title: Maternal Smoking Among Women With and Without Use of Assisted Reproductive Technologies.
abstract: OBJECTIVE
  To estimate smoking prevalence during the year before pregnancy and during pregnancy and adverse outcomes among women who delivered infants with and without assisted reproductive technology (ART) using linked birth certificates (BC) and National ART Surveillance System (NASS) data.
  
  
  METHODS
  Data were analyzed for 384,390 women and 392,248 infants born in Massachusetts and Michigan during 2008-2009. Maternal smoking prevalence was estimated using smoking indicated from BC by ART status. For ART users, to evaluate underreporting, prepregnancy smoking was estimated from BC, NASS, or both sources. Effect of prenatal smoking on preterm and mean birthweight (term only) for singleton infants were examined by ART status.
  
  
  RESULTS
  Maternal smoking prevalence estimates were significantly lower for ART users than nonusers (prepregnancy = 3.2% vs. 16.7%; prenatal = 1.0% vs. 11.1%, p < 0.05). When combining smoking information from BC and NASS, prepregnancy smoking prevalence estimates for ART users could be as high as 4.4% to 6.1%. Adverse effects of smoking on infant outcomes in ART pregnancies were consistent with the effects seen in non-ART pregnancies, specifically decline in infant birthweight and increase in preterm delivery, although association between smoking and preterm was not significant.
  
  
  CONCLUSIONS
  A low, but substantial proportion of ART users smoked before and during pregnancy. As ART users are highly motivated to get pregnant, it should be clearly communicated that smoking can decrease fertility and adversely affect pregnancy outcomes. Continued efforts are needed to encourage smoking cessation and maintain tobacco abstinence among all women of reproductive age.
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Van T
authors.initials: VT
authors.lastname: Tong
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
authors.affiliation: 2 Massachusetts Department of Public Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Dana
authors.initials: D
authors.lastname: Bernson
authors.affiliation: 3 Michigan Department of Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Glenn
authors.initials: G
authors.lastname: Copeland
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Yujia
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: 4 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Lucinda J
authors.initials: LJ
authors.lastname: England
mesh_terms: D000328:Adult; D005260:Female; D005298:Fertility; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008404:Massachusetts; D008423:Maternal Age; D008824:Michigan; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D015995:Prevalence; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: assisted reproductive technology; pregnancy; smoking; surveillance