Maryland's Tobacco Resource Center - Linking Professionals to Best Practices


If all pregnant women stopped smoking it is estimated that the number of infant deaths would decrease by 10%.1

  • Providers: Have you heard about the NEW PREGNANCY REWARDS PROGRAM through the Maryland Tobacco Quitline?  Extended services continue to include 1)  10 pre and post partum sessions 2)  Free NRT with prescription. Now pregnant smokers can earn up to $90 in gift cards! 
  • Also, providers can take advantage of MDH's easy to use, brief intervention toolkit by clicking here


Pregnancy and Smoking

Recent research in the patterns of brain development has shown a strong relationship between prenatal conditions and future development of abnormalities in youth.  Not all abnormalities that develop over a lifetime are the result of prenatal negligence, but many abnormalities seem to have a connection with complications during gestation.  One of the most dangerous behaviors an expecting mother can engage in is exposing her fetus to any of the thousands of chemicals in cigarette smoke, either directly or through secondhand smoke.

  • Roughly 22% of women in the United States use tobacco products and as many as 13-22% of them smoke while pregnant.1
  • Since the fetus’s circulatory system is in part regulated by the mother’s body, anything inhaled by the mother and carried through her bloodstream has direct access to the baby.  These toxins will:2
  • Decrease amount of oxygen the baby receives
  • Increase the baby’s heart rate
  • Increase the baby’s risk of developing respiratory complications
  • Increase the risk of premature birth or miscarriage

Smoking and the Baby

Due to the high rate of development during this time, the baby is highly sensitive to these toxins as slight chemical deviations could significantly alter development.  Smoking while pregnant increases the baby’s risks to a number of complications during development including:3

  • Low birth weight
  • Multiple placental problems
  • Premature birth
  • Death

Smoking while pregnant also increases risk of complications following childbirth including:4

  • Childhood obesity
  • Otitis media
  • Respiratory infections
  • Poor learning skills
  • Problems processing sound
  • Decreased cognitive abilities
  • Asthma
  • Withdrawal symptoms
  • Sudden Infant Death Syndrome (SIDS)

Smoking and the Mother

The risks to the baby during and after the pregnancy are the result of exposure to lethal levels of carbon monoxide, toxicity from the roughly 4,000 chemicals in cigarette smoke, damage to genetic material and significantly decreased amounts of oxygen that reach the baby’s brain during development.3,4,7  These are all risk factors that ultimately explain why babies born to smokers are almost 60% more likely to die as infants than babies born to nonsmokers.1  These problems are not limited to being a consequence of just direct smoke, as research shows that exposure to secondhand smoke is equally as detrimental to the baby’s health during development.2  As alarming as these conditions are, the focus should not solely be on the infant, but also the mother as smoking also puts her at risk for many additional complications including:4,5,6

  • Menstrual and reproductive problems
  • Infertility
  • Conception delay
  • Ectopic pregnancy
  • Spontaneous abortion
  • Decrease of breast milk by 50%
  • Decrease of calories and fat available in remaining breast milk by 40%

Cigarette smoking is extremely harmful to both the mother and child as the negative effects can be seen long before fertilization and long after childbirth.  Cessation rates in pregnant women are as high as 85%, which is likely due to education around such varied and profound negative effects from smoking.7  Women who continue to smoke during pregnancy are likely to be:5,7,8

  • White (non-Hispanic)
  • Low socioeconomic status
  • Between 15-19 years old
  • High school dropouts, or earlier
  • Did not plan pregnancy
  • Overwhelmed by external stresses (e.g., familial, financial, social, etc.)

Unfortunately, quitting mainly for the sake of the baby’s growth during gestation seems to be related to neglecting the other ways in which cigarette smoke can affect the baby’s health after birth.  As a result, these women have extremely high rates of relapse at 50-80% within 6 months after giving birth and 60-90% within the first year.1,2,5,7   Characteristics of women who relapse and remain abstinent, respectively, are:2,7

Characteristics of mothers who…


Remain Abstinent

  • Young
  • Middle-aged
  • Single
  • Married
  • Low education
  • High education
  • Heavy smoker
  • Light to moderate smoker
  • Quit late into pregnancy
  • Quit before or early into pregnancy

Treatment Considerations for a Pregnant Woman

Smoking any tobacco product in any amount has both short-term and long-term detrimental effects and smoking particularly during the second or third trimesters is especially harmful to the baby.5  The more cigarettes a pregnant woman smokes per day, the greater her baby's chances of developing health problems.  There is no "safe" level of smoking while pregnant.

Just as important to the baby’s health is the timing of the mother’s decision to quit.  Essentially, the sooner the mother quits, the more likely her baby is going to be born without tobacco-related health complications. 

Simply getting the message out is the first step towards a healthier future.  A decline in the percentage rate of pregnant smokers by only one point would save over $20 million worth of medical services and would prevent 1,300 cases of low birth weight each year.2

Use of pharmacological interventions such as gum, pills or patches must be considered carefully as nicotine has adverse effects on the baby’s development despite the absence of tobacco’s numerous other chemicals.7  As a result, behavioral techniques are the most ideal as they are associated with the least amount of side effects.7

Treatment Considerations following Birth

Many reasons have been provided regarding the decision to relapse back into smoking, such as…

  • A desire for weight loss, which was consistently seen across studies as one of the more common reasons to begin smoking again.5
  • Reducing stress.9
  • Providing a break in the day.9
  • Alleviating boredom.9
  • Providing a way to socialize with friends.9

Factors that may help counteract relapse and help mothers remain abstinent:

  • Breastfeeding the child routinely following birth.
    • Breastfeeding is not only beneficial for the mother’s weight loss, but also for the baby’s health as well as the health of the mother’s breast.1
    • Unfortunately, women who smoke are significantly less likely to breastfeed their baby than women who do not smoke.5
  • Having a strong social network. 5


Smoke Free Families Smoke-Free Families is a national program supported by The Robert Wood Johnson Foundation working to discover the best ways to help pregnant smokers quit, and spread the word about effective, evidence-based treatments.

Smoke Free Women As a part of the National Cancer Institute's smoke free initiative, this site provides information and tools that specifically address women’s experiences as they become smoke-free. Information, resources, and support to help smokers quit -- wherever they are on their quit journey -- are available.

Rocky Mountain Health Plans 5 A's and Stages of Change PDF File: A document for the Colorado Health Plan's program "Stickers-Suckers-Smokers" that contains the 5 A's and Stages of Change for quitting smoking during pregnancy in an easy-to-read two page chart format

MDQuit Newsletter April 2011 Topic issue of smoking during pregnancy

MDQuit's 2nd Annual Best Practices Conference page Dr. Cathy Melvin's presentation on pregnancy and second hand smoke.

Training for Healthcare Professionals: "Smoking Cessation for Pregnancy and Beyond: A Virtual Clinic"
E-Cigarettes and Pregnancy is a free, online interactive presentation on electronic nicotine delivery systems and their potential health effects during and after pregnancy, and discusses effective tobacco cessation treatments.

  1. Minnesota Department of Health-Family Health Infant Mortality Reduction Initiative. (2004). Health Tip Sheet: Tobacco and Pregnancy. Retrieved October 24, 2011 from
  2. Nazarioa, B. (March 2009). Smoking during pregnancy. Health and Pregnancy. Retrieved October 24, 2011 from
  3. Rodriguez, M.H. (2005). Helping patients to stop smoking. Retrieved October 27, 2011 from
  4. March of Dimes. (2004). Smoking during pregnancy. Retrieved October 31, 2011
  5. Center for Disease Control. (2005). Tobacco use and reproductive outcomes fact sheet. In Women and smoking: A report of the surgeon general 2001. Retrieved October 26, 2011
  6. Moyer, D. (2000). The tobacco reference guide: Chapter 14 pregnancy and fertility. Retrieved October 31, 2011
  7. Fang, W.L., Goldstein, A.O., Butzen, A.Y., Hartsock, S.A., Hartmann, K.E., Helton, M., & Lohr, J.A. (2004). Smoking cessation in pregnancy: A review of postpartum relapse prevention strategies. From the Journal of the American Board of Family Practice. Retrieved October 24, 2011 from
  8. NGA Center for Best Practices Issue Brief. (2001). Tobacco and pregnancy fact sheet. Retrieved October 24,2011 from
  9. Edwards, N. and Sims-Jones, N. (1998). Smoking and smoking relapse during pregnancy and postpartum: Results of a qualitative study. Birth, 25: 94–100. doi: 10.1046/j.1523-536x.1998.00094.x