Maternal Smoking

Sex and Gender-based Analysis of this topic

Definition

The rate of maternal smoking during pregnancy is the number of pregnant women who smoked cigarettes during pregnancy expressed as a proportion of all pregnant women in a given place or time [1]. In 2007, 10% of Canadian women aged 20-44 smoked regularly during pregnancy [2], whereas in 1995, the rate was 19% for the same age group. In British Columbia, maternal smoking prevalence has steadily decreased from 12% in 2001/2002 to 10% in 2005/2006 [3].

 
 
Sex Issues

Maternal smoking has been linked with increased risk of adverse effects for the mother and fetus. [4-7]. Negative health effects specific to pregnant women include: increased risk of miscarriage, premature rupture of membranes, and placenta previa [4, 8]. Smoking elevates the risk of infant mortality through increased incidence of preterm birth, low birth weight, spontaneous abortion, still birth and is also linked with intrauterine growth restriction (IUGR) [9]. Maternal smoking is strongly associated with postnatal smoking, which has potential long-term effects on the health of the child, such as impaired physical and intellectual development, behavioural changes, asthma, and other respiratory infections [4-8, 10-11].

 
 
Gender Issues

Women are exposed to many factors that may increase their risk of maternal smoking. Women are more likely than men to be economically disadvantaged [12], a factor that is associated with smoking and maternal smoking [13].

The smoking habits of a pregnant woman’s partner are also a determinant of maternal smoking and cessation both during and following pregnancy. Living with a partner who smokes elevates the risk of smoking during pregnancy and often decreases the success of cessation during pregnancy and increases the likelihood of relapse post-partum [14-17]. Moreover, persuading a partner to quit smoking may be challenging for some women, regardless of the associated health effects on the entire family.

 
 
Diversity

The prevalence of maternal smoking in Canada varies greatly by region and population subgroup. In 2000/2001, maternal smoking rates ranged from 28% in PEI and Saskatchewan to 14% in British Columbia [3]. Noticeable discrepancies in BC’s smoking during pregnancy rates also exist. The Northern Health Authority has the highest smoking rate in the province of 18%, compared to the lowest rate of 4% in 2006/2007 in the Vancouver Health Authority [3].

Maternal smoking rates also vary greatly by age. In 2007, 23% of women aged 20-24 smoked regularly during pregnancy compared to 8.5% of pregnant women aged 25-44 [3]. Maternal smoking is more prevalent among women who are unmarried and have low income and low education levels [13]. High maternal smoking rates occur among Francophone and Aboriginal women in particular [18, 19].

 
 
Critique

There is limited standardized data addressing maternal smoking, which results in difficulties when trying to compare the data. Maternal smoking data has only recently started to be collected, making the identification of temporal and regional trends a challenge. Behavioral data about maternal smoking, such as whether and how smoking behaviour changes during pregnancy are also lacking. Inaccuracies in current maternal smoking may exist as the data by the National Public Health Survey (NPHS) and the National Longitudinal Survey of Children (NLSC) are collected retrospectively, up to five years after the birth of the child. This data is only collected on children who are alive, which may bias the maternal smoking information [1]. 

The current data on maternal smoking rates may under-represent/underestimate actual rates due to the stigma attached to maternal smoking and self-report data. Adopting biochemical measures to assess tobacco exposure (e.g., urine cotinine concentration) may be a more accurate determination of this indicator.

 
 
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health determinants > substance use > maternal smoking