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Prevalence of smoking is generally higher among men. In 2002, the prevalence of smoking in the three months before pregnancy ranged from 13.6 percent (Utah) to 37.0 percent (West Virginia) in the last three months of pregnancy, from 6.8 percent (Utah) to 25.3 percent (West Virginia) and after pregnancy, from 9.0 percent (Utah) to 33.7 percent (West Virginia) ( Williams et al. CDC’s Pregnancy Risk Assessment Monitoring System is an ongoing, population-based surveillance system designed to identify and monitor selected self-reported maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver a live infant. From 2002 to 2005, 17.3 percent of pregnant women reported smoking cigarettes in the past month ( NSDUH Report 2007). Smoking rates among women of reproductive age vary by other factors such as education, race, and geographic area, ranging from about 10 percent in Utah to nearly 30 percent in Kentucky and West Virginia ( CDC 2005). In 2007, 17.4 percent of all women and approximately 19 percent of women of reproductive age (18 through 44 years) smoked cigarettes ( Centers for Disease Control and Prevention 2008). Along with more than four million births in the United States annually, 10 to 20 percent of pregnancies end in miscarriage or stillbirth before delivery, and another 10 percent of couples who want to conceive a child experience infertility or reduced fertility.

Tobacco smoke contains thousands of compounds, some of which are known to have toxic effects on reproductive health, such as carbon monoxide ( CO), nicotine, and metals. Health professionals have long considered exposure to tobacco smoke harmful to reproduction, affecting aspects from fertility and pregnancy outcome to fetal and child development.

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