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Maternal pregnancy smoking in three Brazilian cities: trends and differences according to education, income, and age



To estimate and assess pregnancy smoking trends since 1978, according to sociodemographic characteristics, in three Brazilian sites.


We used cross-sectional data from the perinatal studies of nine birth cohorts, located in the southeast (Ribeirão Preto—1978/1979, 1994, and 2010), south (Pelotas—1982, 1993, 2004, and 2015), and northeast (São Luís—1997/1998 and 2010) regions of Brazil. We estimated the prevalence of pregnancy smoking at each time point according to age, education, and family income, in each cohort, and evaluated smoking trends.


We analyzed data of 17,275 women in Ribeirão Preto, 19,819 in Pelotas, and 7753 in São Luís. Smoking decreased by 59% in Ribeirão Preto (p < 0.001), 54% in Pelotas (p < 0.001), and 32% in São Luís (p < 0.001). However, among those with 0–4 years of education, smoking did not change in Ribeirão Preto (p-trend = 0.501) nor São Luís (p = 0.556) and increased in Pelotas (p-trend = 0.003).


Pregnancy smoking has been declining during the last decades. However, among less-educated women, pregnancy smoking did not change in two sites and increased in one of them.

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We would like to thank all members, mothers, children, and families, of all this birth cohort for their collaboration and all the people involved in data collection and processing.


Research is supported by Wellcome Trust, “Coordenação de Aperfeiçoamento de Pessoal de Nível Superior” (CAPES), “Conselho Nacional de Desenvolvimento Científico e Tecnológico” (CNPq),” Associação Brasileira de Saúde Coletiva” (ABRASCO), “Fundação de Amparo à Pesquisa do Estado de São Paulo” (FAPESP), “Fundação de Auxílio ao Ensino, Pesquisa e Assistência do HC, FMRP, USP”, “Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul” (FAPERGS), Ministry of Health (Brazil), European Union, National Program for Centers of Excellence - PRONEX (Brazil). None of the funding sources had any role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Correspondence to Christian Loret de Mola.

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The authors declare that they have no conflict of interests.

Ethics approval and consent to participate

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. For all cohorts, written informed consent was required to participate. In Pelotas, perinatal studies were approved by the ethics committee of the Federal University of Pelotas, in Ribeirão Preto by the ethics committee from the “Hospital Das Clínicas” of the Medical School of Ribeirão Preto, and in São Luíz by the Research Ethics Committee of the University Hospital of the Federal University of Maranhão.

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Loret de Mola, C., Cardoso, V.C., Batista, R. et al. Maternal pregnancy smoking in three Brazilian cities: trends and differences according to education, income, and age. Int J Public Health (2020). https://doi.org/10.1007/s00038-019-01328-8

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  • Smoke
  • Pregnancy
  • Trend
  • Population-based
  • Schooling
  • Income