DefinitionWomen who reported smoking during the third trimester of their pregnancies.
NumeratorNumber of women reported on Utah Certificates of Live Births as having smoked in the last trimester of their pregnancies.
DenominatorNumber of live births to Utah residents regardless of where they occurred.
Data Interpretation IssuesCigarette data is obtained through self-report by women through either responses to survey questions within four months of a live birth (PRAMS data), or through Certificates of Live Births (Utah Vital Records data). Either of these processes may result in recall bias. The percent of women who report smoking in the third trimester of pregnancy is higher on the PRAMS surveys (4.5% in 2013 - the most recent data available) which are submitted anonymously, than rates from certificates of live births (3.2% in 2013) on which the mothers' names are included. Due to the stigma attached to smoking during pregnancy, women may be less than forthcoming regarding their use of tobacco resulting in under-reporting of actual cigarette usage.
Why Is This Important?2015 Utah Vital Records data drawn from Certificates of Live Births indicate that 2.7% of women smoked during the last trimester of their pregnancies. According to the 2010 Surgeon General's Report, ''How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Diseases,'' cigarette smoking during pregnancy increases the risk for: low birth weight, neurologic deficits in offspring, increased maternal blood pressure and heart rate, preterm birth, premature rupture of membranes, placental abruption, placenta previa, miscarriage, stillbirth, neonatal mortality, cleft lip/palate, fetal growth restriction/small for gestational age, and Sudden Infant Death Syndrome (SIDS). Additionally, women who smoke are less likely to initiate and continue breastfeeding their infants.
Some unfavorable pregnancy outcomes may be reduced or eliminated through smoking cessation, especially if cessation occurs early in pregnancy. This is true for birth weight which decreases as the number of cigarettes smoked increases; however, smoking cessation by the third trimester of pregnancy can eliminate much of the fetal weight reduction risk incurred through maternal smoking. Maternal smoking may also lead to low birth weight (LBW) through complications requiring premature delivery such as preterm, premature rupture of membranes, placental abruption, or placenta previa. It has been estimated that the occurrence of LBW could be reduced by as much as 20% and fetal growth restriction by 30% if all women were nonsmokers during pregnancy.
Other ObjectivesThere is no Healthy People 2020 Objective for third trimester smoking. However, there is a more general 2020 Objective (MICH-11.3) to increase abstinence from cigarette smoking among pregnant women, with a target of 98.6%. There is another HP2020 Objective (TU-6) to increase smoking cessation during pregnancy, with a target of 30.0%.
How Are We Doing?According to Utah Vital Records, during 2015, 2.7% or 1,351 Utah women experiencing a live birth reported smoking during the third trimester of pregnancy. The percentage of Utah women smoking in the third trimester in 2015 is 2.7% vs. 2.9% in 2014. From 2000 through 2015, the highest percentage of third trimester smoking occurred in 2001 with 7.7% of women experiencing a live birth reporting smoking in the third trimester of pregnancy.
How Do We Compare With the U.S.?There are currently no published national data on smoking in the third trimester of pregnancy.
What Is Being Done?The American Congress of Obstetricians and Gynecologists recommends that pregnant smokers be assessed for smoking activity and readiness to quit and provided resources to assist in cessation at each prenatal visit.
In Utah, all local health departments screen pregnant clients for smoking and provide resources and referrals to promote cessation.
The Utah Department of Health's Medicaid Program and Department of Workforce Services workers screen all pregnant applicants for tobacco use at the time of enrollment. Smokers are provided cessation information and followed-up every six weeks throughout their pregnancies.
Medicaid clients tend to have higher smoking rates than average, so the Tobacco Prevention and Control Program (TPCP) partners with Medicaid to offer quitting services to their clients. The program offers services through the Utah Tobacco Quit Line, and includes coverage of tobacco cessation medications and additional help for pregnant women.
To inform Utahns about tobacco cessation strategies and quit services, the Tobacco Prevention and Control Program (TPCP) at the Utah Department of Health maintains a comprehensive quit website - [http://waytoquit.org]. Utah's anti-tobacco marketing campaign encourages Utah smokers to make quit attempts and informs about [http://waytoquit.org waytoquit.org] and other quit programs.
TPCP is also addressing the use of e-cigarrettes and hookah. Regarding the use of e-cigarettes among high school seniors and 19-24 year olds, the TPCP states:
*In 2011, 8% of high school seniors reported that they had tried e-cigarettes and 3% were current users.
*Among young adults (aged 19-24) surveyed at youth oriented events, 25% reported that they had tried e-cigarettes and 9% reported that they were current users.[[br]]
Local health departments (LHDs) promote quit services at the community level and offer local programs to assist pregnant and teen smokers with quitting. In addition, the TPCP partners with healthcare providers and healthcare organizations such as the Association for Utah Community Health (AUCH) and Medicaid to improve access to quit services, counseling, and medications for populations with higher tobacco use rates.
Beginning in April of 2016, PRAMS began asking about the use of e-cigarettes and hookah, before and during pregnancy. These questions are in addition to questions regarding cigarette smoking.
Additional information on smoking cessation, resources, and helpful website links can be found online at the March of Dimes website [http://www.marchofdimes.com] by clicking on ''Health Topics --> Pregnancy --> Is it safe? --> smoking during pregnancy.''