More than one in four pregnant women in West Virginia smoked during their pregnancies in 1999, the highest rate in the nation, according to a study released Tuesday.

West Virginia's 26.1 percent rate was more than twice the national rate of 12.6 percent. Texas and Arizona shared the lowest rate at 7 percent, according to the report, "The Right Start for America's Newborns: A Decade of City and State Trends (1990-1999).'' The report was a joint project of Child Trends and Kids Count, an initiative of The Annie E. Casey Foundation, and looked at birth certificates provided by the National Center for Health Statistics. "Nationally we've been very successful" in reducing smoking among pregnant women, said Kids Count coordinator Bill O'Hare. "West Virginia has not been." Nationally, the percentage of births to mothers who smoked declined, from 18.4 percent in 1990 to 12.6 percent in 1999. During the same period, West Virginia's rate fell from 27.8 percent in 1990 to 26.1 percent in 1999. The high pregnancy smoking rate mirrors West Virginia's overall smoking rate, said Keith Dalton of the West Virginia Bureau for Public Health. During 2000, 26.1 percent of the state's population smoked, compared to 22.2 percent nationally, Dalton said. "It stands to reason that we're going to have a higher rate of mothers who smoke,'' he said. Other factors, including poverty, unplanned pregnancies and family members who smoke, may encourage pregnant women to smoke, said Jeannie Clark, director of perinatal services with the state Office of Maternal, Child and Family Health. "These girls find themselves in a poverty situation, so they have a lot of stress, they worry, and I guess cigarettes make them feel better,'' Clark said. And for some pregnant women, weight gain is an issue. "They think if they stop smoking that they will gain ... weight,'' she said. Addiction is also a factor, Dalton said. "To say a lady that finds out she's pregnant is going to be able to just turn that addiction off, it's going to be tough,'' he said. Smoking while pregnant can result in lower birth weight, premature births and respiratory problems, state health officials have said. Clark is working to improve the number of healthy births through a free program called, "Right from the Start.'' Pregnant women on Medicaid or who have a maternity services card from Clark's office are eligible. Through the program, nurses and social workers visit women throughout their pregnancies, develop a care plan for them and provide education and support based on their risk factors. The Kids Count study also looked at other birth trends, including the rate of babies born to mothers who received late or no prenatal care. West Virginia's rate improved from 5.7 percent in 1990 to 2.4 percent in 1999, the study said. The national rate dropped from 6.1 percent to 3.8 percent. But adding that figure to a rising rate of pre-term births paints a confusing picture, O'Hare said. The percent of West Virginia's preterm births - babies born before 37 weeks of gestation - rose from 9.9 percent in 1990 to 13 percent in 1999, the study said. The U.S. average rose from 10.6 percent to 11.8 percent. If more West Virginia women are getting better prenatal care, "You would expect the percent of preterm births to go down,'' O'Hare said. "But they didn't, and that may be due to the high rate of smoking during pregnancy.'' O'Hare said he hopes the report will lead to "better policies and programs to improve children's lives.''

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