S. National Institutes of Health; Xenova and ZS Associates. selleck chem Carfilzomib Ms. Peters has no competing interests to declare. Supplementary Material [Article Summary] Click here to view. Acknowledgments The authors thank Laura Solomon, Peter Callas, and Shelly Naud for assistance in data analysis and writing of the paper; Saul Shiffman, Karl Fagerstr?m, and Matthew Carpenter for comments on earlier versions of the manuscript; and Amy Livingston, Patti Gannon, Casey Tuck, and Kelsey Hughes for their assistance in conducting this study.
Cigarette smoking during pregnancy is one of the leading preventable causes of low birth weight (U.S. Department of Health and Human Services, 2001) and is associated with multiple other adverse outcomes, such as placenta previa, premature birth, spontaneous abortions, stillbirth, and potential increased risk of neurodevelopmental disorders (Cnattingius, 2004).

Despite risks to their babies and to themselves, approximately 11%�C22% of U.S. women smoke through pregnancy (Substance Abuse and Mental Health Services Administration, 2000). Annual health care costs due to effects of prenatal smoking on neonatal outcomes are estimated to be $263�C$366 million (Lightwood, Phibbs, & Glantz, 1999), and with the addition of first year of life increase to $593�C$706 million (D. P. Miller, Villa, Hogue, & Sivapathasundaram, 2001). Novel behavioral interventions are needed to improve outcomes and reduce health care costs. Estimates are that 20%�C40% of women stop smoking during pregnancy, with the majority doing so in early pregnancy (Cnattingius, Lindmark, & Meirik, 1992; Fingerhut, Kleinman, & Kendrick, 1990; Wisborg, Henriksen, Hedegaard, & Secher, 1996).

Women who are disadvantaged educationally and financially and those who are heavy smokers or more dependent on tobacco/nicotine are among the least likely to quit smoking during pregnancy (e.g., Cnattingius, 2004). A recent meta-analysis (Lumley, Oliver, Chamberlain, & Oakley, 2004) of 48 trials indicates Carfilzomib a significant reduction in smoking for intervention groups compared with controls; however, absolute differences indicate only a 6% reduction in the number of women who continued to smoke throughout pregnancy. Clearly, more powerful interventions are needed. Providing feedback, particularly about biological markers of risk or harm, may be useful to motivate or reinforce behavior change (W. Miller, Zweben, DiClemente, & Rychtarik, 1992; W. R. Miller & Rollnick, 2002). Objective, normative, and personalized feedback has been used as a primary intervention as well as an adjunct to behavioral treatments. In a review of randomized trials of feedback interventions for smokers, McClure (2004) concludes that there is growing evidence for the efficacy of biological feedback (e.g.