The Need for First Breath

Pregnancy Complications and Birth Outcomes
Pregnancy complications and adverse birth outcomes are higher among women who smoke during pregnancy.

  • Approximately 14% of miscarriages in the United States per year are attributed to smoking. 2
  • Maternal smoking increases risk of low birth weight and preterm birth. 1, 2, 3
  • Economic estimates indicate that the direct medical costs of a complicated birth for a smoker are 66% higher than for a nonsmoker. 4

Impacts on Breastfeeding
Maternal smoking impacts breastfeeding and milk supply.

  • Breastfeeding mothers who use tobacco can pass nicotine through their breast milk. 5
  • Tobacco use while lactating is associated with decreased milk supply 5 and shorter breastfeeding durations. 6

Impacts of Environmental Tobacco Smoke (ETS)
Mothers who smoke postpartum expose their babies to the effects of secondhand smoke. This includes mainstream smoke (smoke that is inhaled, and then exhaled by the smoker) and sidestream smoke (that comes off the end of a burning cigarette). Thirdhand smoke refers to the contaminants left over from secondhand smoke. The toxins stick to furniture, clothes, hair, and skin. Children exposed to ETS are more likely to suffer from:

  • Infant sleep disturbances 7
  • Bronchitis, pneumonia, asthma, and ear infections 7
  • Sudden infant death syndrome (SIDS)1, 2, 7, 8
  • Behavioral problems, lower achievement, and intelligence test scores 9

Health and Psychosocial Effects on Mothers
In addition to well-documented health effects on the mother (lung, breast, cervical cancer, heart disease, respiratory diseases), tobacco use during the perinatal period is also associated with psychosocial problems including:

  • Postpartum depression 10, 12
  • Increased maternal stress 11
  • Concurrent maternal substance use 13

Impact on Wisconsin Women
In 2010, 13% of pregnant women in Wisconsin used tobacco, compared to a national average of 9%. 14 Wisconsin has disproportionate rates of maternal smoking among certain target populations:

  • Younger women (under 25) are twice as likely to smoke during pregnancy as older women. 15
  • Pregnant women with a high school diploma or less are ten times more likely to smoke during pregnancy than women with a college degree. 15
  • Unmarried women are four times more likely to smoke during pregnancy than married women. 15
  • Women insured by Medicaid are three times more likely to smoke during pregnancy as women with private insurance. 14

Birth outcomes in Wisconsin vary greatly between smokers and non-smokers:

  • Between 2008 and 2010, the Infant Mortality Rate among smokers was 9.4 per 1,000 live births compared tp 5.7 per 1,000 live births for non-smokers. 16
  • Between 2008 – 2012, Low Birth Weight (<2,500 grams) among smokers was 11.1 % compared with 6.4% of non-smokers. 16

Certain regions of Wisconsin have higher maternal smoking prevalence. Seventeen counties in Wisconsin have maternal smoking prevalence of 2 ½ times higher than the national average. 15

Smoking During Pregnancy by County



Back to First Breath Provider Portal

  1. The U.S. Department of Health and Human Services outlines the following conclusions: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.
  2. Centers for Disease Control and Prevention. Tobacco Use and Pregnancy. 2012.
  3. U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation. A Report of the Surgeon General. Rockville, Maryland: Public Health Service, Centers for Disease Control, Office on Smoking and Health, 1990.
  4. Anon. Medical Care Expenditures Attributable to Cigarette Smoking During Pregnancy. United States. Morbidity and Mortality Weekly Report, 1997.
  5. Mennella JA, et al. Breastfeeding and Smoking: short term effects on infants and sleep. Pediatrics. 2007 Sep; 120 (3): 497-502.
  6. Giglia R, Binns CW, Alfonso H. Maternal cigarette smoking and breastfeeding duration. Acta Paediatr. 2006 Nov;95(11):1370-4.
  7. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006
  8. Byrd RS, Howard CR. Children’s Passive and Prenatal Exposure to Cigarette Smoke. Pediatric Annals, 1995.
  9. Sexton M, Fox NL, Hebel JR. Prenatal Exposure to Tobacco: II. Effects on Cognitive Functioning at Age Three. International Journal of Epidemiology, 1990.
  10. Glassman, A. Smoking Cessation and Major Depression. JAMA 1990.
  11. Lynch ME, Johnson KC, Kable JA, Carroll J, Coles CD. Smoking in pregnancy and parenting stress: maternal psychological symptoms and socioeconomic status as potential mediating variables. Nicotine Tob Res. 2011 Jul;13(7):532-9. Epub 2011 Mar 24
  12. Allen AM, Prince CB, Dietz PM. Postpartum depressive symptoms and smoking relapse. Am J Prev Med. 2009 Jan;36(1):9-12. PubMed PMID: 19095161.
  13. Powers JR, McDermott LJ, Loxton DJ, Chojenta CL. A Prospective Study of Prevalence and Predictors of Concurrent Alcohol and Tobacco Use During Pregnancy. Matern Child Health J. 2012 Feb 19. [Epub ahead of print]
  14. Smith, S. Smoking and Pregnancy. Insights: Smoking In Wisconsin. University of Wisconsin School of Medicine and Public Health and Center for Tobacco Research and Intervention. 2002.
  15. Palmersheim KA. Smoking During Pregnancy in Wisconsin and the United States: Trends and Patterns, 1990-2010. Milwaukee, Wisconsin: University of Wisconsin-Milwaukee Center for Urban Initiatives and Research, 2012.
  16. Wisconsin Department of health Services. WI Interactive Statistics on Health Data Query System, Maternal Smoking Prevalence Module.