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Public Health Rep. 2008 Sep-Oct;123(5):586-92.

Prenatal smoking prevalence ascertained from two population-based data sources: birth certificates and PRAMS questionnaires, 2004.

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  • 1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.



This study provided a population-based estimate of the prevalence of smoking during pregnancy by combining information from two data sources: birth certificates (BCs) and a self-administered questionnaire.


We analyzed data from 39,345 women who delivered live births in one of 24 states and responded to a questionnaire from the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing, state- and population-based surveillance system. We compared prevalence of smoking during pregnancy based on the BC, the PRAMS questionnaire, and the two data sources combined. Data were weighted to represent all women delivering live births in each of the 24 states during 2004.


The combined estimate indicated that 15.1% of women reported smoking during pregnancy, whereas the BCs alone reported 10.4% and the PRAMS questionnaires alone reported 13.4%.


Based on the combined BC and PRAMS questionnaire data, the number of infants exposed to tobacco in-utero may be 31% higher than is currently reported on the BCs. Combining the data from the two different sources led to higher ascertainment of prenatal smoking.

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