Decreasing Trends of Tobacco Use Disorder among Pregnant People in the United States

Objective: A recent analysis of the Centers for Disease Control and Prevention's National Vital Statistics System found that pregnant people with tobacco use disorder have decreased in the United States. To further validate their findings in a different data source, this study assessed the temporal trends of pregnant people with tobacco use disorder in the Agency for Healthcare Research and Quality's data source. Study Design: This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population included 24,976,627 hospital deliveries from 2016 to 2022. Prevalence rates of pregnant people with a diagnosis of tobacco use disorder were summarized in each year. A multivariable generalized linear model was created to assess the temporal trend, adjusting for maternal age, race/ethnicity, primary payer, census-level median household income, region, other substance use disorder, and mental health disorder. Results: A total of 1,237,415 (5.0%) hospital deliveries had a diagnosis of tobacco use disorder. Annualized prevalence rate of tobacco use disorder decreased by 27.3% from 5.5% in 2016 to 4.0% in 2022 over the 7-year study period (adjusted-prevalence rate ratio [aRR] for 2022 compared with 2016, 0.72, 95% confidence interval [CI]: 0.71-0.72). The relative-decrease from 2016 to 2022 in tobacco use disorder was particularly high among younger (age < 25, 7.1% in 2016-4.7% in 2022, aRR: 0.63, 95% CI: 0.62-0.64; and age 25-29, 6.3% in 2016-4.3% in 2022, aRR: 0.67, 95% CI: 0.67-0.68), those in New England (5.2% in 2016-3.2% in 2022, aRR: 0.67, 95% CI: 0.65-0.70), Mid-Atlantic (4.9% in 2016-3.3% in 2022, aRR: 0.65, 95% CI: 0.64-0.66), and East North Central (8.4% in 2016-6.0% in 2022, aRR: 0.69, 95% CI: 0.68-0.70), and those with mental health condition (anxiety disorder, 15.9% in 2016-8.5% in 2022, aRR: 0.62, 95% CI: 0.61-0.64; and depressive disorder, 16.4% in 2016-9.6% in 2022, aRR: 0.66, 95% CI: 0.65-0.68). Conclusion: This national-level assessment externally validated a prior study that pregnant people with tobacco use disorder have decreased in the United States. A nearly 30% decrease over a 7-year period is clinically significant and encouraging. Key Points: · Tobacco use disorder among pregnant people has decreased in the United States.. · Decrease in tobacco use disorder occurred more in younger pregnant people.. · Decrease in tobacco use disorder was prominent among mental health conditions..