Mothers’ smoking during pregnancy is associated with many adverse outcomes for children, such as intrauterine growth retardation, premature birth, low birthweight, stillbirth and infant mortality, as well as with negative consequences for subsequent health and development., Mothers who are exposed to second-hand (i.e., environmental) smoke are also more likely to have babies with lower weights, putting them at risk for many health problems. Infants whose mothers smoke during pregnancy are three times more likely to die from Sudden Infant Death Syndrome than are babies whose mothers do not smoke during pregnancy. Children born to mothers who smoked while pregnant, and possibly children whose grandmothers smoked while pregnant, have a higher risk of developing childhood asthma.,, In addition, maternal smoking during pregnancy is a risk factor for early childhood obesity.
Smoking during pregnancy is also associated with later problem behaviors for the child. For example, smoking by the mother during pregnancy has been found to be associated with attention deficit hyperactivity disorder (ADHD). and conduct problems,  and with substance abuse and criminal behavior when children reach adulthood. 
Between 1989 and 2006[a], the percentage of all births where mothers reported they smoked during pregnancy decreased by about half, from 20 to 10 percent. Among teen mothers, ages 15 to 19, the percentage where the mother smoked during pregnancy increased slightly between 1994 and 1999 (from 17 to 18 percent), then steadily declined until 2003. Trends were similar for births to the youngest teen mothers (less than 15 years). The latest data from states using the most recent revision of the birth certificate show the proportion of all births where mothers reported they smoked during pregnancy was 8 percent in 2014, while the proportion of births to teen mothers who smoked was 10 percent. Among teen mothers under 15, 3 percent smoked during pregnancy in 2014.
American Indian/Alaska Native women report the highest rates of smoking during pregnancy, followed by white women, then black women. In 2014, in 17 percent of births to American Indian or Alaska Native mothers, 12 percent of births to non-Hispanic white mothers, and 7 percent of births to black mothers, the mother smoked during pregnancy. In contrast, in only one percent of births to Asian or Pacific Islander women, and two percent of births to Hispanic women, did the mother report she smoked during pregnancy in that year. (Figure 2)
There are sizeable variations in smoking rates among subgroups of Hispanic women. Among births to Hispanics in 2014, the share where the mother smoked during pregnancy ranged from less than one percent among births to Central and South American mothers, to seven percent among births to Puerto Rican mothers. (Appendix 1)
Smoking during pregnancy is reported by a higher percentage of young women (ages 15 to 24) than it is by women 25 years and older. In 2014, in 10 percent of births to teens ages 15 to 19, and 13 percent of births to women ages 20 to 24, the mother smoked during pregnancy, compared with less than 9 percent of births to women 25 and older, and less than 3 percent of births to women younger than 15. (Figure 3)
The lowest smoking rates among pregnant women are for those with a bachelor’s degree or more (ages 20 and older only). In 2014, 1 percent of these women smoked during pregnancy. In contrast, smoking was reported for 9 percent of births where women had some college or an associate’s degree, 14 percent where they had a high school diploma, and 17 percent of births to women with a ninth- through twelfth-grade education. In five percent of births to mothers with an eighth-grade education or less, the mother smoked while pregnant. (Figure 4)
2003-2014 estimates (for those states using the 2003 certificate revision) of the percentage of births to mothers who smoked during pregnancy are available at the KIDS COUNT Data Center.
The KIDS COUNT Data Center also has data, from 2003-2010, for states using the 1989 certificate revision.
Estimates of tobacco use and second-hand smoke exposure among women of reproductive age in 14 countries are available from the Centers of Disease Control and Prevention.
Healthy People 2020, an initiative of the federal government, includes a goal to increase the percent of pregnant women who do not smoke during pregnancy from 89.6 percent in 2007 (based on states using the 2003 version of the birth certificate) to 98.6 percent by 2020.
More information is available here. (Goal MICH 11.3)
Women were considered to be smokers if they reported smoking at least one cigarette daily during any trimester of pregnancy.
Because of states’ transition to a new revision of the birth certificate, no complete national-level data are available from 2003 to 2014; instead, we report on the aggregate data from states using the most prevalent revision.
Data from the two versions are not comparable, because the 1989 revision asks a simple yes/no question, whereas the 2003 version asks about amount of smoking in each trimester of pregnancy.
Data through 2006 reflect only those jurisdictions which had not yet adopted the 2003 certificate revision (see table below). Data for 2007 forward include only those jurisdictions that have adopted the 2003 certificate revision (see table below). Although New York State began using the 2003 revision in 2004, New York City continued to use the 1989 revision until 2008, and is excluded for 2007. For details on this change, see http://www.cdc.gov/nchs/nvss/vital_certificate_revisions.htm.
|Year||States Not Included in National Estimates (out of 50 states and DC)||% Births Not Included|
|2003||2 (PA, WA)||6|
|2004||9 (FL, ID, KY, NH, NY, PA, SC, TN, WA)||20|
|2005||13 (FL, ID, KS, KY, NE, NH, NY, PA, SC, TN, TX, VT, WA)||31|
|2006||18 (DE, FL, ID, KS, KY, NE, NH, NY, ND, OH, PA, SC, SD, TN, TX, VT, WA, WY)||35|
||30 (AL, AK, AZ, AR, CT, DC, FL, GA, HI, IL, LA, ME, MD, MA, MI MN, MS, MO, MT,NV, NM, NY, NC, OK, OR, RI, UT, VA, WV, WI)||47|
||27 (AL, AK, AZ, AR, CT, DC, FL, GA, HI, IL, LA, ME, MD, MA, MI, MN, MS, MO, NV, NJ, NC, OK, RI, UT, VA, WV, WI)||35|
||26 (AL, AK, AZ, AR, CT, DC, FL, GA, HI, IL, LA, ME, MD, MA, MI, MN, MS, MO, NV, NJ, NC, OK, RI, VA, WV, WI)||34|
|2010||20 (AL, AK, AZ, AR, CT, FL, GA, HI, LA, ME, MA, MI, MN, MS, NJ, NC, RI, VA, WV, WI)||24|
|2011||15 (AL, AK, AZ, AR, CT, HI, ME, MA, MI, MN, MS, NJ, RI, VA, WV)||17|
|2012||13 (AL, AK, AZ, AR, CT, HI, ME, MI, MS, NJ, RI, VA, WV)||17|
|2013||10 (AL, AZ, AR, CT, HI, ME, MI, NJ, RI, WV)||13|
|2014||3 (CT, NJ, RI)||4|
Data for 2007-2014: National Center for Health Statistics, CDC WONDER online tool. https://wonder.cdc.gov/natality-current.html.
Detailed Asian race data and teen birth data for 2007-2013: National Center for Health Statistics, National Vital Statistics System. VitalStats online tool.
Data for 1990-2006: Centers for Disease Control and Prevention National Center for Health Statistics. (2008). Mothers who smoked cigarettes during pregnancy, by selected characteristics: United States, selected years 1990-2000 and selected states, 2005-2006. Table 11. Available at http://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/Health_US/hus99/Excel/table011.xls
National Vital Statistics System
|Under 15 years||7.5||7.3||7.1||6.0||5.8||5.3||4.8||4.2||3.3||3.4||3.2||2.7||2.9||2.2||2.9||2.5||2.6|
grade or less
|9th-12th grade, no diploma||–||–||–||–||–||–||–||–||–||18.9||17.9||16.2||18.1||16.7||16.8||16.7||17.0|
School Diploma or GED
college or AA degree
|16 years or more||4.5||2.7||2.0||1.9||1.7||1.6||1.5||1.4||1.4||–||–||–||–||–||–||–||–|
|Bachelor’s or more||–||–||–||–||–||–||–||–||–||1.4||1.2||1.2||1.1||1.2||1.0||1.0||0.9|
|Asian or Pacific Islander7||5.5||3.4||2.8||2.8||2.5||2.2||2.3||2.2||2.1||1.6||1.5||1.4||1.3||1.3||1.2||1.2||1.1|
|Hawaiian and part Hawaiian||21.0||15.9||14.4||14.8||13.7||–||–||–||–||–||–||10.9||11.6||9.1||10.6||9.8||9.6|
|Other Asian or Pacific Islander||3.8||2.7||2.3||2.3||2.1||–||–||–||–||–||–||2.0||1.8||1.9||1.7||1.7||1.7|
|Central and South American||3.0||1.8||1.5||1.3||1.3||1.1||1.3||1.1||1.0||0.7||0.7||0.7||0.6||0.6||0.6||0.6||0.6|
|Other and unknown Hispanic||10.8||8.2||7.4||6.8||6.5||6.6||7.7||7.2||6.5||1.5||3.9||3.5||3.3||3.0||3.1||2.7||2.7|
|American Indian or Alaska Native||22.4||20.9||20.0||19.9||19.7||18.1||18.2||16.6||16.5||20.6||17.0||16.2||17.1||19.6||18.0||18.0||16.7|
|“-“: Data not available.
1 Excludes live births for whom smoking status of mother is unknown and data from states that did not require the reporting of mother’s tobacco use during pregnancy on the birth certificate. Reporting area for tobacco use increased from 43 states and the District of Columbia (D.C.) in 1989 to 49 states and D.C. in 2002, and all 50 states and DC. in 2007.
2Data are for the reporting areas that used the 1989 Revision of the U.S. Standard Certificate of Live Birth for prenatal care. Reporting areas that implemented the 2003 revision of the U.S. Standard Certificate of Live Birth are excluded because prenatal care data based on the 2003 revision are not comparable with data based on the 1989 revision. In 2003, 48 states and DC, representing 94 percent of births, used the 1989 revision. In 2004, 41 states and DC, representing 80 percent of births, used the 1989 revision. In 2005 it was 37 states and DC, representing 69 percent of births. In 2006 it was 32 states and DC, representing 65 percent of births. Although New York state began using the 2003 revision in 2004, New York City continued to use the 1989 revision, and is included in these estimates.
3Data are for the reporting areas that used the 2003 Revision of the U.S. Standard Certificate of Live Birth for prenatal care. Reporting areas that did not yet implement the 2003 revision of the U.S. Standard Certificate of Live Birth are excluded because prenatal care data based on the 2003 revision are not comparable with data based on the 1989 revision. In 2007, 21 states, representing 53 percent of births, were using the 2003 revision. In 2008, 24 states, representing 65 percent of births, were. In 2009, 25 states, representing 66 percent of births were using the 2003 revision, in 2010, 30 states and DC, representing 76 percent of births, in 2011, 35 states and DC, representing 83 percent of births, in 2012, 37 states and DC representing 83 percent of births, and in 2014, 40 states and DC, representing 87 percent of births, were using the 2003 revision. Although New York state began using the 2003 revision in 2004, New York City continued to use the 1989 revision until 2008, and is excluded for 2007.
4 Prior to 1997, data are for live births to mothers 45-49 years of age.
5 Includes only mothers of age 20 or older. Data from states that did not require the reporting of mother’s education on the birth certificate are not included.
6All races include those of Hispanic origin, and those of Hispanic origin may be of any race. Reporting of Hispanic origin increased from 47 states in 1989 to include all 50 states and D.C. by 1993.
7 Maternal tobacco use during pregnancy was not reported on the birth certificates of California (except in 2001 and 2002) until 2007. California accounted for 32 percent of the births to Asian or Pacific Islander mothers in 1999. In 2006, California accounted for 29% of the births to Asian or Pacific Islander mothers and 28% of the births to Hispanic mothers.
Sources: Data for 1990-2006: Centers for Disease Control and Prevention National Center for Health Statistics. (2008). Mothers who smoked cigarettes during pregnancy, by selected characteristics: United States, selected years 1990-2000 and selected states, 2005-2006. Table 11. Available at http://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/Health_US/hus99/Excel/table011.xls Detailed Asian race data and teen birth data for 2007-2013: National Center for Health Statistics, National Vital Statistics System. VitalStats online tool. Available at http://126.96.36.199/Vitalstats/ReportFolders/reportFolders.aspx. All other data for 2007-2014: National Center for Health Statistics, CDC WONDER online tool. http://wonder.cdc.gov/natality-current.html.
[a] Monitoring data on maternal smoking during pregnancy is complicated by changes over time in the standard birth certificate used by states. The U.S. standard birth certificate, the source for these data, was revised in 2003; however, states adopted it only gradually. Data from states using the older (1989) revision yields data that are not strictly comparable with the data derived from the 2003 revision due to differences in the way the maternal smoking question was asked. See Definition section for more details.
Data on maternal smoking during pregnancy comes from states’ birth certificates, which (since 2003) are transitioning to a new revision of the U.S. standard certificate. Data from the two versions are not comparable, because the 1989 revision asks a simple yes/no on question, whereas the 2003 versions asks about smoking levels in each trimester of pregnancy. See Definition section for more detail.
Mathews, T. J. (2001). Smoking during pregnancy in the 1990s [Electronic Version]. National Vital Statistics Reports, 49. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_07.pdf.
U.S. Department of Health and Human Services. (2004). The health
consequences of smoking: What it means to you[Electronic Version] fromhttp://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/whatitmeanstoyou.pdf.
Centers for Disease Control and Prevention. (2006). The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General, U.S. Department of Health and Human Services. Available at:http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet2.html
Jaakkola, J. J. K., & Gissler, M. (2004). Maternal smoking in pregnancy, fetal development, and childhood asthma. American Journal of Public Health, 94(1), 136-140.
Lee, W., & Galant, S. (2002). Effects of maternal smoking during pregnancy and environmental tobacco smoke on asthma and wheezing in children. Pediatrics, 110(2), 445-446.
Li, Y. F., Langholz, B., Salam, M. T., & Gilliland, F. T. (2005). Maternal and grand-maternal smoking patterns are associated with early childhood asthma. Chest, 127(4), 1232-1241.
Salsberry, P. J., & Reagan, P. B. (2005). Dynamics of early childhood
overweight. Pediatrics, 116(4), 1329-1338.
Silva, D., Colvin, L., Hagemann, E., & Bower, C. (2014). Environmental risk factors by gender associated with attention-deficit hyperactivity disorder. Pediatrics, 133(1), e14-e22.
Gaysina, D., Fergusson, D. M., Leve, L. D., Horwood,
J., Reiss, D., Shaw, D. S., Elam, K. K., Natsuaki, M. N., Neiderhiser, J. M., & Harold, G. T. (2013). Maternal smoking during pregnancy and offspring conduct problems. JAMA Psychiatry, published online July 24, 2013, Available at: http://dx.doi.org/10.1001/jamapsychiatry.2013.127.
Brennan, P. A., Grekin, E. R., Mortensen, E. L., & Mednick, S. A. (2002). Relationship of maternal smoking during pregnancy with criminal arrest and hospitalization for substance abuse in male and female adult offspring. American Journal of Psychiatry, 159(1), 48-54.
Hispanics may be of any race.
Estimates by maternal education for mothers who smoke while pregnant include only mothers aged 20 or older.
Child Trends Databank. (2016). Mothers who smoke while pregnant. Available at: https://www.childtrends.org/?indicators=mothers-who-smoke-while-pregnant
Last updated: December 2016