Smoking: Effects on Mothers and Babies in West Virginia

MATCHED BIRTH AND DEATH CERTIFICATE DATA. Infants of mothers who smoke are more likely to die in the first year of life. The infant mortality rate for babies of white mothers who smoke is 10.5 per 1,000 live births, 54% higher than the 6.8 rate for nonsmoking white mothers. For black and other races, the infant mortality rate for infants of mothers who smoke is 15.6 compared with 12.0 for those born to mothers who do not smoke, a 30% difference in rates.

Tobacco smoke may be a significant contributor to SIDS, or sudden infant death syndrome. White infants of mothers who smoke are more than three times more likely to die of SIDS than are babies of mothers who do not smoke. Since many of these infants die during the postneonatal period, this implies that either smoking has latent effects or that the mother's continued smoking can affect the baby's health (5).

Cigarette smoking contributes to serious respiratory problems in infants. In addition, any environmental tobacco smoke in the home, car, restaurant, day care setting, or in the general environment may seriously damage the infant's developing respiratory system. Cigarette smoking mothers are more likely to be teenagers if they are white, to be over 30 if they are nonwhite, to be less educated, and to begin prenatal care later in pregnancy. Babies of smokers are more likely to be premature, to be low birth weight, to die in infancy, and to experience respiratory problems.

PRAMS DATA. In February 1993, PRAMS, the Pregnancy Risk Assessment Monitoring System, started collecting data for research in defining and exploring risk factors in infant mortality and low birth weight. Sample data are collected by sending questionnaires to randomly selected mothers of babies born within the past six months. In surveying mothers, a special attempt is made to reach high-risk mothers.

A substantial proportion of women still smoke during the last three months of their pregnancy. This proportion of last trimester smoking prevalence in West Virginia is 23.9%, which ranked as the highest in the nation in 1997. Many women who stop smoking during pregnancy resume smoking following delivery. For the same year, the prevalence of smoking at two to six months after pregnancy was again the highest in the nation at 29.3%.

SMOKING CESSATION AND HEALTH CARE FUNDING. In attempting to resolve the dilemma of perinatal maternal smoking in West Virginia, a consideration of the numbers of health insurance covered individuals compared to those not covered should be made. This has significance when looking at programs for quitting smoking in the state. A tobacco cessation telephone "quitline" is a free service available to all Public Employee Insurance Agency (PEIA) insured West Virginians, as well as all Medicaid recipients. This program makes health professionals available with confidential assistance in smoking cessation. This can involve individual phone coaching, mailed information and materials, nicotine replacement therapy and other pharmacological aids to cessation, or a combination of options.

The numbers relating to health insurance coverage indicate that there are 199,530 publicly covered PEIA recipients plus 29,999 with dual PEIA/Medicare coverage for a total of 229,529 covered individuals. This compares with a Medicaid-eligible population of 251,297 plus 11,251 with dual Medicaid/Medicare eligibility for a total of 262,548 (6).

CONCLUSION. It is the intent of this paper to relate the importance of eliminating adverse tobacco use behaviors in order to increase the well-being of the mother, fetus, and newborn infant. It is beyond the scope of this brief to recommend strategies to accomplish this, although it must be recognized that only through specific interventions will the numbers of mothers and babies at risk for smoking-related disease and disability be reduced. Efforts toward this end are addressed in the Healthy People 2010 Objectives for West Virginia, including reduction of the prevalence of smoking among young women aged 18-24 to 25% or less, reduction of the prevalence of smoking among pregnant women to 12% or less, and an increase in smoking cessation early in pregnancy to 60% or more.

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