Mothers-to-be who smoke or drink could be hiding their habits in private - because of negative reactions, a study has found.
Pregnant women told Cardiff University researchers they felt "irritated and alienated" by people if they smoke or drank in public.
According to the latest figures, 21% of women in Wales smoke at the date of their first pregnancy assessment.
Researchers said women need "empathy" rather than being stigmatised.
The study claimed women who smoke or drank during pregnancy said they had "awkward" relationships with their midwives and would receive health advice in a "judgemental tone", making them less likely to seek support.
Some women said they were also judged negatively by anti-smoking partners, although others were encouraged to drink alcohol at home as it was an enjoyed shared activity prior to pregnancy.
But despite the feedback, it did not stop women smoking, with many saying that in private it is "acceptable" for pregnant women.Image copyright Thinkstock Image caption Women who feel "judged" for smoking in public are doing so at home instead and not engaging with stopping services, the study said
Dr Aimee Grant, from Cardiff University's Centre for Trials Research, said: "Moral judgements are commonly directed towards mothers through reference to health behaviour in pregnancy, and working-class mothers are particularly subject to this criticism, ignoring the challenges of living on a low income.
"Our study shows that these looks and comments - including by members of the public - irritate and alienate pregnant women, making them less likely to seek help. No one wants to be judged and shamed."
Dr Dunla Gallagher, also from the study team, said smoking is a "coping strategy" for some low-income, expectant mothers.
She said: "Rather than stigma, women need empathy and a recognition of the challenges that pregnancy can bring in terms of women's independent choices."
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