A critical review of smoking, cessation, relapse and emerging research in pregnancy and post-partum.

INTRODUCTION: Smoking during pregnancy causes adverse health outcomes. Though the prevalence of smoking among pregnant women has declined, postpartum relapse rates remain high and smoking-related maternal, fetal and infant morbidity and mortality remains a public health burden. SOURCES OF DATA: A comprehensive literature search on smoking in pregnancy was conducted to provide a practical review for health professionals. AREAS OF AGREEMENT: Psychosocial support is an effective evidence-based treatment for pregnant women. Bio-psycho-socio factors that influence likelihood of quitting and remaining quit should be addressed. AREAS OF CONTROVERSY: Electronic cigarettes are marketed as a harm reduction tool, but research on safety and effectiveness are lacking for pregnant women. GROWING POINTS: The safety and efficacy of pharmacotherapy for use among pregnant women remains unclear. Clinicians should increase discussions regarding all resources for tobacco use treatment and secondhand smoke (SHS) exposure during pregnancy and postpartum and offer psychosocial support to all pregnant women. AREAS TIMELY FOR DEVELOPING RESEARCH: Research on developing stronger tobacco control policies in low- and middle-income countries, increasing cessation and relapse prevention among pregnant smokers with mental health conditions and increasing the impact of evidence-based supports, such as the quitline, among pregnant women can decrease consumption of tobacco in pregnancy.