Smoking Prevalence and Cessation Before and During Pregnancy: Data From the Birth Certificate, 2014.

OBJECTIVES This report presents findings for 2014 on maternal smoking prevalence and cessation before and during pregnancy as collected on the 2003 U.S. Standard Certificate of Live Birth, for a 46-state and District of Columbia reporting area, representing 95% of all births in the United States. METHODS Cigarette smoking and cessation rates 3 months before and during pregnancy are presented by maternal age; race and ethnicity; marital status; educational attainment; source of payment at delivery (private insurance, Medicaid, and self-pay); receipt of benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children; prenatal care initiation; and jurisdiction. RESULTS About 1 in 10 women who gave birth in 2014 smoked during the 3 months before pregnancy (10.9%), and about one-quarter of these women (24.2%) did not smoke during pregnancy (i.e., quit before pregnancy). The smoking rate at any time during pregnancy was 8.4%, with 20.6% of women who smoked in the first or second trimesters quitting by the third trimester. Smoking during pregnancy was more prevalent for women aged 20–24 (13.0%) than for other ages, and by race and Hispanic origin, the highest rate was for non- Hispanic American Indian or Alaska Native women (18.0%). Smoking during pregnancy ranged from 1.8% in California to 27.1% in West Virginia. The highest smoking cessation rates before and during pregnancy were for women with the highest educational attainment, private insurance, and non-Hispanic Asian and Hispanic race and ethnicity. On average, women who continued to smoke during pregnancy smoked fewer cigarettes as the pregnancy progressed, from 13 per day before pregnancy to 9 per day by the third trimester.