Background: Continuation of tobacco use during pregnancy affects maternal health and has negative impact on fetal health as well. The number of smokers during pregnancy in a developing country like Nepal is soaring high. Different socio-demographic factors might have association with tobacco use during pregnancy.

Objective: To examine the prevalence of tobacco use and its association with socio-demographic variables among pregnant women in Nepal

Methods: The present study was based on the nationally representative sample collected through Nepal Demographic Health Survey (NDHS), 2011. A total of 798 pregnant women (15-49 years old) were included in the study. The information about socio-demographic variables and use of different forms of tobacco was collected through questionnaire survey and household interviews. Descriptive statistics with chi-square test was used to calculate the prevalence of tobacco use (overall tobacco use, cigarette smoking, number of cigarette in 24 hour, chewing tobacco, pipe and bidi smoking) and socio-demographic variables (age, ethnicity, religion, region, type of place of residence, education, occupation, wealth index, number of living children, duration of current pregnancy). Binary logistic regression analysis was then used to calculate the crude and adjusted odd ratios (OR) with 95% confidence intervals (CI) for the association between tobacco use (overall tobacco use, cigarette smoking) and socio-demographic variables.

Results: The prevalence of tobacco use among pregnant women was 22%. Cigarette smoking was the most common form of tobacco use. Adjusted logistic regression model showed that socio-demographic variables such as age, ethnicity, religion, region, education, occupation, wealth index and duration of current pregnancy were significantly associated with tobacco use (overall) and cigarette smoking. Women of higher age group had higher odds of tobacco use [Odd Ratios 6.17, 95% Confidence Interval (2.67-14.24)] and cigarette smoking [OR 6.47, 95% CI (2.44-17.16)]. "Low caste" Dalits had higher odds of tobacco use [OR 2.90, 95% CI (1.61-5.22)] and cigarette smoking [OR 3.96, 95% CI (2.11-7.44)]. Women from Terai region were less likely to use tobacco and smoke cigarette. Educated women and also women who lived with educated partners were less likely to smoke cigarettes. Those engaged in agricultural work had higher odds of cigarette smoking [OR 2.65, 95% CI (1.08-6.54)]. Those categorized as poor were more likely to smoke cigarette and women during late pregnancy period had higher odds of cigarette smoking [OR 1.96, 95% CI (1.06-3.61)].

Conclusion: Tobacco use among pregnant women in Nepal was found high. Different socio-demographic characteristics such as higher age, low ethnicity, other religious group, residents of Terai region, higher education, agriculture and other occupation, higher wealth index and late pregnancy period were strongly associated with tobacco use. Immediate attention of policy makers to formulate action oriented strategies among target group in order to prevent and control tobacco use during pregnancy is required.