Missouri has one of the highest rates of maternal smoking in the country, according to new data from the Centers for Disease Control and Prevention.
The new report reveals that one in 14 women who gave birth in the U.S. in 2016, or 7.2 percent, reported smoking during pregnancy.
But in Missouri, that figure is much higher, with 15.3 percent of women reporting smoking during pregnancy.
“It’s pretty pervasive to have moms who smoke here in Kansas City and it is hard because there’s so much we don’t know still in terms of how to help them,” said Devika Maulik, an assistant professor at the University of Missouri-Kansas City and an obstetrician-gynecologist at Children’s Mercy Hospital and Truman Medical Center who specializes in high-risk pregnancies.
Smoking can have a huge impact on a pregnancy, Maulik said. It can increase the risk of pre-term birth, cause the fetus to be smaller, increase the risk of stillbirth, and increase the risk for SIDS after birth.
“Long-term data also show that babies born to smoking mothers are more likely to have asthma and obesity,” Maulik said.
According to the new research, West Virginia had the highest percentage of pregnant women who smoked at 25.1 percent; followed by Kentucky, 18.4 percent; Montana, 16.5 percent; and Vermont, 15.5 percent. States with the lowest percentage of pregnant smokers were Arizona, California, Connecticut, Hawaii, New Jersey, New York, Nevada, Texas and Utah.
Kansas, at 10.2 percent, also was above the national average and ranked 21st in the country.
The report, which also looked at the prevalence of smoking among pregnant women by race and educational attainment, is the first to include data for all states since maternal smoking habit questions on birth certificates were revised in 2003.
Generally, as women had more schooling, fewer smoked while pregnant, the study found. The prevalence of smoking during pregnancy was highest among women with a high school education, at 12.2 percent. Women with a bachelor’s degree or higher had a prevalence of smoking during pregnancy of 1 percent or less.
Smoking prevalence also varied by the race and ethnicity of the mother. Among non-Hispanic women, American Indian or Alaska Native women had the highest prevalence of smoking during pregnancy at 16.7 percent; followed by whites at 10.5 percent; blacks at 6 percent; Pacific Islanders at 4.5 percent; and Asians at .6 percent. Among Hispanic women, the rate was 1.8 percent.
So what can a pregnant woman do to quit smoking?
“The biggest factor in quitting smoking is whether the patient is motivated or not. Pregnancy itself is a big motivating factor," Maulik said.
But for those having a difficult time quitting, the options are limited. Research is mixed on whether nicotine replacement therapies like the patch and gum will help pregnant women, Maulik said. Those options would limit exposure to toxins, but nicotine can still negatively impact the fetus.
“We generally recommend quitting cold turkey if they can,” she said.
In addition to the high percentage of pregnant smokers, Missouri also has a higher maternal mortality rate than the rest of the U.S. , which already has the highest maternal mortality rate of all developed nations. The United Health Foundation’s 2016 Health of Women and Children Report pegged the national average at about 19.9 deaths per 100,000 live births, while Missouri’s maternal mortality rate was 28.5 deaths per 100,000 live births, which ranked 42nd nationally.
The leading causes of maternal death in Missouri are all cardiac-related, with embolisms caused by blood clots topping the list. The state’s high rates of smoking and obesity during pregnancy put women at higher risk for those complications. They also make them more likely to have diabetes or high blood pressure.
All of those risks are compounded when pregnant women don’t see a doctor regularly. A report released by the Missouri Department of Health and Senior Services in May found that 17.5 percent of Missouri women received no prenatal care in the first trimester of pregnancy.
That’s partly an issue of access, as well as cost: 67 Missouri counties don’t have a single OB/GYN, and 26 percent of Missouri women were uninsured in the months before they got pregnant.
Missouri Rep. Sarah Unsicker, a Democrat from the St. Louis area, has introduced a bill to establish a committee to look into every maternal death in the state.
Unsicker acknowledged that smoking during pregnancy is unhealthy, but she cautioned against overly stigmatizing people who do it. She said everyone makes choices that are not optimal for their health, whether it's what they eat and drink, how much they exercise or how they drive.
"We have to be careful not to moralize behavior just because the person who does it is pregnant," Unsicker said. "And we need to look at all causes of maternal death.”
Unsicker's bill has yet to advance to a vote, but Missouri Department of Health and Senior Services director Randall Williams previously said he supports the concept.