MYRTLE BEACH, S.C. (WBTW) – While South Carolina has made big gains in decreasing the number of mothers who smoke while pregnant, many counties still lag behind, according to the state’s health agency.

In 2020, almost one in five expectant mothers in Union County smoked while they were pregnant, according to the South Carolina Department of Health and Environmental Control. That same year, more than 10% of expectant mothers in 16 South Carolina counties smoked while pregnant. Only eight out of the state’s 46 counties were below 5%, with Richland County coming in at the lowest at 1%.

Overall, the state has seen a dramatic drop over the last 30 years in how many expectant mothers smoke.

In 1990, 19.4% of expectant mothers smoked, not too far from the current rate in Union County. By 2020, the statewide rate had reached 6.5%, which was a .9 percentage-point difference from the previous year.

The state rate didn’t dip below 10% until 2015.

In 1990, Allendale County had the lowest rate of mothers who smoked while pregnant, at 11.1%. The most was in Lancaster County, at 28.3%.

Within those 30 years, some counties saw more gains than others. While Lancaster County saw a drop of 21.3 percentage points, York County saw a decrease of 19.3 percentage points and Charleston went down by 16.5 percentage points, Williamsburg County’s number only decreased by 1.6 percentage points.

In Georgetown County, which only dropped by 3.4 percentage points over 30 years, 10.5% of expectant mothers still smoke while they’re pregnant.

“Unfortunately, we do see that about pretty consistently,” said Monica Selander, an OB-GYN at Tidelands Health.

Smoking while pregnant can cause serious issues for a developing baby. The chemicals from tobacco are toxic to a baby’s brain, and smoking increases the risk of preterm delivery and low birth weights, among other complications. Smoking can also cause fertility issues and increases the risk of sudden infant death syndrome.

Selander spends a lot of time educating expectant parents about how dangerous it can be. They know that smoking can lead to lung cancer, but not about how it affects a developing baby.

“I think they generally know that it is frowned upon, and they are used to hearing you shouldn’t smoke while pregnant,” she said.

And if a patient’s partner smokes, she said that makes it nearly impossible to quit, and also adds in the dangers from secondhand smoke.

DHEC data shows that mothers between the ages of 20 and 24 are the most likely to smoke while pregnant, with 7.9% doing so in 2020. In 1990, the age group with the highest rate was those over the age of 45, at 42.9%.

White women who are pregnant are also more likely to smoke than other races, with 8.8%, compared to 4.4% of pregnant Black women and 1.5% of pregnant Hispanic women.

The state already faces a large obstacle when cutting the rates because people in South Carolina smoke more overall than in other states. About 18.1% of adults smoke in South Carolina compared with the national rate of 14%.

Some women will stop smoking while they’re pregnant but will restart after giving birth, according to Catherine Warner, the outreach coordinator for the DHEC Division of Tobacco Prevention and Control.

It’s even harder to quit while pregnant, Warner said, because pregnant women can’t use cessation tools like nicotine patches.

It’s one of the reasons why DHEC’s BABY & ME – Tobacco-Free Program offers individualized counseling for those looking to quit.

“It creates a positive feedback loop when you have a one-on-one connection with somebody who knows your name, and knows the process, and knows what you need to do to stay on it,” Warner said. 

The program uses carbon monoxide sensors to assure that women don’t smoke while pregnant. Those who stay smoke-free can get a $25 voucher for diapers and wipes. Support partners are also eligible. 

The DHEC program started in 2015, concentrating on areas with the highest tobacco use, before expanding to other regions. Since then, Warner said more than 500 people have gone through the program and 50 tobacco-free babies have been born. 

The counselors sit down with participants to uncover why they began smoking. After that, they’re able to create a tailored plan.

Warner said staff members need to take into account the person’s environment, income and education levels. People in rural areas also tend to smoke more than others, which might be linked to sellers in those regions offering steeper discounts.

“We know that when people see an advertisement for a discount on a tobacco product, if they quit smoking, the research shows it’s a trigger and that gets them thinking about it, and it’s right there, and they might cave,” Warner said. 

While health care professionals were concerned that more pregnant women would smoke during the pandemic, 2020 data shows that was not the case that year. 

Warner said the program stayed available via telehealth. 

Overall, the state wants to see a 3% to 5% decrease in how many South Carolinians smoke each year.

Selander said even cutting how many cigarettes a pregnant woman smokes is better than nothing but that the best option is still to quit.

“I always tell them that any effort they can make can make some difference,” she said.

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