By Peggy O'Farrell
The Cincinnati Enquirer

Women with less education are more likely to smoke before, during and after pregnancy, says a researcher at Cincinnati Children's Hospital Medical Center.

Dr. Robert Kahn, a pediatrician at Cincinnati Children's, says his findings indicate a need for more supportive care for disadvantaged women even after they give birth.

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The American Lung Association offers hypnosis for smoking cessation and the Freedom from Smoking program, a six-week workshop that focuses on behavioral changes and building support systems. 985-3990.

Dr. Kahn reviewed data from the 1988 National Maternal and Infant Health Survey and a 1991 follow-up. The survey of more than 8,000 women was designed to identify factors related to poor pregnancy outcomes. He focused on maternal smoking during pregnancy and three years after delivery.

"When I reviewed the data, over time, 30 percent of more educated women quit smoking and stayed quit compared to essentially no change among less-educated women. The less-educated women either kept smoking while pregnant and continued after delivery or quit during pregnancy and relapsed after delivery," he says.

Smoking during pregnancy increases a woman's risk of miscarrying and can contribute to low infant birth weight.

Dr. Kahn says he'd hate to see people blame the women for their inability to kick the smoking habit.

"It would be unfair if this was ultimately viewed as women making poor choices: choosing to smoke, choosing to relapse. There really are major obstacles" to giving up smoking, he says.

His findings, published in the November issue of the American Journal of Public Health, include:

More than 70 percent of women who quit smoking during pregnancy were smoking again within about a year. "To me that represents a huge backward slide of health gains women have achieved during pregnancy," Dr. Kahn says. "In the third trimester, a woman is frequently in the best health she'll ever be in: the lowest rate of drinking, the lowest rate of smoking, the best nutrition." Women also have more access to health care during and immediately after pregnancy, he says.

Disadvantaged women who smoke "do considerably worse" during and immediately after pregnancy. "First, they're more likely to enter pregnancy smoking. They're more likely to continue smoking, and they're more likely to relapse after delivery," Dr. Kahn says. "So over those three stages, they fall further and further behind more advantaged women, and so do their children."

Disadvantaged women "face a whole set of hurdles along the way that make their choices more challenging. They face a cluster of risk factors ... that includes poverty, depression and the very powerful cues that come from other people in the household smoking," he says. "It becomes very difficult for a woman who succeeded in quitting during pregnancy to stay quit when faced with the stress of a new infant and the cues of another smoker in the household. Throw in poverty and depression and it becomes very hard to quit and stay quit."

Pregnancy has become a "watershed" in women's health, Dr. Kahn says. It might be the only time they have ready access to medical services. After delivery, it's more difficult for women without health insurance to access health care and counseling about health behaviors.

"I think a health service approach that is more continuous and more comprehensive for women is needed if we really want to help everyone make the health gains during pregnancy and sustain them well after delivery," he says.

More comprehensive smoking cessation programs also are needed for disadvantaged women.

"Very targeted efforts that only focus on smoking and not on the contributing factors will have limited success. The people who could quit easily have quit," he says. "Those sorts of programs could conceivably be funded through the tobacco settlement money. It's unclear to me that states are using that money to establish the kinds of health goals that remain so important, especially in Ohio and the Tristate area."

E-mail pofarrell@enquirer.com