Smoking During Pregnancy in Indiana

Indiana

Smoking cigarettes and using other tobacco products while pregnant is harmful to both the woman 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).

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 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.

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 ages 20-24 compared with younger and older women.
• Pregnant women who are American Indian/Alaska Native or white compared with those who are Hispanic or Asian.
• Pregnant women who did not graduate or attend college. Women with a bachelor’s degree or higher are significantly less likely to smoke during pregnancy.

Community support, clinical intervention and life changes can influence smoking behavior. 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. The smoking habits of other household members have a powerful influence on cessation, therefore effective interventions should involve partners as well. 

Estimates show that for every dollar invested in smoking cessation programs, $3 is saved in neonatal intensive care costs.

The U.S. Preventive Services Task Force 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. 

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 help to support the immediate and long-term needs of women trying to quit smoking, including a dedicated section for pregnant women.

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.” 2020. Obstetrics & Gynecology 135 (5): e221–29. https://doi.org/10.1097/AOG.0000000000003822.

Adams, E. K., C. L. Melvin, C. Raskind-Hood, P. J. Joski, and E. Galactionova. 2011. “Infant Delivery Costs Related to Maternal Smoking: An Update.” Nicotine & Tobacco Research 13 (8): 627–37. https://doi.org/10.1093/ntr/ntr042.

Centers for Disease Control and Prevention. 2002. “Women and Smoking: A Report of the Surgeon General (Executive Summary).” MMWR. Morbidity and Mortality Weekly Report, Recommendations and Reports, 51 (RR-12). https://stacks.cdc.gov/view/cdc/13512.

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

Higgins, Stephen T., Eric P. Slade, and Donald S. Shepard. 2020. “Decreasing Smoking during Pregnancy: Potential Economic Benefit of Reducing Sudden Unexpected Infant Death.” Preventive Medicine 140 (November): 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. 2014. “The Association between Smoking and Ectopic Pregnancy: Why Nicotine Is BAD for Your Fallopian Tube.” Edited by Hiroyoshi Ariga. PLOS ONE 9 (2): e89400. https://doi.org/10.1371/journal.pone.0089400.

Petersen, Ruth, Kathryn A. Clark, Katherine E. Hartmann, and Cathy L. Melvin. 2005. “Getting Focused: Missed Opportunities for Smoking Interventions for Pregnant Women Receiving Medicaid.” Preventive Medicine 40 (2): 209–15. https://doi.org/10.1016/j.ypmed.2004.05.023.

Pineles, Beth L., Edward Park, and Jonathan M. Samet. 2014. “Systematic Review and Meta-Analysis of Miscarriage and Maternal Exposure to Tobacco Smoke During Pregnancy.” American Journal of Epidemiology 179 (7): 807–23. https://doi.org/10.1093/aje/kwt334.

Ruger, Jennifer Prah, and Karen M. Emmons. 2008. “Economic Evaluations of Smoking Cessation and Relapse Prevention Programs for Pregnant Women: A Systematic Review.” Value in Health 11 (2): 180–90. https://doi.org/10.1111/j.1524-4733.2007.00239.x.

Schneider, Sven, Christina Huy, Jessica Schütz, and Katharina Diehl. 2009. “Smoking Cessation during Pregnancy: A Systematic Literature Review.” Drug and Alcohol Review 29 (1): 81–90. https://doi.org/10.1111/j.1465-3362.2009.00098.x.

U.S. Department of Health and Human Services. 2016. “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. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf.