Smoking Causes Poor Reproductive 

Health Outcomes 

Cigarette smoking before or during pregnancy can affect the 

likelihood of pregnancy, adverse pregnancy outcomes, and the 

health of mother and baby. Maternal smoking causes:

• Reduced fertility

• Pregnancy complications, including premature rupture of 

membranes, placenta previa, placental abruption, ectopic 

pregnancy, and preterm delivery; evidence also suggests that 

smoking may cause miscarriage

• Fetal growth restriction and low birth weight 

• Congenital malformations like orofacial clefts

• Adverse effects on fetal lung and brain development

• Stillbirth and perinatal mortality 

• Sudden infant death syndrome (SIDS)

Maternal exposure to secondhand smoke during pregnancy causes 

small reductions in birth weight and research suggests it may cause 

preterm delivery. Infants exposed to secondhand smoke are at 

higher risk for SIDS, middle ear disease, lower respiratory illness, and 

decreased lung function.

Smoking Cessation Improves 

Reproductive Health Outcomes

Smoking cessation is one of the most important actions women who 

smoke can take for a healthy pregnancy and a healthy baby. The best 

time for women to quit smoking is before they try to get pregnant. 

But quitting at any time during pregnancy can benefit mother and 

baby’s health. 

Benefits of Smoking Cessation

` Smoking cessation during pregnancy reduces the effects of smoking on fetal growth. Cessation early in pregnancy eliminates the adverse 

effects of smoking on fetal growth. 

` Smoking cessation before or during early pregnancy reduces the risk for a small-for-gestational-age birth.

` Research suggests that smoking cessation may reduce the risk of preterm delivery.

Smoking and Reproductive Health 

What Healthcare Professionals Need to Know

Smoking cessation improves reproductive 

outcomes. Healthcare professionals, particularly 

those in obstetric care, should treat patients’ 

tobacco use and dependence. 
Clinical Interventions Work 

Tobacco use and dependence is a chronic, relapsing condition that often requires 

repeated intervention and long-term support. Quitting can be hard, but evidence-based 

treatments (listed below) improve success. 

• Behavioral Counseling: Pregnant women who smoke should be encouraged to 

attempt cessation using behavioral interventions, such as counseling and social 

support, before considering pharmacologic approaches. Brief counseling can 

increase quit success, but studies indicate intensive and tailored counseling is most 

effective in helping pregnant women quit smoking. Counseling can be in-person 

(one-on-one or in a group) or over a telephone quitline. Web- and text-based 

programs also help people quit smoking.

• Medication: There are seven FDA-approved smoking cessation medications. 

However, to date, there is insufficient evidence for the effectiveness of these 

medications in pregnant women and the balance of benefits and harms is not clear. 

Nicotine replacement therapy and other FDA-approved medications (bupropion, 

varenicline) can be considered on a case-by-case basis. These decisions should be 

made carefully while considering the specific circumstances and weighing the risks 

of using medication against the risks of continued smoking.

E-Cigarettes and Pregnancy

` E-cigarettes are not safe to use during 

pregnancy.

` Nicotine is a health danger for pregnant 

women and developing babies and can 

damage a developing baby’s brain and lungs. 

` There is currently not enough evidence to 

know whether e-cigarettes increase smoking 

cessation. 

` E-cigarettes are not currently approved by the 

U.S. Food and Drug Administration (FDA) as a 

smoking cessation aid.

The Entire Clinical Care Team Can Help

A team approach is the best way to treat tobacco use and dependence. Integrating treatment into the routine clinical workflow and engaging the entire 

healthcare team in treatment delivery can make a difference.

Advise Patients to Quit 

• Ask patients about their tobacco use.

• Advise patients that quitting is one of the most important things they can do to improve their health and the health of their baby.

• Remind patients that it is never too late to quit smoking. Although smoking cessation at any point during pregnancy yields health 

benefits, quitting early in pregnancy provides the greatest benefit to mother and baby. 

• Provide patients support, regardless of their readiness to quit smoking. 

Offer Patients Treatment 

• Offer patients treatment at the first prenatal visit and throughout the entire pregnancy and postpartum period.

Refer Patients to Additional Support

• Refer patients to cessation resources and programs in your health system and community. You can also refer them to telephone 

quitlines (1-800-QUIT-NOW) and web- and text-based programs. 

Follow Up With Patients 

• Assess your patients’ progress over time and provide additional support. It may take several attempts for them to quit smoking. 

• Try new strategies, such as new approaches to handling triggers. 

• Provide ongoing support and encourage patients to keep trying and not give up.

Smoking Cessation Resources for Clinicians

` CDC resources: www.cdc.gov/TobaccoHCP

` Million Hearts resources: Tobacco Treatment Protocol, Action Guide, and Change Package available at 

millionhearts.hhs.gov

` Treating Tobacco Use and Dependence, Clinical Practice Guideline: 2008 Update available at 

www.ahrq.gov

` U.S. Preventive Services Task Force: Tobacco Smoking Cessation in Adults, Including Pregnant Women: 

Behavioral and Pharmacotherapy Interventions available at www.uspreventiveservicestaskforce.org

` The American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice 

Opinion available at www.acog.org

08-XX-2020

09-21-2020