GUIDE

Smoking During Pregnancy

Smoking during pregnancy is one of the most preventable causes of pregnancy complications. There is no safe amount.

Cigarette smoke contains over 7,000 chemicals, including nicotine, carbon monoxide, and lead — all of which cross the placenta and reach the baby. Smoking increases the risk of preterm birth, low birth weight, stillbirth, placental abruption, and SIDS. Quitting at any point during pregnancy reduces these risks. Vaping and e-cigarettes are not safe alternatives.

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How Smoking Harms the Baby

When you smoke during pregnancy, your baby smokes too. Nicotine crosses the placenta and constricts blood vessels, reducing the flow of oxygen and nutrients to the baby. Carbon monoxide binds to hemoglobin in the baby's blood, further reducing oxygen delivery. The result is a baby who is chronically underfed and under-oxygenated throughout development.

This is not a theoretical risk — it is well-documented and dose-dependent. The more you smoke, the greater the risk, but even light smoking (1-5 cigarettes per day) increases the likelihood of complications. There is no safe number of cigarettes during pregnancy. Smoking is one of the factors that may lead to a high-risk pregnancy classification.

Risks of Smoking During Pregnancy

Preterm birth — smoking significantly increases the risk of delivering before 37 weeks
Low birth weight — babies born to smokers weigh an average of 200 grams (about half a pound) less
Stillbirth — smoking doubles the risk of stillbirth
Placental abruption — the placenta separates from the uterine wall prematurely, causing dangerous bleeding
Placenta previa — the placenta attaches too low in the uterus, covering the cervix
Ectopic pregnancy — smoking increases the risk of the embryo implanting outside the uterus
SIDS (Sudden Infant Death Syndrome) — babies exposed to smoke in utero have a significantly higher SIDS risk
Cleft lip and palate — smoking is associated with a higher risk of orofacial clefts
Reduced lung development — babies exposed to smoke have smaller lungs and higher rates of asthma and respiratory problems

These risks are well-established from decades of research involving millions of pregnancies. Quitting reduces every one of these risks.

Benefits of Quitting — At Any Stage

Quitting before 15 weeks — reduces the risk of preterm birth and low birth weight to nearly that of a non-smoker
Quitting in the second trimester — significantly reduces risks of low birth weight and growth restriction
Quitting in the third trimester — improves oxygen delivery during critical final growth and reduces SIDS risk
Quitting at any point — reduces carbon monoxide exposure, improves placental blood flow, and benefits the baby's brain development
After birth — reduces SIDS risk, improves breast milk production, and protects the baby from secondhand smoke

It is never too late to quit. The benefits begin within hours of your last cigarette, as carbon monoxide levels in your blood drop and oxygen delivery improves.

Your body starts healing immediately

Within 20 minutes of your last cigarette, your heart rate drops. Within 12 hours, carbon monoxide levels in your blood normalize. Within 2-3 days, nicotine is cleared from your body. Every cigarette you skip is one less dose of harmful chemicals reaching your baby. Progress is not all-or-nothing — reducing is better than not trying.

Quitting Resources

Talk to your OB provider — they can provide counseling, support plans, and discuss nicotine replacement therapy if appropriate
1-800-QUIT-NOW — free national quitline with trained counselors, available 24/7
Smokefree.gov — free texting program (text BABY to 222888) specifically designed for pregnant people
Behavioral counseling — proven effective for smoking cessation during pregnancy, often covered by insurance
Support groups — in-person and online groups for pregnant people quitting smoking
Nicotine replacement therapy (NRT) — patches, gum, or lozenges may be recommended by your provider if counseling alone is not sufficient. NRT is considered less harmful than continued smoking.

You do not have to quit alone. These resources are free and specifically designed to help pregnant people quit smoking.

Also Not Safe During Pregnancy

E-cigarettes and vaping — contain nicotine, heavy metals, and unknown chemicals. Not FDA-approved for cessation.
Smokeless tobacco (chew, snuff, snus) — contains nicotine and cancer-causing chemicals
Hookah — delivers nicotine and carbon monoxide, often in higher amounts than cigarettes
Herbal cigarettes — still produce carbon monoxide and other combustion byproducts when burned
Marijuana — smoking marijuana during pregnancy exposes the baby to many of the same combustion chemicals as tobacco, plus THC crosses the placenta

If it delivers nicotine or involves combustion, it is not safe during pregnancy. There is no 'safer' way to use tobacco or nicotine products.

Support Without Judgment

If you are struggling to quit, you are not alone and you are not a bad parent. Nicotine addiction is a medical condition — it physically alters your brain chemistry. Quitting is hard, and many people need multiple attempts. The most important thing is to keep trying.

Talk to your provider honestly about your smoking. They are there to help, not judge. Behavioral counseling during pregnancy is effective, and nicotine replacement therapy may be recommended if counseling alone is not enough — the controlled nicotine from NRT is considered less harmful than the thousands of chemicals in cigarette smoke.

For other substances to avoid during pregnancy, see our alcohol during pregnancy guide and our caffeine during pregnancy guide. For overall prenatal care and support, see our prenatal visit schedule. For safe medication options, see our pregnancy-safe medications guide.

This guide is for informational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider with any questions about your pregnancy.

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