Urve Kaasik-Aaslav, Mare Vanatoa, Ene Kotkas


Backround: Worldwide, approximately 1 billion people, from which 200-250 million  are women, smoke. Based on the Estonian Medical Birth Register data,  in 2010,  7,5% of pregnant women were smokers, and  in 2012, 7% of pregnant women were smoking during their pregnancy. Thus, smoking rates among pregnant women fell only 0,5%. The objective of the research was to find out the views of pregnant women who were smoking during pregnancy of the effect of smoking on the health of them and their babies, and experiences in quitting smoking, changing indicators, e.g. smoking and socioeconomical status (initial exposure to smoking, employment, long-term partnerships etc.) in 2009-2013.

Methods: This research is a phenomenological study, which was being carried out from October 2009 until January 2013. Data collection methods were semi-structured interviews with 45 pregnant women smoking during their pregnancy and being  registered for antenatal care  in three health care institutions of Republic of Estonia. An inductive approach for qualitative analysis was used.

Results: Most women smoking during pregnancy started smoking in their teens, their parents smoked, they were under 30 years old housewives or unemployed. On an average of 11-20 cigarettes were consumed each day, the pregnancy of the research group did not influence frequency and tobacco intake. The participants in the research group reported that tobacco consumption helped them relax, gave them a chance to spend time in a good company, and it was not regarded as a bad habit but a social addiction, being caused by availability of tobacco products. Although most of them had an opinion about  harmful effects of smoking, e.g. a cough, asthma and rapid fatigue,  on the health of them and less on their expected babies, they continued smoking.

Conclusions: The smoking and socioeconomical status of women smoking during pregnancy in 2009-2013 has not changed,  health awareness of them is low and has not improved. Support groups with close relatives are needed to motivate cessation. In the first place, prevention needs  a good example, purposeful cooperation, which starts in daily life context – at homes, in educational institutions and in the community. Limiting the availability of tobacco products, postponing and preventing an initial exposure to smoking are thought to be of great importance. The results of the research will be introduced in health care institutions and they can be used in the health promotion process.


pregnancy, smoking, harmfulness, health, social environment, cessation.pregnancy, smoking, harmfulness, health, social environment, cessation.

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Agrawal, A., Knopik,V. S., Pergadia M. L., Waldron, M., Bucholz, K. K., Martin, N.G., Heath, A. C.

& Madden, P. A. F. (2008). Correlates of cigarette smoking during pregnancy and its genetic and environmental overlap with nicotine dependence. Nicotine & Tobacco Research, 10(4), 567-578.


Alex, S. (2009). Ernährung in der Schwangerschaft [Nutrition in pregnancy]. Dissertation in Der Klinik für Geburtsmedizin der Medizinischen Fakultät Charité [Department of Obstetrics of the Medical Faculty Charité], Berlin. Retrieved from http://d-nb.info/1023696622/34

Bogdanovic, G., Ljuca, D., Ostrvica, E., Babovic,A. & Nevacinovic, E. (2012). Human mature placenta in a relation to cigarettes smoking during pregnancy. HealthMed, 6(2), 703-701. Retrieved from http://connection.ebscohost.com/c/articles/73311379/human-mature-placenta-relation-cigarettes-smoking-during-pregnancy

Eesti Meditsiiniline Sünniregister ja Raseduskatkestusandmekogu. Suitsetamine raseduse ajal 1992 – 2012 (xls) [Estonian Medical Birth Registry and Estonian Abortion Registry. Smoking during pregnancy 1992 – 2012 (xls)]. (2013). National Institute for Health Development. Retrieved from


Ergin, I., Hassoy, H., Tanik, F. A. & Aslan, G. (2010). Maternal age, education level and migration: Socioeconomic determinants for smoking during pregnancy in a field study from Turkey. BMC Public Health, 10:325. Retrieved from http://dx.doi.org/10.1186/1471-2458-10-325

Giglia, R. C., Binns, C. W. & Alfonso, H. S. (2006). Which women stop smoking during pregnancy and the effect on breastfeeding duration. BMC Public Health, 6(1):195. Retrieved from


Gilbert, E. S. (2011). Manual of High Risk Pregnancy and Delivery. St. Louis: Mosby. Elsevier.

Gilman, S.E., Breslau, J., Subramanian, S.V., Hitsman, B. & Koenen, K.C. (2008). Social Factors, Psychopathology, and Maternal Smoking During Pregnancy. American Journal of Public Health, 98(3), 448-453. Retrieved from http://dx.doi.org/10.2105/AJPH.2006.102772

Hannõver, W., Thyrian, A. E., Röske, K., Grempler, J., Kühl, R., Hapke, U., Fusch, C., & John, U. (2008). Smoking During Pregnancy and Postpartum: Smoking Rates and Intention to Quit Smoking or Resume After Pregnancy. Journal of Women's Health, 17(4), 631-640. Retrieved from http://dx.doi.org/10.1089/jwh.2007.0419

Higgins, S. T., Heil, S. H, Badger, G. J., Skelly, J. M., Solomon, L. J. & Bernstein, I. M. (2009). Educational Disadvantage and Cigarette Smoking During Pregnancy. Drug and Alcohol Dependence, 104(1), S100-S105. Retrieved from 10.1016/j.drugalcdep.2009.03.013

Ingvarsson, R. F., Bjarnason, A. O., Dagbjartsson, A., Hardardottir, H., Haraldsson, A. & Thorkelsson, T. (2007). The effects of smoking in pregnancy on factors influencing fetal growth. Acta Paediatrica, 96, 383-386. Retrieved from http://dx.doi.org/10.11/j.1651-2227.2007.00103.x

Kelmanson, I. A. (2009). Maternal smoking during pregnancy and sleep problems in 2-month-old infants. Somnologie, 13 (4), 244-250. Retrieved from http://dx.doi.org/10.1007/s11818-009-0435-3

Karatay, G., Kublay, G. & Emiroglu, O. N. (2010). Effect of motivational interviewing on smoking cessation in pregnant women. Journal of Advanced Nursing, 66(6), 1328-1337. Retrieved from


Koshy, P., Mackenzie, M., Tappin, D & Bauld, L.(2010). Smoking cessation during pregnancy: the influence of partners, family and friends on quitters and non-quitters. Health and Social Care in the Community, 18(5), 500-510. Retrieved from http://dx.doi.org/10.1111/j.1365-2524.2010.00926.x

Lanting, C. I., Buitendijk, S.E., Crone, M.R ., Segaar, D., Bennebroek Gravenhorst, J. & van Wouwe, J. P. (2009). Clustering of Socioeconomic, Behavioural, and Neonatal Risk Factors for Infant Health in Pregnant Smokers. PLoS ONE Lanting. 2009; 4(12), e8363. Retrieved from


Levene, M. I., Tudehope, D. I. & Sinha, S. (2008). Essential neonatal medicine.United Kingdom: Blackwell Publishing.

Martin, L. T., McNamara, M., Milot, A., Bloch, M., Hair, E. C. & Halle, T. (2008). Correlates of smoking before, during, and after pregnancy. American Journal of Health Behavior, 32(3), 272-282. Retrieved from http://dx.doi.org/10.5993/AJHB.32.3.5

Mesiäislehto-Soukka, H. (2012).The effect of smoking during pregnancy. Evidence-based Learning and Practice: conference presentation. Tallinn. Retrieved from http://riks.ttk.ee/index.asp?action=102&tid=13177

Mostafa, R. M. (2011). Dilemma of women’s passive smoking. Annals of Thoracic Medicine, 6(2),

-56. Retrieved from http://dx.doi.org/10.4103/1817-1737.78410

Norwitz, E. R., Belfort, M. A., Saade, G.R. & Miller, H. (2010). Obstetric clinical algorithms, management and evidence. Oxford: Wiley-Blackwell.

Ojala, K., Ani, Ü., Lipand, A., Ingerainen, D. & Härm, T. (2010). Suitsetamisest loobumise nõustamine Eestis [Smoking cessation consulting in Estonia], 2010. National Institute for Health Development. Retrieved from https://intra.tai.ee/images/prints/documents/131471005246_Suitsetamisest_loobumise_noustamine_eestis_est.pdf

Raseduse jälgimise juhend [Guideline of pregnancy care]. (2011). Eesti Naistearstide Selts [Estonian Gynaecologists Society]. Retrieved from http://www.ens.ee/content/estonian-gynaecologists-society

Reitzel, L. R., Vidrine, J. I,, Li, Y., Mullen, P. D., Velasquez, M. M., Cinciripini, P. M., Cofta-Woerpel. L., Greisinger, A. & Wetter, D. W. (2007). The Influence of Subjective Social Status on Vulnerability to Postpartum Smoking Among Young Pregnant Women. American Journal of Public Health, 97(8), 1476-1482. Retrieved from http://dx.doi.org/10.2105/AJPH.2006.101295

Roelands, J., Jamison, M. G., Lyerly, A. D. & James, A. H. (2009). Consequences of Smoking during Pregnancy on Maternal Health. Journal of Women’s Health, 18(6), 867-872. Retrieved from http://dx.doi.org/10.1089/jwh.2008.1024

Salihu, H. M., Aliyu, M.H., Pierre-Louis, B.J. & Alexander, G. R. (2003). Levels of Excess Infant Deaths Attributable to Maternal Smoking During Pregnancy in the United States. Matern Child Health J, 7(4), 219-227. Retrieved from http://dx.doi.org/10.1023/A:1027319517405

Schneider, S. & Schütz, J. (2008). Who smokes during pregnancy? A systematic literature review of population-based surveys conducted in developed countries between 1997 and 2006. The European Journal of Contraception and Reproductive Health Care, 13(2), 138-147. Retrieved from http://dx.doi.org/10.1080/13625180802027993

Shih, S.-F., Chen, L., Wen, C. P., Yang, W.-C. & Shih, Y.-T. (2008). An investigation of the smoking behaviours of parents before, during and after the birth of their children in Taiwan. BMC Public Health, 8(1):67. Retrieved from http://dx.doi.org/10.1186/1471-2458-8-67

Tekkel M, Veideman T, Rahu M.(2009). Health behavior among Estonian adult population, 2008.

National Institute for Health Development. Retrieved from

http://www.sportkoigile.ee/images/stories/uuringud/tku2008.pdf (04.04.2014)

Tekkel, M., Veideman, T., Rahu. M. (2013). Health behavior among Estonian adult population, 2012.

National Institute for Health Development. Retrieved from

https://intra.tai.ee/images/prints/documents/136479842690_TKU_2012.pdf (04.04.2014)

Tervise Arengu Instituudi terviseportaal [Health Portal of National Institute for Health Development]. (2010). National Institute for Health Development. Retrieved from http://www.terviseinfo.ee

Tombor, I., Urban, R., Berkes, T. & Demetrovics, Z. (2010). Denial of smoking-related risk among pregnant smokers. Acta Obstetrica et Gynecologica, 89 (4), 524-530. Retrieved from


Toshiro, I. (2009). Maternal smoking during pregnancy and offspring obesity: Meta-analysis. Pediatrics International, 52 (1), 94-99. Retrieved from http://dx.doi.org/10.1111/j.1442-200X.2009.02883.x

Tupakointi huomattava keskenmenojen riskitekijä [Smoking as a significant risk factor for spontaneus abortion].(2014). Helsinki: Uutispalvelu Duodecim (Duodecim news service). Retrieved from

http://www.terveyskirjasto.fi/terveyskirjasto/tk.koti?p_artikkeli=uut17185&p_teos=uut&p_osio=&p_selaus= (17.02.2014)

Vardavas, C. I., Chatzi, L., Patelarou, E., Plana, E., Sarri, K., Kafatos, A., Koutis, A. D. & Kogevinas, M. (2010). Smoking and smoking cessation during early pregnancy and its effect on adverse pregnancy outcomes and fetal growth. European Journal of Pediatrics, 169(6), 741-748. Retrieved from http://dx.doi.org/10.1007/s00431-009-1107-9

Vasina, O., Rezeberga, D., Zodzika, J., Bite, R. , Pundure, I., Vidnere, I., Matule, D., Zile,O., Pavlova, Z., Silberga, I., Socenova, J. & Melngaile O. (2012). Influence of socioeconomic factors and smoking on vaginal pH in pregnant women during 1st trimester. Riga East University Hospital, Latvia. European Congress of Obstetrics and Gynaecology (EBCOG): Tallinn. Retrieved from


Woolston, C. (2006). How smoking during pregnancy affects you and your baby. Reviewed by Baby Center Medical Advisory Board. Retrieved from http://researchedworks.com/smoking-tobacco-consumption-philippines.php

Yang, L., Tong, E. K., Mao, Z. & Hu, T-W. (2010). Exposure to secondhand smoke and associated factors among non-smoking pregnant women with smoking husbands in Sichuan province, China. Acta Obstetricia et Gynecologica, 89 (4), 549-557. http://dx.doi.org/10.3109/00016341003713851

DOI: http://dx.doi.org/10.12955/emhpj.v7i1.496


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