RESEARCH ARTICLE Associations between lifestyle factors and smoking status during pregnancy in a group of Romanian women S. Voidazan 1 | M. Tarcea 2 | Z. Abram 3 | M. Georgescu 4 | C. Marginean 5 | O. Grama 5 | F. Buicu 6 | F. Ruţa 2 1 Department of Epidemiology, University of Medicine and Pharmacy of Tîrgu Mures , , Tîrgu Mures , , Romania 2 Department of Community Nutrition and Food safety, University of Medicine and Pharmacy of Tîrgu Mures , , Tîrgu Mures , , Romania 3 Department of Hygiene, University of Medicine and Pharmacy of Tîrgu Mures , , Tîrgu Mures , , Romania 4 Ward No. Gynecology 1, Regional Emergency Hospital of Tîrgu Mures , , Tîrgu Mures , , Romania 5 Department of Gynecology II, University of Medicine and Pharmacy of Tîrgu Mures , , Tîrgu Mures , , Romania 6 Department of Public Health, University of Medicine and Pharmacy of Tîrgu Mures , , Tîrgu Mures , , Romania Correspondence Monica Tarcea, Department of Community Nutrition, University of Medicine and Pharmacy of Tîrgu Mures , , Tîrgu Mures , , Romania. Email: monica.tarcea@umftgm.ro Funding information Fogarty International Center and the National Cancer Institute of the National Institutes of Health, Grant/Award Number: R01 TW009280-01. Background: There is an estimated birth rate of 9.27 births/1,000 population in Romania each year, with approximately 8.4% born with low birth weight (LBW). Our purpose was to evaluate the relationships between maternal smoking and LBW and preterm birth in Mures , County, Romania. Methods: We conducted a cross-sectional survey of 1,278 mothers who had given birth in Mures , County obstetrical wards in 2015, based on a lifestyle questionnaire of 109 items and personal and laboratory data from hospitals records. Results: The variables associated with smoking during pregnancy taken into account were: Rroma ethnicity, education <8 grades, income lower than 140 dollars (mini- mum wages in our country), and lack of facilities in their households. In a multivariable model, smoking during pregnancy was correlated with a low level of education (p 5 .02), coffee and alcohol use (p 5 .0001), and lack of interest in poten- tial environmental and behavioral risks during pregnancy (including smoking and diet). The newborn baby’s weight was associated with smoker status of the mother (OR 1.71, 95%CI 1.09–2.66, p 5 .01), by the lack of ownership of a household (OR 3.52, 95%CI 2.27–5.47, p 5 .0001), and by the pregnant woman not receiving proper information regarding a healthy behavior and diet during pregnancy (OR 1.91, 95%CI 1.33–2.74, p 5 .0005). Conclusion: Our study aimed to emphasize the high rates of maternal smoking dur- ing pregnancy and its importance in LBW outcomes in Romanian pregnant women. Moreover, the study highlights disparities in smoking status observed in ethnic minor- ities and those living in poverty. KEYWORDS lifestyle, low birth weight, pregnancy, risk factors, smoking 1 | BACKGROUND Maternal tobacco smoking has serious long-term health impli- cations for women and infants. Smoking increases the health risks from the intrauterine period by influencing gestational age, birth weight, and term of delivery. Some of the most det- rimental complications in pregnancy include placental abrupt- ion, anemia, miscarriage, low birth weight (LBW), preterm birth, stillbirth, and neonatal death or anemia (Baba, Wikstr€ om, Stephansson, & Cnattingius, 2012; Kallen, 2001; Rogers, 2009; Salihu & Wilson, 2007; Vardavas et al., 2010). Smoking before, during, and after pregnancy is a global phenomenon. In high-income countries, such as Australia, Can- ada, Denmark, New Zealand, Sweden, the United Kingdom, and the United States, the prevalence of smoking in pregnancy has been declining significantly in the last decade while the Birth Defects Research. 2018;110:519–526. wileyonlinelibrary.com/journal/bdr2 V C 2018 Wiley Periodicals, Inc | 519 DOI: 10.1002/bdr2.1190