Introduction:
Smoking and secondhand exposure to tobacco smoke during pregnancy is well-known health risk factor for pregnant woman, fetus, newborn and small child. Smoking also determines children’s health in further stages of his life and through epigenetic modifications may influence on the health of future generations.

Objectives:
To evaluate prevalence, patterns and trends of tobacco smoking among pregnant women in Poland.

Material and Methods:
Population-based questionnaire studies on health beliefs and behaviors of pregnant women are carried out in Poland since 2009. They were conducted by trained sanitary-epidemiological inspectors in gynecological and maternity wards and based on study concept and questionnaire used in the Pregnancy Risk Assessment Monitoring System (PRAMS), a surveillance project of the Centers for Disease Control and Prevention (CDC). In order to make comparable analysis, presented paper is based on study results from 2013 (N=2913) and 2017 (N=3451). Both studies were coordinated by the Chief Sanitary Inspectorate and financed from the Swiss-Polish Cooperation Program.

Results:
In 2017, 33.8% of Polish pregnant women smoked tobacco before or during pregnancy. 11,9% of them quit smoking before and 15.7% during pregnancy whereas 5.9% continued smoking when were pregnant. Prevalence of current smoking during pregnancy is at highest level among the least educated women and women from households with the lowest income. Average number of cigarettes smoked daily tends to be twice reduced during pregnancy – from 6,6 cigarettes a day 3 months before pregnancy to 3,3 cigarettes a day just before delivery. Results of the 2017 study also show that 33% of pregnant women is exposed to secondhand smoke (SHS) at home (18% at daily basis) and 16% at worksite (9,8% at daily basis). Comparison of the 2013 and 2017 study results indicate that both active and passive smoking among pregnant women were substantially decreased in Poland.

Conclusions:
Tobacco smoking and SHS exposure during pregnancy is still at high level in Poland. Although it was reduced in last decade, additional tobacco control activities are recommended to strengthen this trend. In particular, there is a need to: 1/ implement hospital-based tobacco control and smoking cessation programs, including brief intervention, for pregnant women treated in all gynecological and maternity clinics, 2/ organize trainings on the risk of tobacco use during pregnancy and treatment of tobacco dependence for gynecologists, pediatricians and midwives, 3/ incorporate recommendations on smoking cessation and treatment of tobacco dependence into gynecological and obstetric guidelines, 4/ conduct media and social campaigns on the risk of smoking before, during and after pregnancy, with focus on children’s health and epigenetic consequences.