Getting focused: missed opportunities for smoking interventions for pregnant women receiving Medicaid

Background. The prevalence of smoking, and cessation and relapse rates for pregnant women have health and financial implications. Our objectives were to describe smoking among pregnant smokers receiving Medicaid including characteristics associated with reporting discussion of smoking with providers and the association between those discussions with quitting and maintenance. Methods. Analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 15 states for 20,287 women with Medicaid for prenatal care during 1998–2000. Results. Thirty-four percent of women smoked before pregnancy (N = 7,686). Most smokers (93%) and nonsmokers (88%) reported discussions about smoking during prenatal care. Women were less likely to have discussed smoking if they were lighter smokers (OR = 1.47; CI = 1.03, 2.12), or reported a previous low-birthweight infant (OR = 1.72; CI = 1.03–2.86). Women reporting discussions (compared to those not) were less likely to quit (ARR = 0.70: CI = 0.59–0.91). Quitters reporting discussions (compared to those not) were no more likely to maintain cessation (ARR = 0.89; CI = 0.7, 1.21). Conclusions. Smoking cessation interventions can be improved for pregnant women receiving Medicaid, especially if focused to address individual needs of light smokers, those with previous low-birthweight infants, or those who find it most difficult to quit.