Smoking and stressful life events during pregnancy, Maryland, 2001-2007

Background: Smoking during pregnancy is a risk factor for poor birth outcomes. The goal of this analysis was to understand the associations between smoking and stressful life events during pregnancy.

Methods: Data were obtained from a stratified random sample of 10898 mothers who delivered live infants during the years 2001-2007 and completed the Maryland Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Descriptive analyses were performed using SAS. Smoking during pregnancy was based on the number of cigarettes smoked daily during the last 3 months of pregnancy. Stressful life events were those that occurred in the 12 months before delivery.

Results: In Maryland, of the 9.5% of mothers who reported smoking during pregnancy, 4.5% smoked <= cigarettes/day (lighter smokers), and 5.0% smoked >5 cigarettes/day (heavier smokers). Smoking was most prevalent among White non-Hispanics.

Twenty-one percent of heavier smokers experienced a large number (6-13) of stressful events compared to lighter smokers (11.2%) and nonsmokers (4.4%). Smokers were significantly more likely than nonsmokers to report experiencing all types of stressful events surveyed, including: separation/divorce, inability to pay bills, physical fight, jail or partner in jail, homelessness, and job loss.

There were racial disparities, especially among heavier smokers. Black heavier smokers were significantly more likely to report homelessness (Black:28.0%; White:9.1%), and physical fights (Black:33.0%; White:8.9%).

Discussion: This analysis indicates that smoking during pregnancy is associated with increased stressful life events. Multiple serious difficulties disproportionately face women that smoke during pregnancy. Knowledge about these associated factors may affect the design of smoking cessation programs.