Top 5 Takeaways

  1. Prevalence of Smoking: In 2021, 12.1% of women reported smoking before pregnancy, 5.4% during pregnancy, and 7.2% postpartum. Smoking cessation during pregnancy was reported by 56.1% of those who smoked before.
  2. Variability by Demographics: Smoking rates varied significantly by demographic factors and jurisdictions, with the highest rates before pregnancy in West Virginia (20.2%) and during pregnancy in Maine (11.0%).
  3. Health Care Provider Inquiries: High rates of healthcare inquiries about smoking were reported during prenatal visits (93.7%), but significantly fewer women (57.3%) were asked about smoking during postpartum checkups.
  4. Impact of Interventions: Evidence-based strategies such as public health campaigns and smoke-free policies have been effective in reducing smoking rates among pregnant women, demonstrating the importance of sustained tobacco control measures.
  5. Recommendations for Practice: Routine assessment of smoking behavior by health care providers can improve cessation support and should be integrated consistently throughout pre-pregnancy, pregnancy, and postpartum care.

Original Article Author and Citation

Corresponding Author

Shanna Cox, MSPH,

Suggested Citation

Kipling L, Bombard J, Wang X, Cox S. Cigarette Smoking Among Pregnant Women During the Perinatal Period: Prevalence and Health Care Provider Inquiries — Pregnancy Risk Assessment Monitoring System, United States, 2021. MMWR Morb Mortal Wkly Rep 2024;73(17):393–398. DOI:


This report highlights the continued challenge of cigarette smoking among pregnant women in the U.S., noting varying prevalence across different states and demographic groups. It underscores the critical role of health care providers in addressing this issue through consistent screening and intervention.


Data was analyzed from the 2021 Pregnancy Risk Assessment Monitoring System (PRAMS), covering self-reported smoking behaviors before, during, and after pregnancy, including inquiries by healthcare providers at different stages of care.


The findings indicate a need for more consistent healthcare provider involvement in smoking cessation, particularly during the postpartum period, to sustain the gains made during pregnancy and support long-term cessation.


Enhanced and consistent screening for smoking by healthcare providers throughout the perinatal period is essential for reducing smoking rates among pregnant and postpartum women and mitigating risks to maternal and infant health.

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