This volume highlights both good news and bad news about smoking during pregnancy. The good news is that many women quit spontaneously either just before or soon after becoming pregnant; pregnancy specific counselling with appropriate print materials results in additional cessation; and the percentage of women who smoke throughout pregnancy continues to decline. The bad news is that, each year, additional adverse impacts of maternal smoking on the fetus and infant are reported; one in five to one in six pregnant women smoke throughout their pregnancies; many pregnant smokers do not report their smoking status to their obstetric providers; most women who stop smoking during pregnancy relapse soon after childbirth; and there is no obvious powerful anti-smoking intervention appropriate for pregnant women on the horizon. Also, most of the tobacco use in pregnancy is concentrated among the poorest women—those with other adverse health behaviours, those who are the most heavily addicted, and those who often have the least psychosocial resources to overcome this addictive behaviour.

In an attempt to develop effective smoking cessation methods useful in pregnancy, the Robert Wood Johnson Foundation and its Smoke-Free Families program funded the 11 programs described in this volume, attempting to evaluate methods to increase cessation among pregnant smokers. We learned a number of lessons from observing these projects. First, many women smokers did not admit they were smoking on entry into care, thereby decreasing the number of women available for each of the studies. Second, the seismic shift in the medical care system during the project period, with many women changing from hospital and …