Pregnancy Nutrition Surveillance System - Smoking/Drinking Indicators

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Smoking/Drinking Indicators

Smoking During Pregnancy refers to the active use of cigarettes. It is associated with an increased risk for low birthweight delivery, spontaneous abortion, sudden infant death syndrome as well as long-term negative effects on growth and development, behavior and cognition of the infant. (IOM, 1996, Healthy People 2010) Healthy People 2010 calls for an increase in smoking cessation during pregnancy during the first trimester of pregnancy. (HP 2010)

Cigarette smoking 3 months prior to pregnancy indicates the number of women who reported smoking any number of cigarettes during the 3 months before pregnancy and is used to determine smoking cessation. According to the Surgeon General's report on the benefits of smoking cessation, women who discontinue smoking prior to becoming pregnant deliver babies of the same birthweight as women who never smoked. (Surgeon General, 1990)*

  • Cigarette smoking during pregnancy indicates the number of women who reported smoking at the initial prenatal visit (the time of enrollment in the participating PNSS program) and is used to determine smoking cessation at the initial prenatal visit. It is estimated that 20 percent of low birthweight deliveries could be prevented with the elimination of smoking during pregnancy. (Surgeon General Report, 1990)
  • Cigarette smoking during the last 3 months of pregnancy indicates the number of women who reported smoking any number of cigarettes during the last 3 months of pregnancy. Postpartum women are asked if they smoked the last 3 months of pregnancy. Women who quit smoking at later stages, up to 30 weeks gestation, deliver babies with higher birthweights than women who continue smoking. (Surgeon General Report, 1990)
  • Cigarette smoking during the postpartum period indicates the number women who reported that they were currently smoking at the time of their postpartum visit. It is used to determine smoking cessation at the postpartum visit. Of the women who stopped smoking during pregnancy, 70 percent resume smoking within a year of delivery. Children of women who smoke after delivery report more frequent respiratory and middle ear infections. (Surgeon General Report, 1990)

Smoking Changes are health indicators that show changes in the smoking behaviors of women that smoked cigarettes prior to pregnancy and quit by the first prenatal visit.

  • Quit smoking by the first prenatal visit refers to the number of women who smoked 3 months prior to pregnancy but quit by their initial prenatal visit (the time of enrollment in the participating PNSS program). Women who smoke during the first and second trimesters have a 70 percent increased risk of delivering a low birthweight infant compared to a 30 percent increased risk for women who smoked during the first trimester only. (Surgeon General, 1990)
  • Quit smoking by first prenatal visit stayed off cigarettes refers to the number of women who reported smoking 3 months before pregnancy but quit smoking at the initial prenatal visit (time of enrollment in the participating PNSS program) and were not smoking during the last three months of pregnancy. Women who quit smoking during the first 3-4 months of pregnancy and remain abstinent throughout pregnancy reduce their risk of having a low birthweight baby to that of women who never smoked. (Surgeon General, 1990)

Smoking In Household refers to the exposure to tobacco-contaminated air at home. This indicator assesses whether anyone in the household other than the pregnant woman smoked at the time of her prenatal visit. A study on the exposure to tobacco smoke among young infants (6 -8 weeks old) living in homes where one member of the family other than the mother smoked showed higher levels of cotinine compared to infants not exposed to smoking. (Chilmonczyk, 1990) Infants and children exposed to particles from secondhand smoke are at risk for impaired health, growth and development. Exposure to tobacco smoke is associated with lower and upper respiratory problems and asthma. (IOM, 1996) A recent review (Misra and Nguyen, 1999) indicates that mothers exposed to environmental tobacco smoke were 1.5 – 4 times more likely to deliver infants who were low birthweight or small-for-gestational age than mothers who were not exposed.


Drinking refers to the use or consumption of alcohol during pregnancy. Alcohol is rapidly absorbed and enters fetal circulation and maternal milk. Pregnant women who consume more than 6 ounces of liquor (or the equivalent) per day have a 20 percent chance of having a child with Fetal Alcohol Syndrome (FAS). (Benson and Pernell, 1994). Adverse physical and neurological problems may occur at lower levels of exposure to alcohol. (Bloss, 1994) Healthy People 2010 calls for abstinence from alcohol during pregnancy. Drinking during pregnancy is assessed using the two indicators listed below.

  • Drinks consumed 3 months prior to pregnancy - This indicator reflects the number of women who reported any drinking during the three months prior to pregnancy. Although women tend to decrease alcohol consumption once they realize they are pregnant, many don't realize they are pregnant until late in the first trimester (Floyd 1999). In reporting first trimester consumption, many women report their drinking levels after they became aware that they were pregnant. Alcohol consumption prior to pregnancy is reported to be a better measure of consumption during the first trimester.(Day 1993)
  • Drinks consumed during the last 3 months of pregnancy – This indicator reflects the number of women who reported any drinking during the last three months of pregnancy. In general, drinking during pregnancy decreases once a woman realizes she is pregnant and continues throughout pregnancy. (Day 1993) However women who continue to drink throughout pregnancy are at a higher risk for poor pregnancy outcomes. (Day 1993)