See the discussion online at

Key Points

• The more a pregnant woman smokes, the greater the risk of premature delivery and low-birth-weight infants, unless she stops smoking by the fourth month of gestation.

• Smoking during pregnancy increases the risk of congenital abnormalities, mental retardation, learning problems, and attention-deficit/hyperactivity disorder (ADHD).

• The risk is increased for spontaneous abortion, placenta previa, and premature rupture of membranes.

• Reduced fertility is proportional to the number of cigarettes smoked.


Because of the serious risks of smoking to the pregnant smoker and the fetus, whenever possible pregnant smokers should be offered person-to-person psychosocial interventions that exceed minimal advice to quit (Fiore et al., 2008) (SOR: A). Although abstinence early in pregnancy will produce the greatest benefits to the fetus and expectant mother, quitting at any point in pregnancy can yield benefits. Therefore, physicians should offer effective tobacco-dependence interventions to pregnant smokers at the first prenatal visit and throughout pregnancy (Fiore et al., 2008) (SOR: B).

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