Maternal Smoking During Pregnancy and Adverse Childhood Experiences: The Role of Socioeconomic Status in Adulthood and Perinatal Abuse

Objectives: Previous research has linked adverse childhood experiences (ACEs) to maternal smoking, but the role of socioeconomic status (SES) in adulthood and perinatal abuse remains unclear. This study examined the strength of the association between ACEs and maternal smoking behaviors before, during, and after pregnancy and investigated whether maternal SES and perinatal abuse modify this association. Methods: This cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System survey (2017–2020). The weighted prevalence of self-reported ACEs and smoking was calculated. Multivariate logistic regression models were conducted to examine the association between ACEs and maternal smoking throughout pregnancy, accounting for maternal SES and perinatal abuse. Results: Of the 6,595 respondents, nearly 20% of mothers reported experiencing one ACEs, while 29.3% reported three or more. Smoking prevalence was significantly higher among those with ACEs: 2.3% (95% CI 1.7%-3.2%) for mothers reporting zero ACEs, compared to 18.7% (95% CI 16.7%-20.8%) for those reporting three or more ACEs. While SES and perinatal abuse partially explained the association, women with three or more ACEs still had over four times the odds of smoking during pregnancy (aOR = 4.84, 95% CI 3.29–7.10), even after full adjustment. Conclusions: These results highlight the long-lasting consequences of adversities encountered in early life, which can shape the smoking behaviors of women even during the critical stages of their own pregnancy. There is a need for tobacco control interventions among the most vulnerable that extend beyond the traditional services and address deeply rooted factors from past experiences.