Maternal Cigarette Smoking Trajectories and Risk of Low Birthweight in the United States: A Population-Based Analysis of 2023 to 2024 Natality Data
- 1Grambling State University
Abstract
BackgroundMaternal cigarette smoking is associated with adverse birth outcomes, but low birthweight may reflect preterm delivery, restricted fetal growth, or both. Contemporary evidence distinguishing smoking trajectories is limited.
ObjectivesTo examine associations between maternal cigarette-smoking trajectories and low birthweight among U.S.-resident singleton live births in 2023 to 2024.
MethodsWe analysed 5,861,166 U.S.-resident singleton live births in the 2023 to 2024 National Vital Statistics System natality files. Low birthweight was defined as birthweight <2,500 g. Trajectories were never smoking, quitting before pregnancy, quitting during pregnancy, persistent smoking, or other/intermittent smoking. Modified Poisson regression estimated adjusted risk ratios (aRRs) and 95% confidence intervals controlling for birth year and maternal, pregnancy, and infant characteristics.
ResultsLow-birthweight prevalence was 6.4% among never smokers, 7.7% among mothers who quit before pregnancy, 11.2% among those who quit during pregnancy, 14.6% among persistent smokers, and 10.2% among those with other/intermittent smoking. Compared with never smoking, adjusted risks were higher for quitting before pregnancy (aRR 1.06, 95% CI 1.03, 1.09), quitting during pregnancy (aRR 1.46, 95% CI 1.42, 1.51), persistent smoking (aRR 1.95, 95% CI 1.93, 1.98), and other/intermittent smoking (aRR 1.36, 95% CI 1.25, 1.49). Associations varied little by year (joint interaction P = 0.102).
ConclusionsPersistent smoking showed the strongest association with low birthweight. Because the outcome combines preterm delivery and impaired fetal growth, the estimates should not be interpreted as associations with fetal growth restriction alone.
Synopsis
Study questionHow are maternal cigarette-smoking trajectories before and during pregnancy associated with low birthweight among U.S.-resident singleton live births in 2023-2024?
Whats already knownMaternal smoking during pregnancy is associated with low birthweight, and earlier smoking cessation is generally associated with more favourable birth outcomes.{superscript 2}-
What this study addsAmong 5,861,166 births, persistent smoking showed the strongest association with low birthweight (aRR 1.95, 95% CI 1.93, 1.98), followed by quitting during pregnancy (aRR 1.46, 95% CI 1.42, 1.51). Quitting before pregnancy showed only a small residual association (aRR 1.06, 95% CI 1.03, 1.09). Findings were consistent across 2023-2024 and support distinguishing smoking trajectories rather than using a simple binary exposure.
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BibTeX
@misc{onwuameze2026maternal,
title = {{Maternal Cigarette Smoking Trajectories and Risk of Low Birthweight in the United States: A Population-Based Analysis of 2023 to 2024 Natality Data}},
author = {C. Onwuameze and G. Orji and M. A. Bate and V. O. Madu and P. Kaya and J. E. Inalegwu},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.01.26364505},
url = {https://www.medrxiv.org/content/10.64898/2026.10.01.26364505v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Maternal Cigarette Smoking Trajectories and Risk of Low Birthweight in the United States: A Population-Based Analysis of 2023 to 2024 Natality Data
AU - C. Onwuameze
AU - G. Orji
AU - M. A. Bate
AU - V. O. Madu
AU - P. Kaya
AU - J. E. Inalegwu
PY - 2026
DA - 2026/10/01
PB - medRxiv
DO - 10.64898/2026.10.01.26364505
UR - https://www.medrxiv.org/content/10.64898/2026.10.01.26364505v1
AB - BackgroundMaternal cigarette smoking is associated with adverse birth outcomes, but low birthweight may reflect preterm delivery, restricted fetal growth, or both. Contemporary evidence distinguishing smoking trajectories is limited. ObjectivesTo examine associations between maternal cigarette-smoking trajectories and low birthweight among U.S.-resident singleton live births in 2023 to 2024. MethodsWe analysed 5,861,166 U.S.-resident singleton live births in the 2023 to 2024 National Vital Statistics System natality files. Low birthweight was defined as birthweight <2,500 g. Trajectories were never smoking, quitting before pregnancy, quitting during pregnancy, persistent smoking, or other/intermittent smoking. Modified Poisson regression estimated adjusted risk ratios (aRRs) and 95% confidence intervals controlling for birth year and maternal, pregnancy, and infant characteristics. ResultsLow-birthweight prevalence was 6.4% among never smokers, 7.7% among mothers who quit before pregnancy, 11.2% among those who quit during pregnancy, 14.6% among persistent smokers, and 10.2% among those with other/intermittent smoking. Compared with never smoking, adjusted risks were higher for quitting before pregnancy (aRR 1.06, 95% CI 1.03, 1.09), quitting during pregnancy (aRR 1.46, 95% CI 1.42, 1.51), persistent smoking (aRR 1.95, 95% CI 1.93, 1.98), and other/intermittent smoking (aRR 1.36, 95% CI 1.25, 1.49). Associations varied little by year (joint interaction P = 0.102). ConclusionsPersistent smoking showed the strongest association with low birthweight. Because the outcome combines preterm delivery and impaired fetal growth, the estimates should not be interpreted as associations with fetal growth restriction alone. Synopsis Study questionHow are maternal cigarette-smoking trajectories before and during pregnancy associated with low birthweight among U.S.-resident singleton live births in 2023-2024? Whats already knownMaternal smoking during pregnancy is associated with low birthweight, and earlier smoking cessation is generally associated with more favourable birth outcomes.{superscript 2}- What this study addsAmong 5,861,166 births, persistent smoking showed the strongest association with low birthweight (aRR 1.95, 95% CI 1.93, 1.98), followed by quitting during pregnancy (aRR 1.46, 95% CI 1.42, 1.51). Quitting before pregnancy showed only a small residual association (aRR 1.06, 95% CI 1.03, 1.09). Findings were consistent across 2023-2024 and support distinguishing smoking trajectories rather than using a simple binary exposure.
ER -