Assessment of Women's Knowledge of the Impact of Smoking During Pregnancy


Smoking affects women’s health and increases their risk for some diseases. Women who smoke have problems with the reproductive system, and if women are pregnant have a high risk for fetal, and neonatal problems and consequences on their health. Quitting smoking at any time during pregnancy improves the condition of mother and baby. This study aims to identify the level of knowledge women have about smoking and effects on pregnancy aged between 1545 years. This study is cross-sectional and was implemented for the period of August-November 2021 was conducted at UHOG “Queen Geraldine” Tirana, Albania. The survey included 200 pregnant women, who agreed to complete the questionnaire. Data were coded and elaborated using IBM SPSS Statistics 26 software. Descriptive results on each question, comparison between important topics, and binary logistic regression for the five final questions were performed. Nevertheless, 30% of the total women in the study were smokers, 16% of them were pregnant smokers, and 14% were smokers before pregnancy. The women who continued to smoke were from urban areas, we do not have heavy smokers, and only 2.9% of them smoked >10 cigarettes a day. Women with secondary education report that the chance of ectopic pregnancy from smoking increases OR = 0.73. As the weeks of pregnancy pass, the likelihood of discovering that smoking increases the risk of having a baby with birth defects (OR = 0.78) increases. There were women in the first pregnancy and younger age groups that represented the highest level of knowledge related to the birth of an underweight baby because of smoking p = 0.003. In 31.6% of cases, the cessation of smoking had come because of the nursing counseling that they had received in the primary service. The trend of smoking among Albanian women is growing and information on the consequences of smoking is a necessity for a healthy population in the future. Women who smoke need assistance and counseling to quit smoking before becoming pregnant. The role of health care professionals in informing women about the risks of smoking to the baby and the mother should be expanded.

Keywords: pregnancy, knowledge, smoking, smoking cessation, counseling

[1] Albania Institute of Statistics, Institute of Public Health, and ICF. Albania demographic and health

[2] survey 2017–18. 2018. Available from: FR348/FR348.pdf

[3] Horne AW, Brown JK, Nio-Kobayashi J, Abidin HBZ, Adin HBZ, Boswell L, et al. The association between smoking and ectopic pregnancy: Why nicotine is bad for your fallopian tube. PLoS ONE. 2014;9(2):e89400.

[4] Bauld L. Smoking during pregnancy and smoking cessation services. Journal of Smoking Cessation. 2008;4:2–5.

[5] Bickerstaff M, Beckmann M, Gibbons K, Flenady V. Recent cessation of smoking and its effect on pregnancy outcomes. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2012;52(1):54–58.

[6] Burazer G, Bregu A, Qirjako G, Roshi. E, Bukli M. National Health_Report_Health_status_of_the_Albanian_population. 2015. Available from:

[7] Meghea C, Rus D, Rus I, Summers Holtrop J, Roman L. Smoking during pregnancy and associated risk factors in a sample of Romanian women. European Journal of Public Health. 2010;22(2):229–233.

[8] Caleyachetty R, Tait C, Kengne A, Corvalan C, Uauy R, Echouffo-Tcheugui J. Tobacco use in pregnant women: Analysis of data from Demographic and Health Surveys from 54 low-income and middle-income countries. The Lancet Global Health. 2014;2(9):E513–E520.

[9] Diamanti A, Papadakis S, Schoretsaniti S, Rovina N, Vivilaki V, Gratziou C, et al. Smoking cessation in pregnancy: An update for maternity care practitioners. Tobacco Induced Diseases. 2019;17(August):57.

[10] Essie T. Torres 2013 understanding sociodemographic and sociocultural factors that characterize tobacco use and cessation during pregnancy among women in the Dominican Republic. Maternal and Child Health Journal. 2014;18(10):2275–2283.

[11] WHO. Tobacco. Washington, DC: Institute of Health Metrics; 2019. Available from:

[12] Ross H, Zaloshnja E, Levy D, Tole D. Results from the Albanian Adult Tobacco Survey. Central European Journal of Public Health. 2008;16:182–188.

[13] Institute of Public Health. Health status of the Albanian Population. 2014 [cited 2015 April 5]. Available from: Health-Report

[14] Samet JM, Yoon SY (Eds.). Women and the tobacco epidemic: Challenges for the 21st century. Gender, Technology and Development. 2010;6(2):301–305.

[15] Salvage J. Nursing standard global institutions – The World Health Organization (WHO). Global Institutions. 2011;25(35):30.

[16] Polen K, Sandhu P, Honein M, Green K, Berkowitz J, Pace J, Rasmussen S. Knowledge and attitudes of adults towards smoking in pregnancy: Results from the HealthStyles© 2008 Survey. Maternal and Child Health Journal. 2015;19(1):144–154.

[17] Lieberman E, Gremy I, Lang JM, Cohen AP. Low birthweight at term and the timing of fetal exposure to maternal smoking. American Journal of Public Health. 1994;84(7):1127–1131.

[18] McCowan LM, Dekker GA, Chan E, Stewart A, Chappell LC, Hunter M, et al. Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: Prospective cohort study. BMJ. 2009;338:b1081.

[19] Organization W. 2022. WHO global report on trends in prevalence of tobacco use 2000-2025, third edition [Internet]. 2022 [Accessed 2022 September 26]. Available from:

[20] Preventive health care behavior among Albanian American population. Journal of Community Medicine Public Health. 2018;2(3).

[21] Raynor K, Tankard S, Department for National Drug Control. (2020). Survey of Pregnant Women 2020. Alcohol Use Disorders Identification Test (AUDIT) & Tobacco and Marijuana Use among Pregnant Women Presenting for Prenatal Care. Government of Bermuda; 2020.

[22] Raed B. Waterpipe tobacco labeling and packaging and World Health Organization Framework Convention on Tobacco Control (WHO FCTC): A call for action. Addiction. 2014;109(2):333.

[23] Rozman T, Mivšek P, Jug Došler A, Kusterle M. A survey among women who continued smoking during pregnancy in Slovenia. European Journal of Midwifery. 2018;2(October).

[24] Samet J, Yoon S, Initiative W. 2022. Women and the tobacco epidemic: Challenges for the 21st century [Internet]. 2022 [Accessed 2022 September 26]. Available from:

[25] Orton S, Bowker K, Cooper S, Naughton F, Ussher M, Pickett K, et al. Longitudinal cohort survey of women’s smoking behavior and attitudes in pregnancy: Study methods and baseline data. BMJ Open. 2014;4(5):e004915.

[26] Curry SJ, Keller PA, Orleans CT, Fiore MC. The role of health care systems in increased tobacco cessation. Annual Review of Public Health. 2008;29:411–428.

[27] Lange S, Probst C, Rehm J, Popova S. National, regional, and global prevalence of smoking during pregnancy in the general population: A systematic review and meta-analysis. The Lancet Global Health. 2018;6(7):e769–e776.

[28] Shrestha S, Ghimire R, Wang X, Trivers K, Homa D, Armour B. Cost of cigarette smoking–Attributable productivity losses, U.S. American Journal of Preventive Medicine. 2022;63(4):478–485.

[29] Rozman T, Mivšek P, Došler AJ, Kusterle M. A survey among women who continued smoking during pregnancy in Slovenia. European Journal of Midwifery. 2018;2:12.

[30] Xu X, Rao Y, Wang L, Liu S, Guo J, Sharma M, et al. Smoking in pregnancy: A cross-sectional study in China. Tobacco Induced Diseases. 2022;15:35.

[31] WHO. WHO report on the global tobacco epidemic 2021: Addressing new and emerging products [Internet]. 2021 [Accessed 2022 September 26]. Available from: