摘要:We investigated the relative importance of sociodemographic factors and psychiatric disorders for smoking among 453 pregnant women in the National Epidemiological Survey on Alcohol and Related Conditions. Women with less than a high school education and those with current-year nicotine dependence had the highest risk of smoking (90.5%), compared with women with a college degree and without nicotine dependence (3.9%). More effective and accessible interventions for nicotine dependence among pregnant smokers are needed. Maternal smoking during pregnancy increases the risk of birth complications 1 – 3 and has long-term developmental consequences for child development, including deficits in general intelligence, academic skills, and cognitive functioning. 4 – 7 As social inequalities in smoking have increased over time, 8 , 9 maternal smoking during pregnancy has become concentrated among women with lower levels of education (e.g., more than 20% among women without a high school degree). 10 – 14 In part, the relationship between education and continued smoking is attributable to nicotine dependence, which remains the most prominent obstacle to smoking cessation 15 – 19 and is associated with lower education. 20 Smoking during pregnancy may also be related to worse maternal mental health. 21 – 25 However, this evidence is not entirely consistent 26 – 28 and is based predominantly on clinical samples with above-average rates of psychopathology. In the general population, mood, anxiety, and substance-use disorders predict smoking initiation and persistence, 29 , 30 which suggests that treatment of maternal mental disorders (e.g., antidepressant pharmacotherapy or cognitive behavioral mood management) may promote smoking cessation and reduce fetal exposure to tobacco. 24 , 25 , 31 However, whether the focus of treatment should be on aspects of smoking behavior; symptoms of nicotine dependence 32 – 34 ; symptoms of concomitant mood, anxiety, or substance disorders; or a combination of these remains unresolved. We examined the independent associations of educational attainment, nicotine dependence, and common psychiatric disorders with maternal smoking during pregnancy.