Fewer women in the United States are smoking cigarettes while pregnant, but the problem remains worrisome in Kentucky and Ohio.

Nationwide, maternal smoking dropped from 13 percent in 1996 to 11.4 percent in 2002, according to a report released this month by the U.S. Centers for Disease Control and Prevention. But no change occurred in Kentucky, where 24 percent of women smoked during pregnancies in 2002, the second-highest percentage in the nation. Ohio's prevalence of maternal smoking fell from 19.5 percent to 17.9 percent, but it's still higher than the national average. "You'd be surprised at how many pregnant women still don't realize the dangers that can arise from smoking," said Andrea Birkemeier, a health educator who coordinates smoking-cessation programs with the Northern Kentucky Health District. Smoking during pregnancy can slow fetal growth and nearly doubles a woman's risk of having a baby with low birth weight - less than 5.5 pounds. In 1998, 12 percent of babies born to smokers in the U.S. were of low birth weight, compared to 7.2 percent of babies of non-smokers. Low-birth-weight babies face an increased risk of serious health problems, including respiratory distress, cerebral palsy and mental retardation. "There's also some evidence that these babies can experience a withdrawal syndrome similar to what infants born to mothers addicted to narcotics go through," said Dr. Jim Greenberg, director of neonatology at Cincinnati Children's Hospital Medical Center. Maternal smoking costs the United States $366 million a year in neonatal health-care costs - $704 per maternal smoker, according to the CDC report. U.S. health officials are calling on obstetricians to fully assess the smoking status of pregnant women. Doctors are asked to link women to smoking-cessation programs. Ten states, including Kentucky, reported increases in smoking by pregnant teens. In Kentucky, 34.1 percent of girls ages 15-19 smoked during pregnancy, up from 31 percent in 1995. Ohio is slowly headed in the right direction, but its numbers are "totally unacceptable to the health of our families and the well-being of our state," said Icilda Dickerson, assistant director of the Ohio Tobacco Use Prevention and Control Foundation. Kentucky's culture and history as a tobacco-growing state partly explain the state's high smoking rate among pregnant women, said Ellen Hahn, an associate professor of nursing at the University of Kentucky and a member of the Kentucky Tobacco Policy Research Program. "But a big reason is that our tobacco-control policies are weak," Hahn said. For example, Kentucky's 3-cent excise tax on cigarettes is the second-lowest in the nation, Hahn said. The national average for state cigarette excise taxes is 73 cents per pack. Kentucky's Medicaid program also turns its back on the problem, Hahn said. Medicaid will pay for pregnant women to receive tobacco-dependence counseling, but unlike most other states, Kentucky won't pay for tobacco-cessation products, such as prescription nicotine nasal spray or the drug Zyban. Because smoking rates are generally higher among low-income residents, Medicaid is often their only form of health insurance. "We don't withhold treatment for pregnant women who are alcoholics, but we do for moms who are nicotine addicts," Hahn said. Smoking rates Figures reflect maternal smoking rates from 1996 and 2002 West Virginia: 25.5 percent, 26.2 percent (Ranked No.1) Kentucky: 24.5 percent, 24.4 percent (Ranked No. 2) Ohio: 19.5 percent, 17.9 percent (Ranked No. 10) Indiana: Not available, 19.1 percent (Ranked No. 6) U.S. Average: 13.6 percent, 11.4 percent Looking for help? The American Cancer Society can link pregnant women to smoking-cessation programs in their area. Call (866) 66-START. Source: U.S. Centers for Disease Control and Prevention

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