Maternal cigarette smoking is the single most modifiable factor to reduce pregnancy-related morbidity and mortality among mothers and infants.Exposure to cigarette smoke increases the risks of ectopic pregnancy, spontaneous abortion, placental abruption and premature labor.In the US, approximately 800,000 infants are prenatally exposed to cigarette smoke.Evidence suggests that maternal smoking and prenatal exposure to nicotine alter fetal and postnatal development of multiple organ systems, including the nervous, respiratory and cardiovascular systems.Infants exposed to cigarette smoke prenatally weigh 150-300 g less than those born to non-smokers;are prone to sudden infant death syndrome, increased childhood ailments and cognitive delay.Several studies have shown that reduction or cessation of smoking during pregnancy can improve birth weight and other complications.There are a number of challenges that adversely impact the tobacco exposure reduction and cessation programs in pregnant women.Most notably, nicotine is considered a neuroteratogen in animal experiments and classification of nicotine in the D category raises questions about its use in the pregnant women.Evidence suggests that women who adhere to nicotine replacement therapy (NRT) have fewer tobacco-related adverse effects.Regrettably, lack of adherence to the nicotine replacement therapy has been interpreted NRT to be an ineffectual therapy in pregnant women.Furthermore, pregnant mothers face numerous social and economic barriers in seeking counseling to reduce cigarette smoke exposure.In a number of trials, little attention has been paid to the tobacco reduction support for partners.Although few studies have used financial incentives to reduce tobacco exposure,they hold promise to reduce cigarette smoke exposure in pregnant women.Randomized clinical trials are needed to quantify the effectiveness of nicotine replacement therapy, financial incentives and overall family support in addition to support groups and counseling.