are almost 17% more likely to have a premature birth than are nonsmokers. Premature babies, like low weight babies, have more health problems than full-term babies (4).

Mothers who smoke also tend to begin prenatal care later than nonsmoking mothers. Among white smoking mothers, only 72.3% received prenatal care in the first trimester, compared with 82.9% for nonsmokers. On average, nonwhite mothers begin prenatal care later than whites.

Continue to Matched Birth and Death Certificate Data.