Throughout the past decade, smoking has remained the single most important modifiable cause of poor pregnancy outcome in the USA. It accounts for 20% of low birth weight deliveries, 8% of preterm births, and 5% of all perinatal deaths.1 New studies have found that maternal smoking during pregnancy contributes to sudden infant death syndrome and may cause important changes in fetal brain and nervous system development.2-7 New economic estimates indicate that the direct medical costs of a complicated birth for a smoker are 66% higher than for non-smokers—reflecting the greater severity of complications and the more intensive care required.8 While quitting smoking early in pregnancy is most beneficial, important health benefits accrue from quitting at any time during the pregnancy.1

Moreover, the health hazards and health care burden to women and their family members caused by smoking do not begin or end with pregnancy. Before pregnancy, smoking increases the risk of serious medical complications for women using oral contraceptives and can impair fertility.1 After pregnancy, in addition to adversely affecting women's health, smoking exposes infants and young children to environmental tobacco smoke. This exposure is linked to SIDS, respiratory illnesses, middle ear infections, and decreased lung function.3 4 9 Currently, 27% of US children aged 6 years and under are exposed to tobacco smoke at home,10with the annual direct medical costs of parental smoking estimated at $4.6 billion and loss of life costs estimated at $8.2 billion.11

Recent national survey data indicate that the goal of reducing smoking among pregnant women from 25% in 1985 to 10% by the 2000 was not met.12 While some reduction was achieved, about 20% of US women currently smoke during pregnancy, based on the 1994, 1995, and 1996 SAMSHA national surveys (table 1). …