Cigarette smoking during pregnancy substantially increases the risk of low-weight birth, and infants born to smokers weigh less, on average, than those born to nonsmokers. Low birth weight is an important predictor of neonatal morbidity and death, and the intensity of neonatal care is significantly higher for low-birth-weight infants. In this study, we estimate expenditures on neonatal care based on the relation between maternal smoking during pregnancy and the incidence of low-weight births. Our results indicate that maternal smoking during pregnancy was responsible for 35,816 low-weight births in the U.S. in 1983, or about 14.5% of all low-weight births. We also estimate that 14,977, or 6.6%, of all admissions to neonatal intensive care units were a result of maternal smoking and that these admissions cost approximately $272 million, representing 8.5% of total national expenditures on neonatal intensive care services. We estimate that the average cost of neonatal care was $288 higher for infants born to smokers than for those born to nonsmokers.
PIP: An estimated 21-39% of low-birthweight births are attributable to maternal smoking during pregnancy. Low birthweight is the single most important predictor of neonatal morbidity and mortality; moreover, the intensity of neonatal care is significantly higher for these infants. Previous studies of the economic burden of cigarette smoking-related morbidity have not considered the costs that arise due to smoking during pregnancy. This study calculated expenditures on neonatal care in the US based on the relationship between maternal smoking and the incidence of low-birthweight deliveries. In 1983, maternal smoking during pregnancy was responsible for 35,816 low-weight births (under 2500 grams) in the US, or 14.5% of the total number of low-weight births in that year. 14,977 (6.6%) of admissions to Neonatal Intensive Care Units in 1983 were attributable to smoking during pregnancy. Total costs for these hospitalized infants were US$272 million--approximately 8.5% of total national expenditures on neonatal intensive care. Of this amount, US$267 million represents costs that would not have been incurred in the absence of maternal smoking during pregnancy. The cost of neonatal care in the US in 1983 was thus an average of US$288 higher for infants born to women who smoked during pregnancy. These findings show that, in addition to representing a significant threat to neonatal health, cigarette smoking during pregnancy also imposes a substantial economic burden on the medical care system. Greater attention to the relationship between maternal smoking and neonatal care expenditures is needed to stimulate health care providers to plan interventions aimed at reducing smoking during pregnancy.