The accompanying prospective national cohort study by Hawkins and colleagues adds to the literature on acculturation (the social and psychological exchanges that take place when different cultural groups interact), health disparities, and the use of alcohol and tobacco during pregnancy.1 It finds that after women immigrate to England, their maternal health behaviours worsen as their length of residency increases.

Smoking and alcohol consumption during pregnancy are common in the United States and Europe and are important preventable causes of maternal morbidity during pregnancy, poor fetal development, and poor infant health.1 2 As smoking and alcohol consumption increase in developing countries, such as those in South East Asia and the Western Pacific region,3 4 taboos against these behaviours in women weaken, and more women are at risk of smoking and drinking alcohol during pregnancy.

The World Health Organization predicts that 20% of all women will smoke by 2025, up from 12% in 2005. Although similar worldwide data on trends are not available for alcohol use by sex, a proportional rise in consumption of alcohol in …