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Every package of cigarettes sold in the United States includes a warning about the dangers of smoking while pregnant. Fetal deaths, premature births, and low birthweight are up to twice as frequent in mothers who are smokers than in those who do not smoke (Juárez & Merlo, 2013). Infants exposed to smoke while in the womb are prone to congenital heart defects, respiratory problems, and sudden infant death syndrome and, as children, show more behavior problems, have attention difficulties, and score lower on intelligence and achievement tests (He, Chen, Zhu, Hua, & Ke, 2017; Lee & Lupo, 2013; Sutin, Flynn, & Terracciano, 2017). Moreover, maternal smoking during pregnancy shows epigenetic effects on offspring, influencing predispositions to illness and disease in childhood, adolescence, and even middle adulthood (Joubert et al., 2016; Tehranifar et al., 2018). There is no safe level of smoking during pregnancy. Even babies born to light smokers (one to five cigarettes per day) show higher rates of low birthweight than do babies born to nonsmokers (Berlin, Golmard, Jacob, Tanguy, & Heishman, 2017; Tong, England, Rockhill, & D’Angelo, 2017). Although e-cigarettes are commonly believed to be “safer” than cigarettes, animal research suggests that exposure to e-cigarette vapor prenatally is associated with an increased risk for asthma and cognitive and neurological changes (T. Nguyen et al., 2018; Sharma et al., 2017). Research is sparse and just emerging, but it is likely that e-cigarettes have similar effects as smoking traditional cigarettes. Quitting smoking before or during pregnancy reduces the risk of adverse pregnancy outcomes.

Cigarette packages in many countries include warnings of the dangers smoking poses to prenatal development.

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