Background Rates of smoking among pregnant women in West Virginia are higher than national prenatal smoking rates. Recent research has pointed to the benefit of smoking reduction among a sample of pregnant women who participated in a clinical study in West Virginia. The purpose of the current study is to examine trends associated with reduced smoking exposure among a representative sample of pregnant women in the state. Method Secondary data analysis was conducted using de-identified weighted PRAMS 2005-2010 data from West Virginia examining factors associated with favorable change in prenatal smoking behavior, either quitting or reducing smoking in pregnancy. Results Multivariable analyses results demonstrate that pregnant women are more likely to engage in a favorable smoking behavior change if they were younger (< 35 years of age), were primiparous, and had a higher level of education. Discussion Findings from the study identified factors that contribute to women's likelihood of quitting or reducing smoking in pregnancy in West Virginia. Health care providers and policy makers should consider these factors in implementing approaches that will be effective in promoting smoking cessation and reduction among pregnant women in the state thereby reducing prenatal smoking exposure. Conclusion Population-based research has been used to identify factors associated with smoking cessation or reduction that can be used to develop appropriate and effective approaches to modifying health behaviors in specific populations.