Factors Related to Smoking in a Sample of Pregnant Women in Baghdad City

Muna Abdul Kadhum Zeidan
Authors Emails are requested on demand or by logging in
Keywords : Smoking, Factors, Pregnant women.
Medical Journal of Babylon  14:1 , 2017 doi:1812-156X-14-1
Published :16 July 2017


Smoking during pregnancy is significant health problems. Smoking is related to different adverse health effects consist of chronic respiratory diseases in children sudden infant death syndrome. To determine the rate of smoking in a sample of Pregnant women. To identify factors associated with the smoking habits (Maternal age, maternal education ,maternal occupation, gestational age, parity, socio economic status, health problems, and stress). A cross-sectional study conducted in Baghdad in Al- Karkh teaching hospital and Bab-Almoadham primary health center. Sampling was (non-probability convenient) & sample size was 276. The study started from 1st of June 2015 to 1st of October 2015. Data was collected by questionnaire to obtain socio- demographic information. The result shows that mean age of the subjects was 29.02± 6.7 years, and the 49.6% were housewives; about (343.4%) of pregnant women in the sample were smokers. About (43.5%) of the pregnant women with smoker were mainly at 2nd trimester of their pregnancy, the frequency of women who had more than one baby was higher among smokers than among non-smokers , about (62.8%) of the subjects were low socio economic status. Analysis of results by (chi-square test) show that (maternal occupation, parity, socio economic status, health problems, and stress) were significant factors associated with anemia. This study shows the rate of smoking during pregnancy was 34.4%, factors that were associated with higher rate of smoking were unemployment, parity, smoking was more related with low socio economic status, health problems and stress.


Smoking very important health problems most countries in the world. According to cause of preventable mortality in some countries [1,2]. The public health society makes focus on efforts to educate the population around the risks of smoking. These dangers are harmful. Many studies have found that females who smoked throughout pre gnancy had higher exposed for pre mature birth, birth and spontaneous abortion, low birth weight , and newborns deaths [3,4]. As well as , "death syndrome" in infants, and "respiratory diseases" in children has been linked to mother s smoking behind birth and fetus exposure to those half hand smoke [5]. Smoking lead to a threat both to the mother s and her newborns expect. Tobacco causes for many complications consist of miscarriage caused by tobacco, deaths caused by disturbances in the perinatal period and newborns requiring admission to the intensive care unit for newborns [6], low birth weight [7,8], and mortality resulting from "sudden infant death syndrome" [8]. Cigarette smoking lead to increase the danger of in fertility and delayed pregnancy [9], and adverse pregnancy outcomes, for example, placental abruption, stillbirth, premature birth [10] Smoking pregnant mothers of preterm birth also raises the risk [11]. Smoking responsible of death in many countries females are higher smokers and the cigarette is cause for nearly five million mortality a year [12]. The percentage of men smokers are higher than female. It has shows decline in pre valence in developed countries[13]. Accompanied by many of Mother factors and father related to smoking during gestation; such as, female who smoke throughout pregnancy are more young, [14], have an economic position of social lower and the low level of education low income [15], and the pregnancy more unplanned [16] of the female who did not smoking by pre gnancy. Similar to a study done in London, they are less likely to engage in behaviors associated with health or to feel responsible for the health of children [17] pregnant women who smoke. And it increased differences in smoking rates, according to the mother s life in Denmark [18].

Materials and methods

A cross- sectional study design was used. The study was conducted in Al- Karkh teaching hospital and Bab-almoadham primary health center. The sample was selected (non probability convenient sampling),  pregnant women were selected with the exception of those who fulfilled the pre defined criteria of pregnancy induced hypertension, preeclampsia, eclampsia or chronic hypertension, gestational diabetes which include 276 samples.
The study has started from 1st June to 30th October 2015. The data were collected by direct interview using special questionnaire .information included socio demographic data (age, education and occupation), obstetrical history (gestational age and parity) and socio economic status.

Socio-economic status scales (SESS): SES is defined in terms of a standard sociological paradigm consisting of three components: (a) occupation ; (b) education;


Table (1) shows that (276) pregnant women that were in age group (25-29) years & mean age of them was ( 29.02± 6.7) years. As for education (32.6 %) were primary education, and about (49.6%) were housewives and about (34.8%) of pregnant women have 1-3 child , about 43.5% were non smokers and 34.4% were smokers.


It has long been known mother s smoking throughout pre gnancy to be a danger factor for morbidity and mortality of newborns, including low birth weight, shortened pregnancy, premature birth, birth weight [22]. In this study, most of the pregnant women belongs to the age 25-29 years and the mean age of pregnant women was 29.02 ± 6.7 years. The finding of the present study is agreement with findings reported in Istanbul [23], in Brazil [24], in Japan [25], and in Switzerland [26], and in Canada [27], they have identified the mothers current age was positively associated with smoking with p-value <0.000. This could be explained by the extreme ages of reproductive years are well known risk factors for smoking during pregnancy. This study shows that about (49.6%) of pregnant women were housewives, this result confirms the finding in Turkey [28] , found a high percentage (79.4%) of the pregnant women were housewives this could be a possible reason for women having health problem during their pregnancy [29]. 34.4% of the subjects were smokers while (43.5%) were non-smokers and (16.5%) had passive smokers disagrees finding were reported in Canada [27], in Brazil [24], in US [30], they found (55.4 %) are non-smokers, (25.5%) were smokers, a possible explanation for this may be due to the contrast in time and place of the studies and selection of study population. Gestational age variables strongly associated with smoking in pregnancy p – value <0.000, similar finding were reported in Canada [27], found that the pre valence of smoking in the 3rd trimester were (10.5%). This may be due to failure to attend ante natal classes and stressful events pre and during pre gnancy [27]. . Parity have significant association with smoking in pregnancy with p– value <0.000 this result confirms the finding in Brazil [24], and in Switzerland [26], they found significant association between parity &smoking p – value (0.002), this could be a possible reason for women having low health education and gave birth to a healthy child [31,32]. Smokers during pregnancy had a higher frequency of reporting low socio economic status, similar finding were reported in Japan [25], in Switzerland [26], and in Canada [27], they found Smokers during pregnancy was related to low socio- economic status, And may be because females had a higher frequency to continue smoking economic problems [25]. The present study shows that pregnant women who had smokers had higher rate of health problems about (54.8%), this result confirms the finding in Brazil [24], found that women who smoked during pre gnancy had a higher frequency of complications for examples placenta previa, and, premature birth, ectopic pregnancy, and birth weight, low birth weight, and mortality of newborns, and weakness of the child s physical growth, and this may be due to drug use is a growing problems that is related to significant morbidity mother and fetus [33]. The present study shows that pregnant women who had smokers had higher rate of stress about (51.6%), this result confirms the finding in Brazil [24], in Switzerland [26], and in Canada [27], they found that stress have significant association with smoking during pregnancy, And this may be due to starvations and not have the job in these societies may be important causes for these higher frequency [34].


This study shows the frequency of women who had more than one baby was higher among smokers than among nonsmokers , factors that were associated with higher rate of smoking were unemployment, parity, smoking was more related with low socio economic status, health problems and stress.


1-. Kolas T, Nakling J, Salvesen KA. Smoking during pregnancy increases the risk of preterm birth among parous women. Acta Obstet Gynecol Scand 2000;79:644–8.
2- Burguet A, Kaminski M, Abraham-Lerat L, Schaal JP, Cambonie G, Fresson J, et al. The complex relationship between smoking in pregnancy and very preterm delivery: results of the Epipage study. BJOG 2004; 111:258–65.
3- Shah NR, Bracken MB. A systematic review and meta analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery. Amer J Obst Gynecol. 2000; 182(2): 465-72.
4- DiFranza JR, Lew RA. Effect of maternal cigarette smoking on pregnancy compli-cations and sudden infant death syndrome. J Family Practice. 1995; 40(4): 385-94.
5- Ventura SJ, Hamilton BE, Matthews TJ, Chandra A. Trends and variations in smoking during pregnancy and low birth weight: evidence from the birth certificate, 1990-2000. Pediatrics. 2003 May; 111 (5 Part 2): 1176-80.
6- Adams EK, Miller VP, Ernst C, Nishimura BK, Melvin C, Merritt R: Neonatal health care costs related to smoking during pregnancy. Health Econ 2002, 11:193-206.
7- Bachir R, Chaaya M: Maternal smoking: Determinants and associated morbidity in two areas in Lebanon. Matern Child Health J 2008, 12:298-307.
8- Salihu HM, Wilson RE: Epidemiology of prenatal smoking and perinatal outcomes. Early Hum Dev 2007, 83:713-720.
9- Centers for Disease Control and Prevention (CDC): Smoking during pregnancy--United States, 1990-2002. MMWR Morb Mortal Wkly Rep 2004; 53:911-915.
10- Ng SP, Zelikoff JT: Smoking during pregnancy: Subsequent effects on offspring immune competence and disease vulnerability in later life. Reprod Toxicol 2007; 23:428-437.
11- Tucker J, McGuire W. Epidemiology of preterm birth. BMJ 2004;329:675–8.
12- World Health Organization -WHO; 2008 [Access: 2009 December 08]. WHO Reporton the Global Tobacco Epidemic - The global tobacco crisis. Available from: http://www.who.int/tobacco/mpower/mpower_ report_tobacco_crisis_2008.pdf.
13- Ministério da Sa?de (BR), Instituto Nacional do Câncer, Secretaria de Vigilância em Sa?de. Inquérito domiciliar sobre comportamentos de risco e morbidade referida de doenças e agravos n?o transmiss?veis: Brasil, 15 capitais e Distrito Federal 2002-2003 – Tabagismo. Rio de Janeiro (RJ): INCA; 2004.
14-Moussa K, Ostergren PO, Grahn M, Kunst AE, Eek F, Essén B. Socioeconomic differences in smoking trends among pregnant women at first antenatal visit in Sweden 1982-2001: increasing importance of educational level for the total burden of smoking. Tob Control 2009;18(2):92–97.
15-Ergin I, Hassoy H, Tanik FA, Aslan G. Maternal age, education level and migration: socioeconomic determinants for smoking during pregnancy in a field study from Turkey. BMC Public Health 2010;10:325.
16-Orr ST, James SA, Reiter JP. Unintended pregnancy and prenatal behaviors among urban black women in Baltimore, Maryland: the Baltimore preterm birth study. Ann Epidemiol 2008;18(7);545–551.
17- Haslam C, Lawrence W. Health-related behavior and beliefs of pregnant smokers. Health Psychol 2004;23(5):486–491.
18-Egebjerg Jensen K, Jensen A, N?hr B, Krüger Kjaer S. Do pregnant women still smoke? A study of smoking patterns among 261,029 primiparous women in Denmark 1997-2005. Acta Obstet Gynecol Scand 2008; 87(7): 760–767.
19- Giordana de C?ssia Pinheiro da Motta, Isabel Cristina Echer, Am?lia de F?tima Lucena. Factors Associated with Smoking in Pregnancy. Rev. Latino-Am. Enfermagem 2010; 18(4):809-15.
20- Tiwari S, Kumar A. Development of standardization of a scale to measure socio-economic status in urban and rural communities in India. Indian. J Med, 2005; 122:309-314.
21-. Fenercio?lu AK, Y?ld?r?m G, Karatekin G, G?ker N. The relationship of gestational smoking with pregnancy complications and sociodemographic characteristics of mothers. J Turkish-German Gynecol Assoc 2009; 10: 148-51.
22-Ingvarsson RF, Bjarnason AO, Dagbjartsson A, Hardardottir H, Haraldsson A, Th orkelsson T. Th e effects of smoking in pregnancy on factors influencing fetal growth. Acta Paediatr 2007; 96: 383-6.
23-Fatih BOLAT, zge EREN, Güher BOLAT, Emrah CAN, Serdar CMERT, Hasan Sinan USLU, Asiye NUHO?LU, Maternal smoking during pregnancy and eff ects on neonatal anthropometry: a prospective study, 2012; 42 (6): 999-1005.
24-Giordana de C?ssia Pinheiro da Motta Isabel Cristina Echer Am?lia de F?tima Lucena. Factors Associated with Smoking in Pregnancy. 2010; 18(4):809-15.
25- Harumi Bawdo, Masanobu Yamakawa, Tohru Yoshida. Factors related to the continuation of smoking among pregnant women: a cross-sectional study in a Japanese city. JJHEP,2013;21(2):135-141.
26-Arnaud Chiolero, Pascal Bovet, Fred Paccaud. Association between maternal smoking and low birth weight in Switzerland: the EDEN study. SWISS MED WKLY 2005 ; 135 : 525 – 530 •
27-Ban Al-Sahab , Masarat Saqib, Gabriel Hauser and Hala Tamim. Prevalence of smoking during pregnancy and associated risk factors among Canadian women: a national survey. Al-Sahab et al. BMC Pregnancy and Childbirth 2010, 10:24.
28-Dilek Aslan, Meltem ?engelen, Pelin Ca?atay. Factors Related to Smoking Status of Pregnant Women Aged 15-49 in Turkey. Turk Toraks Derg 2014; 15: 27-32.
29- Nesimi A, Mustafa O, Aytul Z., Fehmi O. Anaemia prevalence and its affecting factors in pregnant women of Is parta Province. Biomed Res (India) 2004; 16 (1): 11-14.
30-Schneider S, Maul H, Freerksen N, Potschke-Langer M: Who smokes during pregnancy? An analysis of the German perinatal quality survey 2005. Public Health 2008, 122: 1210-1216.
31-Torrent M, Sunyerb J, Cullinand P, Basaga?ab X, Harrisd J, Garc?ac O, et al. Smoking cessation and associated factors during pregnancy. Gac Sanit. 2004; 18(3): 184-9.
32-McLeod D, Pullon S, Cookson T. Factors that influence changes in smoking behaviour during pregnancy. N Z Med J, 2003 [Access: 2007 August 09]; 116(1173). Available from: http:// www.nzma.org.nz/journal/116-1173/418/.
33-Haller DL, Miles DR, Dawson KS. Victimization and perpetration among perinatal substance abusers. J Interpers Violence 2003; 18:760-780.
34-Godel JC, Pabst HF, Hodges PE, Johnson KE, Froese GJ, Joffres MR: Smoking and caffeine and alcohol intake during pregnancy in a northern population: Effect on fetal growth. CMAJ 1992, 147:181-188.

The complete article is available as a PDF File that is freely accessible. The fully formatted HTML version can be viewed as HTML Page.

Medical Journal of Babylon

volume 14 : 1

Share |

Viewing Options

Download Abstract File

Related literature

Cited By
Google Blog Search
Other Articles by authors

Related articles/pages

On Google
On Google Scholar
On UOBabylon Rep

User Interaction

759  Users accessed this article in 1 year past
Last Access was at
19/06/2019 04:15:05