PROBLEM:  Tobacco is the leading preventable cause of death in the United States, killing over 178,000 women each year.   The Centers for Disease Control and Prevention (CDC) reports devastating consequences caused by smoking during pregnancy: A pregnant women who smokes is between 1.5 and 3.5 times more likely to have a low birth weight baby.   Cigarette smoking has been associated with increased risk of ectopic pregnancy, placenta complications and stillbirth.  Additionally, infants whose mothers smoke during pregnancy have 2.3 times the risk of Sudden Infant Death Syndrome than infants of non-smoking pregnant women.

EVIDENCE OF SMOKING IN PREGNANCY IN ILLINOIS:

• Overall, between 15 percent and 30 percent of women smoke at some point during their pregnancy. 

• According to Pregnancy Risk Assessment Monitoring System (PRAMS) data, Illinois Medicaid-eligible women are more likely to smoke than non-Medicaid women prior to pregnancy. 

• Approximately 28% of the Medicaid-eligible women smoke three months prior to pregnancy while 18% of the non-Medicaid women smoke three months prior to pregnancy.

EFFECTS OF SMOKING CESSATION INTERVENTION:

• Infants of women who quit smoking by the first trimester have weight and body measurement comparable to infants of nonsmokers. 

• Prenatal smoking cessation programs have been shown to have a protective effect on intrauterine growth retardation.

ECONOMIC BENEFITS OF SMOKING CESSATION PROGRAMS:

• The CDC reports the total cost of adult smoking to Medicaid in 1997 was estimated to be more than $17 billion, or 12.1 % of all Medicaid expenditures.  This estimate did not include neonatal health care costs. 

•  The CDC further reports that direct neonatal health care costs attributable to maternal smoking that were paid by Medicaid in 1996 are estimated to be more than $227 million.  Early studies suggest that every $1 spent on smoking cessation for pregnant women could save about $3 in reduced neonatal intensive care costs. 

• A single percentage point decline in smoking prevalence among pregnant women could prevent 1,300 cases of low birth weight among babies annually and save $21 million in direct medical costs.

• Currently, the Illinois Department of Public Aid (IDPA) covers pharmacology therapy, however, no studies are currently available on the effectiveness or safety of these products for pregnant women.  Therefore, physicians may be reluctant to recommend these products to pregnant women.  Currently, IDPA does not cover smoking cessation counseling or classes, as a separate, unique service.

ESTIMATED COST:  It is estimated that approximately $1.5 million would be needed to cover smoking cessation counseling for pregnant women who smoke.  The cost of services is dependent on the number of women who take advantage of smoking cessation services during their pregnancy.  It is also possible that cost savings could be realized with the addition of this service. 

RECOMMENDATIONS REGARDING SMOKING CESSATION INCLUDE:

•  Funding for provider education to encourage assessment and counseling.
•  Funding for public educational materials. 
•  Funding for smoking cessation intervention targeting women before they get pregnant. 
•  Funding for provider reimbursement for intensive an smoking cessation program includes one-to-one counseling, telephone support and cessation classes or support groups for pregnant women who smoke.

Source:  Report to the General Assembly, Public Act 93-0536, State of Illinois.

For more information contact: 

Jennie Pinkwater

March of Dimes Illinois Chapter

111 West Jackson, Suite 2200

Chicago, IL  60604

312-596-4709

jpinkwater@marchofdimes.com