By WENDY HOLDREN
The Register-Herald
BECKLEY, W.Va. — One reason for poor infant outcomes, according to local health care experts, is the high rate of tobacco use among pregnant women in West Virginia.
The Centers for Disease Control and Prevention report that roughly 8.4 percent of women in the U.S. smoke during pregnancy. But rates in West Virginia were more than three times that number from 2011-2015 at 26.2 percent.
According to the West Virginia Health Statistics Center, even the county in West Virginia with the lowest rate of smoking during pregnancy, Putnam County, had a rate nearly twice the national average — 15.5 percent.
Between 2011-2015, a total of 102,361 babies were born in West Virginia. Of those births, 26,802 of the mothers smoked during pregnancy.
“When you separate out Medicaid mothers from non-Medicaid mothers, the data tells a story,” shared Dr. Rahul Gupta, state health officer and commissioner of the West Virginia Bureau for Public Health. “In 2014, there were 42 percent of pregnant moms on Medicaid that smoked, opposed to 12 percent in the non-Medicaid population.”
Predominantly lower-income mothers are smoking at higher rates, which also increases risk of maternal and infant mortality. Mothers who smoke put their babies at greater risk for pre-term birth, low birth weight and other health complications.
Rates for counties in southern West Virginia are some of the worst.
McDowell County had the highest rate in the state at nearly 41 percent. Other southern West Virginia counties, including Mingo, Wyoming and Logan, at 35 percent, 33.8 percent and 33.1 percent, respectively, ranked in the top 10 for worst smoking rates.
“You hear a lot about the drug abuse,” said Molly McMillion, a special projects consultant with the West Virginia Perinatal Partnership, a statewide partnership of health care professionals and public and private organizations working to improve perinatal health.
“But it’s honestly not as prevalent as the tobacco use. We’re No. 1 in the nation for pregnant smokers.”
Smoking while pregnant can cause a host of issues for the baby, McMillion said, including growth restriction and miscarriage.
She said oftentimes people think babies are safe so long as they’re not considered “premature,” but she said even smaller babies or babies who are born before full gestation are put at higher risk for a number of poor outcomes, including increased risk for SIDS (Sudden Infant Death Syndrome).
If babies continue to be exposed to second-hand smoke, their SIDS risk triples, McMillion said.
“It’s so engrained in the culture,” McMillion said. “With tobacco use, people say, ‘My mom smoked with me and I’m fine.’ West Virginia women who are pregnant don’t necessarily quit smoking.”
With so much focus on the opioid epidemic, the state’s rates of tobacco use are sometimes overlooked.
“I never would have thought years ago I would be so involved with smoking cessation,” McMillion said. “I’m a childbirth educator. I’m a lactation consultant. My job is supposed to be all happy and fun, but that’s the reality. Smoking is very engrained in our culture. Just like drug abuse, smoking is a coping mechanism for folks. That’s why they’re so susceptible to pills. It’s a way to feel better, and it’s hard to combat that.”
She said it’s been a difficult issue to combat in West Virginia. And when smoking and drug use are both present during pregnancy, McMillion said babies go through more severe withdrawal due to the nicotine.
“If there’s ever a time women can be motivated, it’s during pregnancy. The next step is trying to keep them quit.”
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The West Virginia Health Statistics Center reported nearly 5 percent of babies born in West Virginia in 2016 were born drug-dependent.
Out of every 1,000 live births in the state last year, 49.9 babies were born with Neonatal Abstinence Syndrome (NAS), a result of the sudden discontinuation of the baby’s in-utero exposure to substances used by the mother during pregnancy.
In 2014, the rate was 32.1 babies per 1,000, and in 2015, the rate was 34.4.
Beth Hughes Ross, a certified nurse-midwife at AccessHealth in Beckley and the current president of the West Virginia chapter of the American College of Nurse-Midwives, said women who are using drugs should seek treatment for their substance use instead of trying to quit cold turkey.
An abrupt stop will cause the baby to withdraw, which can potentially cause miscarriages. However, if the mother receives medication-assisted treatment or can taper off the drugs gradually, the baby will have a much better outcome.
McMillion also said women who seek treatment during pregnancy have a much better chance of keeping their family intact in terms of Child Protective Services actions.
“If they don’t do anything until when the baby is born, and the baby is born with drugs in its system, CPS may open a case.”
Ross notes women can, however, quit tobacco immediately without increased risks to the baby. She oftentimes recommends her patients taper off, simply because they are more likely to be successful in quitting.
Smoking can cause serious in-utero issues, Ross said. When a mother smokes cigarettes, the blood vessels in her body are constricted, therefore limiting the blood supply to the baby.
“The placenta acts like a filter in pregnancy. In response to the toxins of the cigarettes in mom’s bloodstream, the placenta will calcify.”
Babies of pregnant women who smoke cannot receive adequate blood flow, oxygen or nutrients.
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Positive strides have been made in the past two years in smoking rates among pregnant women in West Virginia.
The Bureau for Public Health announced at the end of last year the smoking rate dropped from 28.2 percent in 2014 to 24.2 percent in 2016.
The decreases in smoking rates during pregnancy are similar to decreases in youth smoking rates, the Bureau for Public Health reported. Data from the 2015 Youth Tobacco Survey indicate the percentage of West Virginia high school students who smoke has decreased to 16.2 percent — down from 38.5 percent in 2000.
Dr. Gupta said his office developed a program in 2015 called the West Virginia Management of Maternal Smoking (MOMS) Initiative.
The initiative, which aims to decrease the pregnancy smoking rate, includes representatives from DHHR programs, the West Virginia Perinatal Partnership, U.S. Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, and the Centers for Medicare and Medicaid Services.
“We’ve seen significant gains, but it’s not enough,” Gupta said. “The rate hadn’t changed 15 years prior to that time. But now, we’re seeing smoking rates go down from 28 percent to 24 percent.”
Specifically, he said the non-Medicaid population rate has dropped from 12.5 percent to 9 percent.
“We’re getting close in the non-Medicaid population to the national rate. In the Medicaid population, we have a long way to go.”
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