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1992.04.21 :  Smoking and Pregnancy Data

Contact: Sandra Smith  (301) 436-7551
April 21, 1992

        Drawing data from the expanded birth certificate first used
in 1989, the National Center for Health Statistics today reported
that pregnant women who smoked cigarettes were nearly twice as
likely to have infants of low birth weight -- the single most
important predictor of infant deaths.  
        In 1989, 20 percent of mothers smoked during pregnancy,
according to the NCHS report, the first to analyze data from the
new certificates.  Most at risk were older mothers and those who
smoked the most:  Women who smoked 1.5 to two packs of cigarettes
per day were about one-third more likely to have a low-birth-weight
infant than those who smoked half a pack -- and 2.5 times as likely
as nonsmokers.
        In releasing the report today, HHS Secretary Louis W.
Sullivan, M.D., said, "Our efforts to improve the health of mothers
and babies just took a big leap forward.  For the first time, we
have information on maternal medical and life-style risk factors
for the more than 4 million births annually in the United States. 
We can identify mothers at risk and practices that put them in
harm's way."
        Also at risk to have low-birth-weight infants were the more
than one in five mothers who gained less than 22 to 27 pounds, the
weight gain recommendation in effect in 1989.  Their infants were
two to four times as likely to be low birth weight.  
        Low birth weight was also associated with complications
during labor and delivery and abnormal conditions in the newborn
such as respiratory distress syndrome, a leading cause of infant
deaths.

        James Mason, M.D., assistant secretary for health and head
of the Public Health Service, said, "This analysis of the smoking
risk, as well as other facts and figures still to come, will help
as we carry out our Healthy Start programs in high-infant-mortality
areas."  Mason has been visiting communities to work with them as
they develop new efforts to combat infant mortality.   

        "The findings show conclusively that teen-age parenting can
be a hazard to the mother and to her child," according to William
Roper, M.D., director of the Centers for Disease Control.  "Teen-
age mothers are more likely to have such conditions as anemia and
hypertension during their pregnancies, less likely to receive
prenatal care and less likely to gain the recommended weight during
their pregnancies.  

        "And most importantly," he said, "teen-age mothers 18 and
19 years of age have the highest smoking rates of any age group --
almost one-fourth are smokers."  Young teens -- those under 15 --
however, had the lowest rate of cigarette smoking.

        Overall, black mothers were less likely to smoke than their
white counterparts (17 percent compared to 20 percent), and those
who did smoke, smoked fewer cigarettes.  The rate of cigarette
smoking was also relatively low, at 8 percent, among Hispanic
mothers.  

        Education affects tobacco use.  The proportion of smokers
generally declined with advanced educational attainment:  The
highest rate was 35 percent for women with less than high school
education, and the lowest was for college graduates, 5 percent.  

        Eighteen percent of women whose pregnancies lasted 40 weeks
or longer gained less than 21 pounds, according to Stephanie
Ventura, a senior natality analyst at NCHS who wrote the report. 
Black mothers were almost 60 percent more likely than white mothers
to gain less than 21 pounds and were 86 percent more likely to gain
less than 16 pounds.  Even after controlling for age, marital
status or educational attainment, which also affect weight gain,
large racial differences still persist, she reported.    

        The new certificate has expanded reporting of risk factors,
and also of obstetric procedures performed, methods of delivery,
abnormal conditions and congenital anomalies of the infant. 
Electronic fetal monitoring to record the infant's heart beat and
the mother's uterine contraction was reported for more than two-
thirds of all births -- more than any other procedure.  Ultrasound
had been performed for almost half of the births in 1989.   
        Cesarean section was the method of delivery for 22.8
percent of all births in 1989.  The primary cesarean rate was 16.1
percent for births to women with no previous cesarean delivery. 
More than one-third of the 1989 cesarean deliveries were repeat
procedures.  Among women giving birth who had a previous cesarean
delivery, 19 percent had a vaginal delivery in the 1989 pregnancy. 
 

        Cesarean delivery rates increased directly as mothers get
older, rising from 17 percent for teen-age mothers to nearly one-
third of deliveries for women in their forties.  Certain medical
conditions -- diabetes, genital herpes, hypertension and uterine
bleeding -- made a cesarean more likely. 

        Data in this report are based on 100 percent of the birth
certificates in all states and the District of Columbia.  The vast
majority of states report on all items on the birth record.  Data
are provided to the National Center for Health Statistics through
the Vital Statistics Cooperative Program.  NCHS is part of the
Centers for Disease Control, one of the eight Public Health Service
agencies within the Department of Health and Human Services.  

        Copies of "Advance Report of New Data from the 1989 Birth
Certificate" are available from NCHS, Room 1064, 6525 Belcrest
Road, Hyattsville, Md. 20782.


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