Abstract Objective. To investigate the independent effects of pregnancy planning and smoking during pregnancy on neonatal outcome. Design. Population-based cohort study. Setting. UK Millennium Cohort Study. Sample. 18,178 singleton babies born in UK between 2000 and 2001. Methods. Logistic regression was used to estimate the association between pregnancy planning and/or smoking and neonatal outcome. Adjusted odds ratios were used to calculate population attributable risk fractions(PAFs). Main Outcome measures. Low birthweight (<2.5Kg) and pre-term birth (<37 completed weeks gestation). Results. 43% of mothers did not plan their pregnancy and 34% were smoking just before and/or during pregnancy. Planners were half as likely to be smokers just before pregnancy, and more likely to give up or reduce the amount smoked if smokers. Unplanned pregnancies had 24% increased odds of low birth weight and prematurity compared to planned pregnancies (AOR LBW 1.24, 95%CI1.04-1.48; AOR PREM 1.24, 95%CI1.05-1.45), independent of smoking status. The odds of low birth weight for babies of mothers who were smoking just before pregnancy was 91% higher than that of mothers who were not (AOR LBW 1.91, 95%CI1.56-2.34). Women who quit or reduced the amount smoked during pregnancy lowered the risk of low birth weight by one third (AOR LBW 0.66, 95% CI0.51-0.85) compared with women whose smoking level did not change. Smaller effects were found for prematurity. If all women planned their pregnancy and did not smoke before or during pregnancy, 30% of low birthweight and 14% of prematurity could, in theory, be avoided. Conclusions. Planning a pregnancy and avoiding smoking during pregnancy has clear, independent, health benefits for babies. Quitting or reducing the amount smoked during pregnancy can reduce the risk of low birthweight
