Smoking During Pregnancy in United States

United States

Smoking cigarettes and using other tobacco products while pregnant is harmful to both mother and child. Tobacco use during pregnancy has been linked to serious health problems, including: 

• Miscarriage and ectopic pregnancy.
• Preterm birth and low birth weight.
• Birth defects of the mouth and lip.
• Abnormal bleeding during pregnancy and delivery.
• Damage to a baby’s developing lungs and brain that can last through childhood and into adolescence.
• Increased risk of sudden infant death syndrome (SIDS).

According to the Centers for Disease Control and Prevention (CDC), the percentage of women who reported smoking cigarettes during pregnancy declined from 7.2% to 3.7% between 2016 and 2022, and decreased among all racial and ethnic groups. 

Smoking tobacco during pregnancy is costly. The annual cost of neonatal health care because of smoking during pregnancy is estimated at $122 million in 2004 dollars, without adjusting for inflation. A more recent study estimates that quitting or reducing smoking during pregnancy has an economic benefit of more than half a billion dollars annually in the United States, based on the reduction of sudden unexpected infant deaths. Further reducing smoking during pregnancy could yield as much as an additional $1.16 billion.

Exposure to secondhand smoke can also harm both pregnant women and unborn infants. Adverse health outcomes associated with secondhand smoke exposure include miscarriage, low birth weight, preterm birth and SIDS. 

Electronic cigarettes, commonly known as e-cigs or vape pens, have emerged as an alternative to cigarette smoking. Most e-cigarettes, however, still contain nicotine, which is addictive and toxic to developing fetuses. E-cigarettes are unsafe for youth, young adults and pregnant women. 

Studies have found that smoking during pregnancy is higher among:

• Pregnant women with partners who smoke.
• Pregnant women who already have multiple children.
• Pregnant women insured under Medicaid.
• Pregnant women who are American Indian/Alaska Native and white compared with those who are Hispanic, Black or Asian or Pacific Islander.
• Pregnant women with a high school education or less compared with those with higher educational attainment. 
• Pregnant women with a history of depression before pregnancy.

Community support, clinical intervention and lifestyle changes can influence smoking behavior. Cessation during pregnancy is effective; pregnant women who quit smoking during the first trimester deliver infants of comparable height and weight to those of non-smoking women. The smoking habits of other household members have a powerful influence on cessation, so effective interventions should involve partners as well. 

The U.S. Preventive Services Task Force has concluded that evidence is insufficient to recommend e-cigarettes for smoking cessation in adults, and the American College of Obstetricians and Gynecologists advises against consumption of any tobacco products during pregnancy, including e-cigarettes. 

Routine assessment of smoking behaviors during prenatal and postpartum visits can allow opportunities for health care providers to refer individuals to cessation services like counseling, or provide medication when appropriate. 

The CDC offers state and community resources for preventing and controlling tobacco use. The Smokefree Women website provides free evidence-based information and professional help to support the immediate and long-term needs of women trying to quit smoking, including a dedicated section for pregnant women. Estimates show that for every dollar invested in smoking cessation programs, $3 is saved in neonatal intensive care costs.

Reducing cigarette smoking is a Healthy People 2030 leading health indicator. Other tobacco-related objectives include: 

• Reducing tobacco use of any kind in adults.
• Increasing abstinence from cigarette smoking among pregnant women.
• Increasing successful quit attempts by pregnant women who smoke. 

“ACOG Committee Opinion No. 807: Tobacco and Nicotine Cessation During Pregnancy.” Obstetrics & Gynecology 135, no. 5 (May 2020): e221–29. https://doi.org/10.1097/AOG.0000000000003822.

Adams, Esther Kathleen, Cathy L. Melvin, Cheryl Raskind-Hood, Peter J. Joski, and Ecaterina Galactionova. “Infant Delivery Costs Related to Maternal Smoking: An Update.” Nicotine & Tobacco Research 13, no. 8 (August 1, 2011): 627–37. https://doi.org/10.1093/ntr/ntr042.

Centers for Disease Control and Prevention. “Women and Smoking: A Report of the Surgeon General (Executive Summary).” MMWR. Morbidity and Mortality Weekly Report, Recommendations and Reports, 51, no. RR-12 (August 30, 2002). https://stacks.cdc.gov/view/cdc/13512.

Drake, Patrick, Anne K. Driscoll, and T. J. Matthews. “Cigarette Smoking During Pregnancy: United States, 2016.” NCHS Data Brief No. 305. Hyattsville, MD: National Center for Health Statistics, 2018. https://www.cdc.gov/nchs/data/databriefs/db305.pdf.

Higgins, Stephen T., Eric P. Slade, and Donald S. Shepard. “Decreasing Smoking during Pregnancy: Potential Economic Benefit of Reducing Sudden Unexpected Infant Death.” Preventive Medicine 140 (November 2020): 106238. https://doi.org/10.1016/j.ypmed.2020.106238.

Horne, Andrew W., Jeremy K. Brown, Junko Nio-Kobayashi, Hazirah B. Z. Abidin, Zety E. H. A. Adin, Lyndsey Boswell, Stewart Burgess, Kai-Fai Lee, and W. Colin Duncan. “The Association between Smoking and Ectopic Pregnancy: Why Nicotine Is BAD for Your Fallopian Tube.” Edited by Hiroyoshi Ariga. PLOS ONE 9, no. 2 (February 20, 2014): e89400. https://doi.org/10.1371/journal.pone.0089400.

Kipling, Lauren, Jennifer Bombard, Xu Wang, and Shanna Cox. “Cigarette Smoking Among Pregnant Women During the Perinatal Period: Prevalence and Health Care Provider Inquiries — Pregnancy Risk Assessment Monitoring System, United States, 2021.” MMWR. Morbidity and Mortality Weekly Report 73, no. 17 (May 2, 2024): 393–98. https://doi.org/10.15585/mmwr.mm7317a2.

Martin, Joyce A. “QuickStats: Percentage of Women Who Smoked Cigarettes During Pregnancy, by Race and Hispanic Origin — National Vital Statistics System, United States, 2016 and 2022.” MMWR. Morbidity and Mortality Weekly Report 72, no. 50 (December 15, 2023): 1355. https://doi.org/10.15585/mmwr.mm7250a5.

Pineles, Beth L., Edward Park, and Jonathan M. Samet. “Systematic Review and Meta-Analysis of Miscarriage and Maternal Exposure to Tobacco Smoke During Pregnancy.” American Journal of Epidemiology 179, no. 7 (April 1, 2014): 807–23. https://doi.org/10.1093/aje/kwt334.

Ruger, Jennifer Prah, and Karen M. Emmons. “Economic Evaluations of Smoking Cessation and Relapse Prevention Programs for Pregnant Women: A Systematic Review.” Value in Health 11, no. 2 (March 2008): 180–90. https://doi.org/10.1111/j.1524-4733.2007.00239.x.

Schneider, Sven, Christina Huy, Jessica Schütz, and Katharina Diehl. “Smoking Cessation during Pregnancy: A Systematic Literature Review.” Drug and Alcohol Review 29, no. 1 (January 6, 2010): 81–90. https://doi.org/10.1111/j.1465-3362.2009.00098.x.

U.S. Department of Health and Human Services. “E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General.” Atlanta, GA: 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, 2016. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf.