Objectives: This study examined the patterns and correlates of maternal smoking before, during, and after pregnancy.
Methods: We examined socioeconomic, demographic, and clinical risk factors associated with maternal smoking in a nationally representative cohort of women (n = 8285) who were surveyed 17 +/- 5 months and again 35 +/- 5 months after delivery.
Results: Smoking rates among women with a college degree decreased 30% from before pregnancy to 35 months postpartum but did not change among the least educated women. Risk factors clustered, and a gradient linked the number of risk factors (0, 2, 4) to the percentage smoking (6%, 31%, 58%, P <.0001).
Conclusions: The period of pregnancy and early parenthood is associated with worsening education-related disparities in smoking as well as substantial clustering of risk factors. These observations could influence the targeting and design of maternal smoking interventions.