While everyone knows that smoking is bad for you and that smoking while pregnant is bad for baby, too, pregnant smokers don't receive much help from their physicians to quit smoking, and few quit once they enter prenatal care, according to a new study.

The study found that almost half of pregnant New Jersey smokers quit smoking before entry into prenatal care, but that only about 5 percent quit after entering prenatal care. What's worse is that although prenatal care providers asked almost every woman entering prenatal care if they smoke, "only 56.7 percent reported that a provider counseled them to quit smoking," said lead author Van Tong, of the Centers for Disease Control and Prevention.

"More work is needed to increase the knowledge, promotion and referral of effective cessation programs for pregnant women and, ideally, to prevent young women from ever initiating smoking," she said.

The researchers analyzed questionnaire data from 4,473 women in the Pregnancy Risk Assessment Monitoring System (PRAMS) in New Jersey from 2004 to 2005. They selected New Jersey respondents because that state's survey has additional questions on smoking patterns and the use of cessation services.

The study appears in the October issue of the American Journal of Preventive Medicine.

While some question the accuracy of self-reported data, Corinne Husten, M.D., said that smoking behavior reports in population surveys are actually quite accurate.

"Self-reported smoking behavior gathered through population surveys is generally accurate because it is anonymous," Husten said. "Pregnant women are more likely to misreport their tobacco use in cessation studies and to their personal health care provider. This survey asked the questions in a way to minimize deception." Husten, who is vice president for policy development at the Partnership for Prevention, had no affiliation with the study.

On a positive note, the new data show an estimate of quitting before prenatal care that is 1.8 to 4.5 times higher than estimates from studies conducted from the 1990s and before, Tong said.

However, Husten says the most salient implication of the study is that so many providers aren't doing anything to help pregnant women quit smoking. "A 57 percent intervention in this high-risk population is unacceptable," she said.

Tong VT, et al. Smoking patterns and use of cessation interventions during pregnancy. Am J Prev Med 35(4), 2008.

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