Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Cigarette smoking: Impact on pregnancy and the neonate

Diana Rodriguez-Thompson, MD, MPH
Section Editors
Charles J Lockwood, MD, MHCM
James K Stoller, MD, MS
Deputy Editor
Kristen Eckler, MD, FACOG


Cigarette smoking during pregnancy is the most important modifiable risk factor associated with adverse pregnancy outcomes [1]. In 2002 in the United States, 5 to 8 percent of preterm deliveries, 13 to 19 percent of term infants with growth restriction, 5 to 7 percent of preterm-related deaths, and 23 to 34 percent of sudden infant death syndrome (SIDS) deaths were attributable to prenatal smoking [2].

In addition, smoking and secondhand smoke exposure increase the risk of infertility, placental abruption, preterm premature rupture of membranes (PPROM), and placenta previa. (See "Optimizing natural fertility in couples planning pregnancy".)

The scope of this problem, the pathophysiology and clinical effects of cigarette smoking on fetal outcome, and current recommendations for smoking cessation during pregnancy will be reviewed here. General issues of substance abuse during pregnancy and smoking cessation in a nonpregnant population are discussed separately. (See "Alcohol intake and pregnancy" and "Overview of substance misuse in pregnant women" and "Overview of smoking cessation management in adults".)  


Screening methods — All pregnant women should be asked regularly about tobacco use [3]. In clinical practice, screening for tobacco use is done by asking the patient if she has ever smoked cigarettes, if she smoked when she found out that she was pregnant, and whether she smokes now. Women who smoke should be asked the number of cigarettes smoked per day.

The strong social norms discouraging smoking among pregnant women lead some women to fail to disclose their true smoking status, as detected by measurement of urine cotinine, a nicotine metabolite [4,5]. As an example, a retrospective cohort study comparing maternal urinary cotinine levels with self-reported cigarette use noted 16.5 percent of women tested positive for high-level nicotine exposure and an additional 7.5 percent tested positive for low-level exposure despite a self-reported cigarette use rate of 8.6 percent [6]. Urinary cotinine screening of pregnant women is feasible in practice and could increase detection of tobacco smoke exposure among pregnant women. Cotinine is found in urine, blood, and saliva for approximately five days after exposure to tobacco smoke.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Oct 20, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Heffner LJ, Sherman CB, Speizer FE, Weiss ST. Clinical and environmental predictors of preterm labor. Obstet Gynecol 1993; 81:750.
  2. Tong VT, Dietz PM, Morrow B, et al. Trends in Smoking Before, During, and After Pregnancy — Pregnancy Risk Assessment Monitoring System, United States, 40 Sites, 2000–2010 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6206a1.htm?s_cid=ss6206a1_e (Accessed on November 08, 2013).
  3. Siu AL, U.S. Preventive Services Task Force. Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2015; 163:622.
  4. Spencer K, Cowans NJ. Accuracy of self-reported smoking status in first trimester aneuploidy screening. Prenat Diagn 2013; 33:245.
  5. Swamy GK, Reddick KL, Brouwer RJ, et al. Smoking prevalence in early pregnancy: comparison of self-report and anonymous urine cotinine testing. J Matern Fetal Neonatal Med 2011; 24:86.
  6. Hall ES, Wexelblatt SL, Greenberg JM. Self-reported and laboratory evaluation of late pregnancy nicotine exposure and drugs of abuse. J Perinatol 2016; 36:814.
  7. Cheng D, Salimi S, Terplan M, Chisolm MS. Intimate partner violence and maternal cigarette smoking before and during pregnancy. Obstet Gynecol 2015; 125:356.
  8. Tobacco Product Use Among Adults — United States, 2012–2013. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0624a1.htm?s_cid=mm63e0624a1_e (Accessed on June 24, 2014).
  9. Baba S, Wikström AK, Stephansson O, Cnattingius S. Influence of smoking and snuff cessation on risk of preterm birth. Eur J Epidemiol 2012; 27:297.
  10. Gupta PC, Subramoney S. Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India. BMJ 2004; 328:1538.
  11. Gupta PC, Subramoney S. Smokeless tobacco use and risk of stillbirth: a cohort study in Mumbai, India. Epidemiology 2006; 17:47.
  12. Steyn K, de Wet T, Saloojee Y, et al. The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study. Paediatr Perinat Epidemiol 2006; 20:90.
  13. Wikström AK, Cnattingius S, Stephansson O. Maternal use of Swedish snuff (snus) and risk of stillbirth. Epidemiology 2010; 21:772.
  14. Gunnerbeck A, Wikström AK, Bonamy AK, et al. Relationship of maternal snuff use and cigarette smoking with neonatal apnea. Pediatrics 2011; 128:503.
  15. Curtin SC, Mathews TJ. Smoking Prevalence and Cessation Before and During Pregnancy: Data from the birth certificate, 2014. Natl Vital Stat Rep 2016; 65.
  16. Kmietowicz Z. Smoking rates among pregnant women fall to all time low of 11%. BMJ 2015; 350:h3335.
  17. Kendrick JS, Zahniser SC, Miller N, et al. Integrating smoking cessation into routine public prenatal care: the Smoking Cessation in Pregnancy project. Am J Public Health 1995; 85:217.
  18. Windsor RA, Lowe JB, Perkins LL, et al. Health education for pregnant smokers: its behavioral impact and cost benefit. Am J Public Health 1993; 83:201.
  19. Windsor RA, Woodby LL, Miller TM, et al. Effectiveness of Agency for Health Care Policy and Research clinical practice guideline and patient education methods for pregnant smokers in medicaid maternity care. Am J Obstet Gynecol 2000; 182:68.
  20. Moore L, Campbell R, Whelan A, et al. Self help smoking cessation in pregnancy: cluster randomised controlled trial. BMJ 2002; 325:1383.
  21. Burton GJ, Palmer ME, Dalton KJ. Morphometric differences between the placental vasculature of non-smokers, smokers and ex-smokers. Br J Obstet Gynaecol 1989; 96:907.
  22. Larsen LG, Clausen HV, Jønsson L. Stereologic examination of placentas from mothers who smoke during pregnancy. Am J Obstet Gynecol 2002; 186:531.
  23. Bush PG, Mayhew TM, Abramovich DR, et al. A quantitative study on the effects of maternal smoking on placental morphology and cadmium concentration. Placenta 2000; 21:247.
  24. Lehtovirta P, Forss M. The acute effect of smoking on intervillous blood flow of the placenta. Br J Obstet Gynaecol 1978; 85:729.
  25. Benowitz NL. Nicotine replacement therapy during pregnancy. JAMA 1991; 266:3174.
  26. Xiao D, Huang X, Yang S, Zhang L. Direct effects of nicotine on contractility of the uterine artery in pregnancy. J Pharmacol Exp Ther 2007; 322:180.
  27. Pauly JR, Slotkin TA. Maternal tobacco smoking, nicotine replacement and neurobehavioural development. Acta Paediatr 2008; 97:1331.
  28. Sekhon HS, Jia Y, Raab R, et al. Prenatal nicotine increases pulmonary alpha7 nicotinic receptor expression and alters fetal lung development in monkeys. J Clin Invest 1999; 103:637.
  29. Sekhon HS, Keller JA, Benowitz NL, Spindel ER. Prenatal nicotine exposure alters pulmonary function in newborn rhesus monkeys. Am J Respir Crit Care Med 2001; 164:989.
  30. Hafström O, Milerad J, Sundell HW. Prenatal nicotine exposure blunts the cardiorespiratory response to hypoxia in lambs. Am J Respir Crit Care Med 2002; 166:1544.
  31. Sherman J, Young A, Sherman MP, et al. Prenatal smoking and alterations in newborn heart rate during transition. J Obstet Gynecol Neonatal Nurs 2002; 31:680.
  32. Tuthill DP, Stewart JH, Coles EC, et al. Maternal cigarette smoking and pregnancy outcome. Paediatr Perinat Epidemiol 1999; 13:245.
  33. Substance Profiles: Tobacco Related Exposures, Report on Carcinogens, 11th ed, US Department of Health and Human Services, Public Health Service, National Toxicology Program. http://.ntp.niehs.nih.gov/ntp/roc/eleventh/profiles/s176toba.pdf. (Accessed on October 19, 2005).
  34. de la Chica RA, Ribas I, Giraldo J, et al. Chromosomal instability in amniocytes from fetuses of mothers who smoke. JAMA 2005; 293:1212.
  35. Wang X, Zuckerman B, Pearson C, et al. Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight. JAMA 2002; 287:195.
  36. Aagaard-Tillery K, Spong CY, Thom E, et al. Pharmacogenomics of maternal tobacco use: metabolic gene polymorphisms and risk of adverse pregnancy outcomes. Obstet Gynecol 2010; 115:568.
  37. Park EY, Hong YC, Lee KH, et al. Maternal exposure to environmental tobacco smoke, GSTM1/T1 polymorphisms and oxidative stress. Reprod Toxicol 2008; 26:197.
  38. Pavlidis N. Lung cancer during pregnancy: an emerging issue. Lung Cancer 2008; 59:279.
  39. Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility: a committee opinion. Fertil Steril 2012; 98:1400.
  40. Zenzes MT. Smoking and reproduction: gene damage to human gametes and embryos. Hum Reprod Update 2000; 6:122.
  41. Zenzes MT, Wang P, Casper RF. Cigarette smoking may affect meiotic maturation of human oocytes. Hum Reprod 1995; 10:3213.
  42. Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Hum Reprod 1998; 13:1532.
  43. Pineles BL, Park E, Samet JM. Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol 2014; 179:807.
  44. Winter E, Wang J, Davies MJ, Norman R. Early pregnancy loss following assisted reproductive technology treatment. Hum Reprod 2002; 17:3220.
  45. Pineles BL, Hsu S, Park E, Samet JM. Systematic Review and Meta-Analyses of Perinatal Death and Maternal Exposure to Tobacco Smoke During Pregnancy. Am J Epidemiol 2016; 184:87.
  46. Raymond EG, Cnattingius S, Kiely JL. Effects of maternal age, parity, and smoking on the risk of stillbirth. Br J Obstet Gynaecol 1994; 101:301.
  47. Cnattingius S, Nordström ML. Maternal smoking and feto-infant mortality: biological pathways and public health significance. Acta Paediatr 1996; 85:1400.
  48. Cnattingius S, Forman MR, Berendes HW, Isotalo L. Delayed childbearing and risk of adverse perinatal outcome. A population-based study. JAMA 1992; 268:886.
  49. Ahlborg G Jr, Bodin L. Tobacco smoke exposure and pregnancy outcome among working women. A prospective study at prenatal care centers in Orebro County, Sweden. Am J Epidemiol 1991; 133:338.
  50. Ekwo EE, Gosselink CA, Woolson R, Moawad A. Risks for premature rupture of amniotic membranes. Int J Epidemiol 1993; 22:495.
  51. Hadley CB, Main DM, Gabbe SG. Risk factors for preterm premature rupture of the fetal membranes. Am J Perinatol 1990; 7:374.
  52. Harger JH, Hsing AW, Tuomala RE, et al. Risk factors for preterm premature rupture of fetal membranes: a multicenter case-control study. Am J Obstet Gynecol 1990; 163:130.
  53. Spinillo A, Nicola S, Piazzi G, et al. Epidemiological correlates of preterm premature rupture of membranes. Int J Gynaecol Obstet 1994; 47:7.
  54. Williams MA, Mittendorf R, Stubblefield PG, et al. Cigarettes, coffee, and preterm premature rupture of the membranes. Am J Epidemiol 1992; 135:895.
  55. US Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General. Rockville: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001.
  56. Ellard GA, Johnstone FD, Prescott RJ, et al. Smoking during pregnancy: the dose dependence of birthweight deficits. Br J Obstet Gynaecol 1996; 103:806.
  57. Secker-Walker RH, Vacek PM, Flynn BS, Mead PB. Estimated gains in birth weight associated with reductions in smoking during pregnancy. J Reprod Med 1998; 43:967.
  58. Juárez SP, Merlo J. Revisiting the effect of maternal smoking during pregnancy on offspring birthweight: a quasi-experimental sibling analysis in Sweden. PLoS One 2013; 8:e61734.
  59. Lieberman E, Gremy I, Lang JM, Cohen AP. Low birthweight at term and the timing of fetal exposure to maternal smoking. Am J Public Health 1994; 84:1127.
  60. Bernstein IM, Mongeon JA, Badger GJ, et al. Maternal smoking and its association with birth weight. Obstet Gynecol 2005; 106:986.
  61. Prabhu N, Smith N, Campbell D, et al. First trimester maternal tobacco smoking habits and fetal growth. Thorax 2010; 65:235.
  62. Benjamin-Garner R, Stotts A. Impact of smoking exposure change on infant birth weight among a cohort of women in a prenatal smoking cessation study. Nicotine Tob Res 2013; 15:685.
  63. Fantuzzi G, Vaccaro V, Aggazzotti G, et al. Exposure to active and passive smoking during pregnancy and severe small for gestational age at term. J Matern Fetal Neonatal Med 2008; 21:643.
  64. Varvarigou AA, Asimakopoulou A, Beratis NG. Impact of maternal smoking on birth size: effect of parity and sex dimorphism. Neonatology 2009; 95:61.
  65. Spinillo A, Capuzzo E, Nicola SE, et al. Factors potentiating the smoking-related risk of fetal growth retardation. Br J Obstet Gynaecol 1994; 101:954.
  66. McDonald AD, Armstrong BG, Sloan M. Cigarette, alcohol, and coffee consumption and prematurity. Am J Public Health 1992; 82:87.
  67. Cigarette smoking and the risk of low birth weight: a comparison in black and white women. Alameda County Low Birth Weight Study Group. Epidemiology 1990; 1:201.
  68. Centers for Disease Control (CDC). Effects of maternal cigarette smoking on birth weight and preterm birth--Ohio, 1989. MMWR Morb Mortal Wkly Rep 1990; 39:662.
  69. Eskenazi B, Prehn AW, Christianson RE. Passive and active maternal smoking as measured by serum cotinine: the effect on birthweight. Am J Public Health 1995; 85:395.
  70. Aagaard-Tillery KM, Porter TF, Lane RH, et al. In utero tobacco exposure is associated with modified effects of maternal factors on fetal growth. Am J Obstet Gynecol 2008; 198:66.e1.
  71. Rasmussen S, Irgens LM. The effects of smoking and hypertensive disorders on fetal growth. BMC Pregnancy Childbirth 2006; 6:16.
  72. Polakowski LL, Akinbami LJ, Mendola P. Prenatal smoking cessation and the risk of delivering preterm and small-for-gestational-age newborns. Obstet Gynecol 2009; 114:318.
  73. McCowan LM, Dekker GA, Chan E, et al. Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: prospective cohort study. BMJ 2009; 338:b1081.
  74. Blatt K, Moore E, Chen A, et al. Association of reported trimester-specific smoking cessation with fetal growth restriction. Obstet Gynecol 2015; 125:1452.
  75. Cnattingius S. Maternal age modifies the effect of maternal smoking on intrauterine growth retardation but not on late fetal death and placental abruption. Am J Epidemiol 1997; 145:319.
  76. Raymond EG, Mills JL. Placental abruption. Maternal risk factors and associated fetal conditions. Acta Obstet Gynecol Scand 1993; 72:633.
  77. Ananth CV, Savitz DA, Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. Am J Epidemiol 1996; 144:881.
  78. Chelmow D, Andrew DE, Baker ER. Maternal cigarette smoking and placenta previa. Obstet Gynecol 1996; 87:703.
  79. Kramer MD, Taylor V, Hickok DE, et al. Maternal smoking and placenta previa. Epidemiology 1991; 2:221.
  80. Handler AS, Mason ED, Rosenberg DL, Davis FG. The relationship between exposure during pregnancy to cigarette smoking and cocaine use and placenta previa. Am J Obstet Gynecol 1994; 170:884.
  81. Monica G, Lilja C. Placenta previa, maternal smoking and recurrence risk. Acta Obstet Gynecol Scand 1995; 74:341.
  82. McMahon MJ, Li R, Schenck AP, et al. Previous cesarean birth. A risk factor for placenta previa? J Reprod Med 1997; 42:409.
  83. Zhang J, Fried DB. Relationship of maternal smoking during pregnancy to placenta previa. Am J Prev Med 1992; 8:278.
  84. Li CQ, Windsor RA, Perkins L, et al. The impact on infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy. JAMA 1993; 269:1519.
  85. Cnattingius S, Forman MR, Berendes HW, et al. Effect of age, parity, and smoking on pregnancy outcome: a population-based study. Am J Obstet Gynecol 1993; 168:16.
  86. Shiono PH, Klebanoff MA, Rhoads GG. Smoking and drinking during pregnancy. Their effects on preterm birth. JAMA 1986; 255:82.
  87. Peacock JL, Bland JM, Anderson HR. Preterm delivery: effects of socioeconomic factors, psychological stress, smoking, alcohol, and caffeine. BMJ 1995; 311:531.
  88. Moore E, Blatt K, Chen A, et al. Relationship of trimester-specific smoking patterns and risk of preterm birth. Am J Obstet Gynecol 2016; 215:109.e1.
  89. Seidman DS, Ever-Hadani P, Gale R. Effect of maternal smoking and age on congenital anomalies. Obstet Gynecol 1990; 76:1046.
  90. Malloy MH, Kleinman JC, Bakewell JM, et al. Maternal smoking during pregnancy: no association with congenital malformations in Missouri 1980-83. Am J Public Health 1989; 79:1243.
  91. Shiono PH, Klebanoff MA, Berendes HW. Congenital malformations and maternal smoking during pregnancy. Teratology 1986; 34:65.
  92. Van den Eeden SK, Karagas MR, Daling JR, Vaughan TL. A case-control study of maternal smoking and congenital malformations. Paediatr Perinat Epidemiol 1990; 4:147.
  93. Werler MM. Teratogen update: smoking and reproductive outcomes. Teratology 1997; 55:382.
  94. Wyszynski DF, Duffy DL, Beaty TH. Maternal cigarette smoking and oral clefts: a meta-analysis. Cleft Palate Craniofac J 1997; 34:206.
  95. Lorente C, Cordier S, Goujard J, et al. Tobacco and alcohol use during pregnancy and risk of oral clefts. Occupational Exposure and Congenital Malformation Working Group. Am J Public Health 2000; 90:415.
  96. Källén K. Maternal smoking and orofacial clefts. Cleft Palate Craniofac J 1997; 34:11.
  97. Shaw GM, Wasserman CR, Lammer EJ, et al. Orofacial clefts, parental cigarette smoking, and transforming growth factor-alpha gene variants. Am J Hum Genet 1996; 58:551.
  98. Christensen K, Olsen J, Nørgaard-Pedersen B, et al. Oral clefts, transforming growth factor alpha gene variants, and maternal smoking: a population-based case-control study in Denmark, 1991-1994. Am J Epidemiol 1999; 149:248.
  99. Meyer KA, Williams P, Hernandez-Diaz S, Cnattingius S. Smoking and the risk of oral clefts: exploring the impact of study designs. Epidemiology 2004; 15:671.
  100. Ramirez D, Lammer EJ, Iovannisci DM, et al. Maternal smoking during early pregnancy, GSTP1 and EPHX1 variants, and risk of isolated orofacial clefts. Cleft Palate Craniofac J 2007; 44:366.
  101. Shi M, Christensen K, Weinberg CR, et al. Orofacial cleft risk is increased with maternal smoking and specific detoxification-gene variants. Am J Hum Genet 2007; 80:76.
  102. Werler MM, Mitchell AA, Shapiro S. First trimester maternal medication use in relation to gastroschisis. Teratology 1992; 45:361.
  103. Yuan P, Okazaki I, Kuroki Y. Anal atresia: effect of smoking and drinking habits during pregnancy. Jpn J Hum Genet 1995; 40:327.
  104. Källén K. Maternal smoking during pregnancy and limb reduction malformations in Sweden. Am J Public Health 1997; 87:29.
  105. Czeizel AE, Kodaj I, Lenz W. Smoking during pregnancy and congenital limb deficiency. BMJ 1994; 308:1473.
  106. Lee LJ, Lupo PJ. Maternal smoking during pregnancy and the risk of congenital heart defects in offspring: a systematic review and metaanalysis. Pediatr Cardiol 2013; 34:398.
  107. Sullivan PM, Dervan LA, Reiger S, et al. Risk of congenital heart defects in the offspring of smoking mothers: a population-based study. J Pediatr 2015; 166:978.
  108. Man LX, Chang B. Maternal cigarette smoking during pregnancy increases the risk of having a child with a congenital digital anomaly. Plast Reconstr Surg 2006; 117:301.
  109. Slickers JE, Olshan AF, Siega-Riz AM, et al. Maternal body mass index and lifestyle exposures and the risk of bilateral renal agenesis or hypoplasia: the National Birth Defects Prevention Study. Am J Epidemiol 2008; 168:1259.
  110. Castles A, Adams EK, Melvin CL, et al. Effects of smoking during pregnancy. Five meta-analyses. Am J Prev Med 1999; 16:208.
  111. Voigt M, Neudecker K, Schneider KT, et al. Effects of smoking specified as cigarettes per day and maternal body mass index on hypertensive disorders of pregnancy. Z Geburtshilfe Neonatol 2013; 217:24.
  112. Mehendale R, Hibbard J, Fazleabas A, Leach R. Placental angiogenesis markers sFlt-1 and PlGF: response to cigarette smoke. Am J Obstet Gynecol 2007; 197:363.e1.
  113. Weissman MM, Warner V, Wickramaratne PJ, Kandel DB. Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood. J Am Acad Child Adolesc Psychiatry 1999; 38:892.
  114. Wakschlag LS, Lahey BB, Loeber R, et al. Maternal smoking during pregnancy and the risk of conduct disorder in boys. Arch Gen Psychiatry 1997; 54:670.
  115. Timmermans SH, Mommers M, Gubbels JS, et al. Maternal smoking during pregnancy and childhood overweight and fat distribution: the KOALA Birth Cohort Study. Pediatr Obes 2014; 9:e14.
  116. Martínez-Mesa J, Menezes AM, González DA, et al. Life course association of maternal smoking during pregnancy and offspring's height: data from the 1993 Pelotas (Brazil) birth cohort. J Adolesc Health 2012; 51:S53.
  117. Behl M, Rao D, Aagaard K, et al. Evaluation of the association between maternal smoking, childhood obesity, and metabolic disorders: a national toxicology program workshop review. Environ Health Perspect 2013; 121:170.
  118. Clifford A, Lang L, Chen R. Effects of maternal cigarette smoking during pregnancy on cognitive parameters of children and young adults: a literature review. Neurotoxicol Teratol 2012; 34:560.
  119. Neuman Å, Hohmann C, Orsini N, et al. Maternal smoking in pregnancy and asthma in preschool children: a pooled analysis of eight birth cohorts. Am J Respir Crit Care Med 2012; 186:1037.
  120. Metzger MJ, Halperin AC, Manhart LE, Hawes SE. Association of maternal smoking during pregnancy with infant hospitalization and mortality due to infectious diseases. Pediatr Infect Dis J 2013; 32:e1.
  121. Jones LL, Hashim A, McKeever T, et al. Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis. Respir Res 2011; 12:5.
  122. Gilman SE, Gardener H, Buka SL. Maternal smoking during pregnancy and children's cognitive and physical development: a causal risk factor? Am J Epidemiol 2008; 168:522.
  123. Florath I, Kohler M, Weck MN, et al. Association of pre- and post-natal parental smoking with offspring body mass index: an 8-year follow-up of a birth cohort. Pediatr Obes 2014; 9:121.
  124. Falgreen Eriksen HL, Kesmodel US, Wimberley T, et al. Effects of tobacco smoking in pregnancy on offspring intelligence at the age of 5. J Pregnancy 2012; 2012:945196.
  125. D'Onofrio BM, Rickert ME, Langström N, et al. Familial confounding of the association between maternal smoking during pregnancy and offspring substance use and problems. Arch Gen Psychiatry 2012; 69:1140.
  126. Law KL, Stroud LR, LaGasse LL, et al. Smoking during pregnancy and newborn neurobehavior. Pediatrics 2003; 111:1318.
  127. Stroud LR, Paster RL, Goodwin MS, et al. Maternal smoking during pregnancy and neonatal behavior: a large-scale community study. Pediatrics 2009; 123:e842.
  128. Stroud LR, Paster RL, Papandonatos GD, et al. Maternal smoking during pregnancy and newborn neurobehavior: effects at 10 to 27 days. J Pediatr 2009; 154:10.
  129. Ekblad M, Korkeila J, Parkkola R, et al. Maternal smoking during pregnancy and regional brain volumes in preterm infants. J Pediatr 2010; 156:185.
  130. Linnet KM, Wisborg K, Obel C, et al. Smoking during pregnancy and the risk for hyperkinetic disorder in offspring. Pediatrics 2005; 116:462.
  131. Thapar A, Fowler T, Rice F, et al. Maternal smoking during pregnancy and attention deficit hyperactivity disorder symptoms in offspring. Am J Psychiatry 2003; 160:1985.
  132. Kenner T, Einspieler C, Haidmayer R. Re: "Sudden infant death syndrome: risk factor profiles for distinct subgroups". Am J Epidemiol 1999; 149:785.
  133. Mitchell EA, Tuohy PG, Brunt JM, et al. Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study. Pediatrics 1997; 100:835.
  134. Alm B, Milerad J, Wennergren G, et al. A case-control study of smoking and sudden infant death syndrome in the Scandinavian countries, 1992 to 1995. The Nordic Epidemiological SIDS Study. Arch Dis Child 1998; 78:329.
  135. Hoffman HJ, Damus K, Hillman L, Krongrad E. Risk factors for SIDS. Results of the National Institute of Child Health and Human Development SIDS Cooperative Epidemiological Study. Ann N Y Acad Sci 1988; 533:13.
  136. Schellscheidt J, Oyen N, Jorch G. Interactions between maternal smoking and other prenatal risk factors for sudden infant death syndrome (SIDS). Acta Paediatr 1997; 86:857.
  137. Rubens D, Sarnat HB. Sudden infant death syndrome: an update and new perspectives of etiology. Handb Clin Neurol 2013; 112:867.
  138. Montgomery SM, Ekbom A. Smoking during pregnancy and diabetes mellitus in a British longitudinal birth cohort. BMJ 2002; 324:26.
  139. Butler NR, Goldstein H. Smoking in pregnancy and subsequent child development. Br Med J 1973; 4:573.
  140. Olds DL, Henderson CR Jr, Tatelbaum R. Intellectual impairment in children of women who smoke cigarettes during pregnancy. Pediatrics 1994; 93:221.
  141. Fried PA, Watkinson B, Gray R. Differential effects on cognitive functioning in 9- to 12-year olds prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol 1998; 20:293.
  142. Batty GD, Der G, Deary IJ. Effect of maternal smoking during pregnancy on offspring's cognitive ability: empirical evidence for complete confounding in the US national longitudinal survey of youth. Pediatrics 2006; 118:943.
  143. Kandel DB, Wu P, Davies M. Maternal smoking during pregnancy and smoking by adolescent daughters. Am J Public Health 1994; 84:1407.
  144. Skorge TD, Eagan TM, Eide GE, et al. The adult incidence of asthma and respiratory symptoms by passive smoking in uterus or in childhood. Am J Respir Crit Care Med 2005; 172:61.
  145. Burke H, Leonardi-Bee J, Hashim A, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics 2012; 129:735.
  146. Bauer T, Trump S, Ishaque N, et al. Environment-induced epigenetic reprogramming in genomic regulatory elements in smoking mothers and their children. Mol Syst Biol 2016; 12:861.
  147. Niemelä S, Sourander A, Surcel HM, et al. Prenatal Nicotine Exposure and Risk of Schizophrenia Among Offspring in a National Birth Cohort. Am J Psychiatry 2016; 173:799.
  148. Cornelius MD. People with schizophrenia are more likely to have a mother who smoked during pregnancy than people without the condition. Evid Based Nurs 2014; 17:80.
  149. Jones PB, Rantakallio P, Hartikainen AL, et al. Schizophrenia as a long-term outcome of pregnancy, delivery, and perinatal complications: a 28-year follow-up of the 1966 north Finland general population birth cohort. Am J Psychiatry 1998; 155:355.
  150. Stathopoulou A, Beratis IN, Beratis S. Prenatal tobacco smoke exposure, risk of schizophrenia, and severity of positive/negative symptoms. Schizophr Res 2013; 148:105.
  151. Baguelin-Pinaud A, Robert S, Ménard JF, Thibaut F. Prenatal exposure to tobacco and risk for schizophrenia: a retrospective epidemiological study. Compr Psychiatry 2010; 51:106.
  152. Browne HA, Modabbernia A, Buxbaum JD, et al. Prenatal Maternal Smoking and Increased Risk for Tourette Syndrome and Chronic Tic Disorders. J Am Acad Child Adolesc Psychiatry 2016; 55:784.
  153. Jensen TK, Jørgensen N, Punab M, et al. Association of in utero exposure to maternal smoking with reduced semen quality and testis size in adulthood: a cross-sectional study of 1,770 young men from the general population in five European countries. Am J Epidemiol 2004; 159:49.
  154. Wilcox AJ, Baird DD, Weinberg CR. Do women with childhood exposure to cigarette smoking have increased fecundability? Am J Epidemiol 1989; 129:1079.
  155. Lutterodt MC, Sørensen KP, Larsen KB, et al. The number of oogonia and somatic cells in the human female embryo and fetus in relation to whether or not exposed to maternal cigarette smoking. Hum Reprod 2009; 24:2558.
  156. Mamsen LS, Lutterodt MC, Andersen EW, et al. Cigarette smoking during early pregnancy reduces the number of embryonic germ and somatic cells. Hum Reprod 2010; 25:2755.
  157. Ye X, Skjaerven R, Basso O, et al. In utero exposure to tobacco smoke and subsequent reduced fertility in females. Hum Reprod 2010; 25:2901.
  158. Ernst A, Kristensen SL, Toft G, et al. Maternal smoking during pregnancy and reproductive health of daughters: a follow-up study spanning two decades. Hum Reprod 2012; 27:3593.
  159. Díaz-Gómez NM, Mendoza C, González-González NL, et al. Maternal smoking and the vitamin D-parathyroid hormone system during the perinatal period. J Pediatr 2007; 151:618.
  160. Stone KC, LaGasse LL, Lester BM, et al. Sleep problems in children with prenatal substance exposure: the Maternal Lifestyle study. Arch Pediatr Adolesc Med 2010; 164:452.
  161. Alberg AJ, Korte JE. Invited commentary: Parental smoking as a risk factor for adult tobacco use: can maternal smoking during pregnancy be distinguished from the social environmental influence during childhood? Am J Epidemiol 2014; 179:1418.
  162. Ever-Hadani P, Seidman DS, Manor O, Harlap S. Breast feeding in Israel: maternal factors associated with choice and duration. J Epidemiol Community Health 1994; 48:281.
  163. Letson GW, Rosenberg KD, Wu L. Association between smoking during pregnancy and breastfeeding at about 2 weeks of age. J Hum Lact 2002; 18:368.
  164. Horta BL, Kramer MS, Platt RW. Maternal smoking and the risk of early weaning: a meta-analysis. Am J Public Health 2001; 91:304.
  165. Giglia R, Binns CW, Alfonso H. Maternal cigarette smoking and breastfeeding duration. Acta Paediatr 2006; 95:1370.
  166. Vio F, Salazar G, Infante C. Smoking during pregnancy and lactation and its effects on breast-milk volume. Am J Clin Nutr 1991; 54:1011.
  167. Agostoni C, Marangoni F, Grandi F, et al. Earlier smoking habits are associated with higher serum lipids and lower milk fat and polyunsaturated fatty acid content in the first 6 months of lactation. Eur J Clin Nutr 2003; 57:1466.
  168. Hill PD, Aldag JC. Smoking and breastfeeding status. Res Nurs Health 1996; 19:125.
  169. Mennella JA, Yourshaw LM, Morgan LK. Breastfeeding and smoking: short-term effects on infant feeding and sleep. Pediatrics 2007; 120:497.
  170. Mascola MA, Van Vunakis H, Tager IB, et al. Exposure of young infants to environmental tobacco smoke: breast-feeding among smoking mothers. Am J Public Health 1998; 88:893.
  171. Leonardi-Bee J, Britton J, Venn A. Secondhand smoke and adverse fetal outcomes in nonsmoking pregnant women: a meta-analysis. Pediatrics 2011; 127:734.
  172. Crane JM, Keough M, Murphy P, et al. Effects of environmental tobacco smoke on perinatal outcomes: a retrospective cohort study. BJOG 2011; 118:865.
  173. Salmasi G, Grady R, Jones J, et al. Environmental tobacco smoke exposure and perinatal outcomes: a systematic review and meta-analyses. Acta Obstet Gynecol Scand 2010; 89:423.
  174. Leonardi-Bee J, Smyth A, Britton J, Coleman T. Environmental tobacco smoke and fetal health: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2008; 93:F351.
  175. Cox B, Martens E, Nemery B, et al. Impact of a stepwise introduction of smoke-free legislation on the rate of preterm births: analysis of routinely collected birth data. BMJ 2013; 346:f441.
  176. Radin RG, Hatch EE, Rothman KJ, et al. Active and passive smoking and fecundability in Danish pregnancy planners. Fertil Steril 2014; 102:183.
  177. Tong VT, Dietz PM, Farr SL, et al. Estimates of smoking before and during pregnancy, and smoking cessation during pregnancy: comparing two population-based data sources. Public Health Rep 2013; 128:179.
  178. Alves E, Azevedo A, Correia S, Barros H. Long-term maintenance of smoking cessation in pregnancy: an analysis of the birth cohort generation XXI. Nicotine Tob Res 2013; 15:1598.
  179. Cnattingius S, Lindmark G, Meirik O. Who continues to smoke while pregnant? J Epidemiol Community Health 1992; 46:218.
  180. Orleans CT, Barker DC, Kaufman NJ, Marx JF. Helping pregnant smokers quit: meeting the challenge in the next decade. Tob Control 2000; 9 Suppl 3:III6.
  181. Más R, Escribà V, Colomer C. Who quits smoking during pregnancy? Scand J Soc Med 1996; 24:102.
  182. US Department of Health and Human Services. The Health Benefits of Smoking Cessation: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1990.
  183. Valbø A, Nylander G. Smoking cessation in pregnancy. Intervention among heavy smokers. Acta Obstet Gynecol Scand 1994; 73:215.
  184. Woodby LL, Windsor RA, Snyder SW, et al. Predictors of smoking cessation during pregnancy. Addiction 1999; 94:283.
  185. Stewart DE, Streiner DL. Cigarette smoking during pregnancy. Can J Psychiatry 1995; 40:603.
  186. Adams MM, Brogan DJ, Kendrick JS, et al. Smoking, pregnancy, and source of prenatal care: results from the Pregnancy Risk Assessment Monitoring System. The Pregnancy Risk Assessment Monitoring System Working Group. Obstet Gynecol 1992; 80:738.
  187. Wewers ME, Salsberry PJ, Ferketich AK, et al. Risk factors for smoking in rural women. J Womens Health (Larchmt) 2012; 21:548.
  188. NICE. National Institute for Health and Care Excellence. Quitting smoking in pregnancy and following childbirth (PH26) http://www.nice.org.uk/PH26 (Accessed on June 03, 2013).
  189. Dolan-Mullen P, Ramírez G, Groff JY. A meta-analysis of randomized trials of prenatal smoking cessation interventions. Am J Obstet Gynecol 1994; 171:1328.
  190. Myung SK, Ju W, Jung HS, et al. Efficacy and safety of pharmacotherapy for smoking cessation among pregnant smokers: a meta-analysis. BJOG 2012; 119:1029.
  191. Patnode CD, Henderson JT, Thompson JH, et al. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 163:608.
  192. Filion KB, Abenhaim HA, Mottillo S, et al. The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials. BJOG 2011; 118:1422.
  193. Chamberlain C, O'Mara-Eves A, Oliver S, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2013; :CD001055.
  194. Higgins ST, Washio Y, Heil SH, et al. Financial incentives for smoking cessation among pregnant and newly postpartum women. Prev Med 2012; 55 Suppl:S33.
  195. Chan B, Einarson A, Koren G. Effectiveness of bupropion for smoking cessation during pregnancy. J Addict Dis 2005; 24:19.
  196. AHRQ. Smoking Cessation Interventions in Pregnancy and Postpartum Care http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1871 (Accessed on February 27, 2014).
  197. Hotham ED, Atkinson ER, Gilbert AL. Focus groups with pregnant smokers: barriers to cessation, attitudes to nicotine patch use and perceptions of cessation counselling by care providers. Drug Alcohol Rev 2002; 21:163.
  198. Oncken C, Dornelas E, Greene J, et al. Nicotine gum for pregnant smokers: a randomized controlled trial. Obstet Gynecol 2008; 112:859.
  199. Melvin CL, Dolan-Mullen P, Windsor RA, et al. Recommended cessation counselling for pregnant women who smoke: a review of the evidence. Tob Control 2000; 9 Suppl 3:III80.
  200. Fiore MC, Jae’n CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services Public Health Service; May 2008.
  201. A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. JAMA 2000; 283:3244.
  202. Lancaster T, Stead L. Physician advice for smoking cessation. Cochrane Database Syst Rev 2004; :CD000165.
  203. Robinson MD, Laurent SL, Little JM Jr. Including smoking status as a new vital sign: it works! J Fam Pract 1995; 40:556.
  204. Okuyemi KS, Ahluwalia JS, Wadland WC. The evaluation and treatment of tobacco use disorder. J Fam Pract 2001; 50:981.
  205. Chen YF, Madan J, Welton N, et al. Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health Technol Assess 2012; 16:1.
  206. Naughton F, Prevost AT, Gilbert H, Sutton S. Randomized controlled trial evaluation of a tailored leaflet and SMS text message self-help intervention for pregnant smokers (MiQuit). Nicotine Tob Res 2012; 14:569.
  207. Naughton F, Prevost AT, Sutton S. Self-help smoking cessation interventions in pregnancy: a systematic review and meta-analysis. Addiction 2008; 103:566.
  208. Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, et al. Mobile phone messaging for preventive health care. Cochrane Database Syst Rev 2012; 12:CD007457.
  209. Mantzari E, Vogt F, Marteau TM. The effectiveness of financial incentives for smoking cessation during pregnancy: is it from being paid or from the extra aid? BMC Pregnancy Childbirth 2012; 12:24.
  210. Coleman T, Chamberlain C, Davey MA, et al. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2012; :CD010078.
  211. Fang WL, Goldstein AO, Butzen AY, et al. Smoking cessation in pregnancy: a review of postpartum relapse prevention strategies. J Am Board Fam Pract 2004; 17:264.
  212. Hemsing N, Greaves L, O'Leary R, et al. Partner support for smoking cessation during pregnancy: a systematic review. Nicotine Tob Res 2012; 14:767.
  213. The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline. JAMA 1996; 275:1270.
  214. Hughes JR, Goldstein MG, Hurt RD, Shiffman S. Recent advances in the pharmacotherapy of smoking. JAMA 1999; 281:72.
  215. Jamal A, Agaku IT, O'Connor E, et al. Current cigarette smoking among adults--United States, 2005-2013. MMWR Morb Mortal Wkly Rep 2014; 63:1108.
  216. Committee opinion no. 471: Smoking cessation during pregnancy. Obstet Gynecol 2010; 116:1241.
  217. Silagy C, Lancaster T, Stead L, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2001; :CD000146.
  218. Pollak KI, Oncken CA, Lipkus IM, et al. Nicotine replacement and behavioral therapy for smoking cessation in pregnancy. Am J Prev Med 2007; 33:297.
  219. Hegaard HK, Kjaergaard H, Møller LF, et al. Multimodal intervention raises smoking cessation rate during pregnancy. Acta Obstet Gynecol Scand 2003; 82:813.
  220. Bérard A, Zhao JP, Sheehy O. Success of smoking cessation interventions during pregnancy. Am J Obstet Gynecol 2016.
  221. Coleman T, Cooper S, Thornton JG, et al. A randomized trial of nicotine-replacement therapy patches in pregnancy. N Engl J Med 2012; 366:808.
  222. Mark KS, Farquhar B, Chisolm MS, et al. Knowledge, Attitudes, and Practice of Electronic Cigarette Use Among Pregnant Women. J Addict Med 2015; 9:266.
  223. Swamy GK, Roelands JJ, Peterson BL, et al. Predictors of adverse events among pregnant smokers exposed in a nicotine replacement therapy trial. Am J Obstet Gynecol 2009; 201:354.e1.
  224. Cooper S, Taggar J, Lewis S, et al. Effect of nicotine patches in pregnancy on infant and maternal outcomes at 2 years: follow-up from the randomised, double-blind, placebo-controlled SNAP trial. Lancet Respir Med 2014; 2:728.
  225. Dhalwani NN, Szatkowski L, Coleman T, et al. Nicotine replacement therapy in pregnancy and major congenital anomalies in offspring. Pediatrics 2015; 135:859.
  226. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340:685.
  227. Chun-Fai-Chan B, Koren G, Fayez I, et al. Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. Am J Obstet Gynecol 2005; 192:932.
  228. Briggs GG, Freeman RK, Yaffe SJ. Bupropion. In: Drugs in Pregnancy and Lactation, 8th edition, Lippincott Williams and Wilkins, 2008. p.214.
  229. Alwan S, Reefhuis J, Botto LD, et al. Maternal use of bupropion and risk for congenital heart defects. Am J Obstet Gynecol 2010; 203:52.e1.
  230. Cole JA, Modell JG, Haight BR, et al. Bupropion in pregnancy and the prevalence of congenital malformations. Pharmacoepidemiol Drug Saf 2007; 16:474.
  231. Thyagarajan V, Robin Clifford C, Wurst KE, et al. Bupropion therapy in pregnancy and the occurrence of cardiovascular malformations in infants. Pharmacoepidemiol Drug Saf 2012; 21:1240.
  232. Sachs HC, Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013; 132:e796.
  233. www.micromedex.com (Accessed on October 07, 2013).
  234. Tran T, Reeder A, Funke L, Richmond N. Association between smoking cessation interventions during prenatal care and postpartum relapse: results from 2004 to 2008 multi-state PRAMS data. Matern Child Health J 2013; 17:1269.
  235. Harmer C, Memon A. Factors associated with smoking relapse in the postpartum period: an analysis of the child health surveillance system data in Southeast England. Nicotine Tob Res 2013; 15:904.
  236. Lauria L, Lamberti A, Grandolfo M. Smoking behaviour before, during, and after pregnancy: the effect of breastfeeding. ScientificWorldJournal 2012; 2012:154910.
  237. Kendzor DE, Businelle MS, Costello TJ, et al. Breast feeding is associated with postpartum smoking abstinence among women who quit smoking due to pregnancy. Nicotine Tob Res 2010; 12:983.
  238. Van't Hof SM, Wall MA, Dowler DW, Stark MJ. Randomised controlled trial of a postpartum relapse prevention intervention. Tob Control 2000; 9 Suppl 3:III64.
  239. Levitt C, Shaw E, Wong S, et al. Systematic review of the literature on postpartum care: effectiveness of interventions for smoking relapse prevention, cessation, and reduction in postpartum women. Birth 2007; 34:341.
  240. Levine MD, Cheng Y, Marcus MD, et al. Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial. JAMA Intern Med 2016; 176:443.
  241. Agboola S, McNeill A, Coleman T, Leonardi Bee J. A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Addiction 2010; 105:1362.
  242. McBride CM, Pirie PL, Curry SJ. Postpartum relapse to smoking: a prospective study. Health Educ Res 1992; 7:381.
  243. Barnet B, Duggan AK, Wilson MD, Joffe A. Association between postpartum substance use and depressive symptoms, stress, and social support in adolescent mothers. Pediatrics 1995; 96:659.
  244. Borrelli B, Bock B, King T, et al. The impact of depression on smoking cessation in women. Am J Prev Med 1996; 12:378.
  245. Rausch JL, Nichinson B, Lamke C, Matloff J. Influence of negative affect on smoking cessation treatment outcome: a pilot study. Br J Addict 1990; 85:929.
  246. DiClemente CC, Dolan-Mullen P, Windsor RA. The process of pregnancy smoking cessation: implications for interventions. Tob Control 2000; 9 Suppl 3:III16.