Definition

Women who reported smoking during the third trimester of their pregnancies.

Numerator

Number of women reported on Utah Certificates of Live Births as having smoked in the last trimester of their pregnancies.

Denominator

Number of live births to Utah residents regardless of where they occurred.

Data Interpretation Issues

Cigarette 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 percentage of women who report smoking in the third trimester of pregnancy is higher on the PRAMS surveys (2.3% in 2021) which are submitted anonymously, than rates from certificates of live births (1.4% in 2021) 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?

2022 Utah Vital Records data drawn from Certificates of Live Births indicate that 1.2% of women smoked during the last trimester of their pregnancies. Smoking before pregnancy can make it harder for women to get pregnant. During pregnancy, women who smoke cigarettes have a higher risk of delivering their infant too early and with low birth weight, making it more likely their infant will be sick and have to stay in the hospital longer. These infants also have a higher risk of having some kinds of birth defects such as cleft lip and palate. Infants whose mothers smoked during pregnancy or were exposed to secondhand smoke after delivery have a higher risk of sudden infant death syndrome (SIDS). There is no safe level of tobacco use or exposure for women and their infants. (50 Years of Progress: A Report of the Surgeon General: [https://www.ncbi.nlm.nih.gov/pubmed/24455788])

Other Objectives

There is no Healthy People 2030 Objective for third-trimester smoking. However, there is a more general 2030 Objective (MICH-10) to increase abstinence from cigarette smoking among pregnant women, with a target of 95.7%. Additionally, HP2030 Objective (TU-15) seeks to increase smoking cessation during pregnancy, with a target of 24.4%.

How Are We Doing?

According to Utah Vital Records data, the percentage of people who smoked during the third trimester decreased from 1.7% in 2020 to 1.2% in 2022. Smoking during the third trimester was recorded at higher percentages among residents of rural local health districts such as Southeast (8.7%), TriCounty (6.0%), Central (2.9%), and Tooele (2.8%) compared to all Utah residents who gave birth from 2020-2022.

How Do We Compare With the U.S.?

Current national data for smoking during the third trimester are not available.

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 and Human Services (DHHS) Medicaid Program and Department of Workforce Services workers screen all pregnant applicants for tobacco use at the time of enrollment. Smokers are provided with cessation information and followed up every six weeks throughout their pregnancies. Medicaid clients tend to have higher smoking rates than average, so the DHHS 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 TPCP at the Utah Department of Health and Human Services maintains a comprehensive quit website - [http://waytoquit.org]. The Utah anti-tobacco marketing campaign encourages Utah smokers to make quit attempts and informs them about [http://waytoquit.org waytoquit.org] and other quit programs. 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, the Pregnancy Risk Assessment Monitoring System (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. PRAMS data from 2021 show 20.1% of the people who smoked e-cigarettes in the past two years, said they smoked e-cigarettes in the third trimester of their pregnancies. 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.''[[br]] [[br]]

Available Services

The Utah comprehensive tobacco cessation website, [http://waytoquit.org waytoquit.org], offers help and tips for quitting tobacco, as well as information about the Utah Tobacco Quit Line and the Utah online quit coaching program. To receive more information about Tobacco Prevention and Control Programs in Utah, call the Tobacco Free Resource Line at 1-877-220-3466. For information on quitting smoking, call the Utah Tobacco Quit Line at 1-800-QUIT-NOW or visit the Utah online tobacco cessation support program at: [https://www.quitnow.net/mve/quitnow?qnclient=Utah].

Relevant Population Characteristics

According to 2020-2022 Vital Records, the rate of smoking during the third trimester of pregnancy is highest among women 35-44 years of age. According to 2022 PRAMS data, smoking during the third trimester is more prevalent among women with no post high school education, who are unmarried, and have Medicaid for prenatal care.

Health Care System Factors

According to 2022 PRAMS data, 94% of people were asked during a prenatal care visit if they were smoking cigarettes.

Risk Factors

According to 2020-2022 Vital Records, the rate of smoking during the third trimester of pregnancy is highest among women 35-44 years of age. According to 2022 PRAMS data, smoking during the third trimester is more prevalent among women with no post high school education, who are unmarried, and have Medicaid for prenatal care.

Health Status Outcomes

According to 2020-2022 Utah PRAMS data, women who smoked during the third trimester of pregnancy had statistically significant higher rates of low birth weight infants when compared with non-smokers (9.6% vs 6.2%). Additionally, women who smoked during the third trimester of pregnancy had higher rates of postpartum depressive symptoms than non-smokers (25.4% vs. 15.2%).

Data Source

Utah Birth Certificate Database, Office of Vital Records and Statistics, Utah Department of Health and Human Services

Data Notes

Due to the relatively small number of women reporting smoking in the third trimester of pregnancy, three consecutive years of data are grouped. ** The estimate for the 45-54 age groups has been suppressed because 1) the relative standard error is greater than 50% or the relative standard error can't be determined or 2) the observed number of events is very small and not appropriate for publication.

Data Source

Utah Birth Certificate Database, Office of Vital Records and Statistics, Utah Department of Health and Human Services

Data Notes

Due to the relatively small number of women reporting smoking in the third trimester of pregnancy, three consecutive years of data are grouped together to provide sufficient data for analysis. ** The values for San Juan, Summit, and Wasatch local health districts are suppressed because 1) the relative standard error is greater than 50% or 2) the observed number of events is very small and not appropriate for publication.

Data Source

Utah Birth Certificate Database, Office of Vital Records and Statistics, Utah Department of Health and Human Services

References and community resources

CDC Tobacco Use and Pregnancy[[br]] [https://www.cdc.gov/tobacco/campaign/tips/diseases/pregnancy.html] March of Dimes[[br]] [http://www.marchofdimes.org/pregnancy/smoking-during-pregnancy.aspx] Health Consequences of Smoking - Surgeon General Fact Sheet[[br]] [https://www.hhs.gov/surgeongeneral/reports-and-publications/tobacco/consequences-smoking-factsheet/index.html] The Surgeon General's Report 2010: A Report of the Surgeon General: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, Executive Summary[[br]] [https://www.ncbi.nlm.nih.gov/books/NBK53017/] 50 Years of Progress: A Report of the Surgeon General[[br]] [https://www.ncbi.nlm.nih.gov/pubmed/24455788]