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Smoking During Pregnancy
Smoking During Pregnancy in United States
United States

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United States Value:


Percentage of mothers who reported smoking cigarettes during pregnancy

Smoking During Pregnancy in depth:

Smoking During Pregnancy by State

Percentage of mothers who reported smoking cigarettes during pregnancy

Smoking During Pregnancy Trends

Percentage of mothers who reported smoking cigarettes during pregnancy

Trend: Smoking During Pregnancy in United States, 2022 Health Of Women And Children Report

Percentage of mothers who reported smoking cigarettes during pregnancy

United States

 CDC WONDER, Natality Public Use Files

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Smoking During Pregnancy

Trend: Smoking During Pregnancy in United States, 2022 Health Of Women And Children Report

Percentage of mothers who reported smoking cigarettes during pregnancy

United States

 CDC WONDER, Natality Public Use Files

About Smoking During Pregnancy

US Value: 5.5%

Top State(s): California: 1.0%

Bottom State(s): West Virginia: 21.4%

Definition: Percentage of mothers who reported smoking cigarettes during pregnancy

Data Source and Years: CDC WONDER, Natality Public Use Files, 2020

Suggested Citation: America's Health Rankings analysis of CDC WONDER, Natality Public Use Files, United Health Foundation,, accessed 2023.

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: 

Smoking tobacco during pregnancy is costly. The annual cost of neonatal health care due to smoking during pregnancy is estimated at $366 million in 1996 dollars, without adjusting for inflation. A more recent study estimates that quitting or reducing smoking during pregnancy has an economic benefit of half a billion dollars annually in the United States, based on the reduction of sudden unexpected infant deaths. Increasing smoking cessation or reduction during pregnancy, however, could yield as much as an additional $1.16 billion in infant lives saved.

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 considered unsafe for youth, young adults and pregnant women.

Pregnancy may serve as a major motivator to help women quit smoking. An estimated 54% of pregnant smokers quit by the last three months of pregnancy. Smoking throughout pregnancy is higher among:

  • Mothers with partners who smoke.
  • Mothers of multiple children.
  • Mothers insured under Medicaid.
  • Mothers ages 20-24 compared with younger and older mothers.
  • American Indian/Alaska Native and white mothers compared with Hispanic and Asian mothers.
  • Mothers with a high school diploma or equivalent and those with less than a high school education compared with mothers with a college degree or higher.

Smoking is a behavior that can be influenced by community support, clinical intervention and life changes. Cessation during pregnancy is effective; pregnant women who quit smoking during the first trimester deliver infants that are of comparable weight and height to those of non-smoking women. An increased focus has been placed on providing insurance coverage for cessation medications along with counseling, especially for pregnant women. Interventions may be more effective for individuals if their partners are involved because they can be helpful sources of support. Estimates show that for every dollar invested in smoking cessation programs, three dollars are saved in neonatal intensive care costs.

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, including e-cigarettes. 

The Centers for Disease Control and Prevention offers state and community resources for preventing and controlling tobacco use. The Smokefree Women website provides free evidence-based information and professional assistance to support the immediate and long-term needs of women and pregnant women trying to quit smoking.

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

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

Adams, E. Kathleen, Vincent P. Miller, Carla Ernst, Brenda K. Nishimura, Cathy Melvin, and Robert Merritt. “Neonatal Health Care Costs Related to Smoking during Pregnancy.” Health Economics 11, no. 3 (April 2002): 193–206.

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).

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.

Elliott, Amy J., Hannah C. Kinney, Robin L. Haynes, Johan D. Dempers, Colleen Wright, William P. Fifer, Jyoti Angal, et al. “Concurrent Prenatal Drinking and Smoking Increases Risk for SIDS: Safe Passage Study Report.” EClinicalMedicine 19 (January 20, 2020): 100247.

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.

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.

Petersen, Ruth, Kathryn A. Clark, Katherine E. Hartmann, and Cathy L. Melvin. “Getting Focused: Missed Opportunities for Smoking Interventions for Pregnant Women Receiving Medicaid.” Preventive Medicine 40, no. 2 (February 2005): 209–15.

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.

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.

Schneider, Sven, Christina Huy, Jessica Schütz, and Katharina Diehl. “Smoking Cessation during Pregnancy: A Systematic Literature Review.” Drug and Alcohol Review 29, no. 1 (August 5, 2009): 81–90.

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.

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