• Colin Mendelsohn, Gillian S Gould, and Cheryl Oncken.
• MBBS(Hons), is a general practitioner and tobacco treatment specialist, Sydney, New South Wales.
• Aust Fam Physician. 2014 Jan 1; 43 (1): 465146-51.

BackgroundSmoking is the most important preventable cause of adverse outcomes in pregnancy. However, most smokers who become pregnant continue to smoke and most of those who quit relapse after delivery.ObjectiveThis article explores the relationship between smoking and pregnancy, and reviews the evidence for best practice intervention by general practitioners.DiscussionContinuing to smoke during pregnancy is strongly associated with socioeconomic disadvantage, mental illness and Aboriginal and Torres Strait Islander populations. Quitting is more difficult for these groups and interventions assist only sixin every 100 pregnant smokers to quit. Behavioural counselling is the first-line treatment. Nicotine replacement therapy (NRT) can be offered if the smoker is unable to quit without it, although its efficacy is uncertain. Adequate doses of nicotine and good adherance may be required for the best results. The use of NRT in pregnancy is likely to be less harmful than continuing to smoke. Women should be encouraged to quit smoking before becoming pregnant.

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