Help to stop smoking in pregnancy

Pregnant people can be asked about tobacco, advised to stop and offered counseling and other behavioral support to quit. US guidance (USPSTF, 2021) recommends this for pregnant people who use tobacco and grades it A. For medicines to help with quitting, the task force said the evidence in pregnancy is too thin to judge the balance of benefits and harms. Smoking in pregnancy can raise the risk of problems such as miscarriage and birth defects, and of complications for the child such as sudden infant death syndrome.

Intervention
In this atlas

Overview

Technical summary

USPSTF 2021 covers adults 18 years or older, including pregnant persons, and treats pregnant persons separately. For pregnant persons it recommends asking about tobacco use, advising them to stop and providing behavioral interventions, with high certainty of substantial net benefit on perinatal outcomes and smoking cessation (an A recommendation). Pharmacotherapy in pregnancy is an I statement. The same statement also has an I statement on e-cigarettes in adults including pregnant persons, not recorded as a claim here. The abstract gives no effect sizes for pregnancy.

About this intervention

Type: Service
Mechanism: Not reported

Claims and evidence

Context Pregnant persons who use tobacco (USPSTF 2021)

Recipient: Maternal
Population: Pregnant persons who use tobacco. The USPSTF statement applies to adults 18 years or older, including pregnant persons.
Care setting: Primary care (the review evaluated primary care interventions).
Geography: United States (statement of the US Preventive Services Task Force); the abstract names no country.
Life stage: Pregnancy
Gestational age: Not reported
Postnatal age: Not reported
Follow-up: Not applicable (recommendation context)

Eligibility: 1 inclusion criterion; 1 exclusion criterion

Included: Pregnant persons who use tobacco
Excluded: Not stated in the PubMed abstract

Recommendation Guidance Certainty not assessed

The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco. It grades this an A recommendation and concludes with high certainty that the net benefit of behavioral interventions for tobacco smoking cessation on perinatal outcomes and smoking cessation in pregnant persons is substantial.
Applies to Maternal
- Pregnant persons who use tobacco. The USPSTF statement applies to adults 18 years or older, including pregnant persons.
- Primary care (the review evaluated primary care interventions).
- United States (statement of the US Preventive Services Task Force); the abstract names no country.
- Pregnancy
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Not applicable (recommendation context)
Certainty method
Not assessed

Limitations
The PubMed abstract prints each grade after its statement, so the A for the pregnancy statement appears at the start of the next sentence. The same statement covers all adults 18 years or older, including pregnant persons; this claim is about the pregnancy part only. The abstract gives no benefit numbers for pregnant persons. USPSTF certainty levels are the task force’s own wording and not a GRADE rating, so certainty is not assessed.

Last checked
2026-10-14

Next evidence check due
Not scheduled
Sources and citations (6)
1. Supports Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
  
  Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-01-19 · DOI: 10.1001/jama.2020.25019 · PMID: 33464343
  
  Locator
  Abstract, RECOMMENDATIONS, sentence 2
  
  How it applies
  PubMed abstract of the USPSTF 2021 statement.
  
  Retrieved
  2026-10-14T18:18:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  3745ae7e6024e6141d1bea59b2cb79113d2dd865c5a2531fb9276a0e08f8a558
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Supports Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
  
  Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-01-19 · DOI: 10.1001/jama.2020.25019 · PMID: 33464343
  
  Locator
  Abstract, RECOMMENDATIONS, sentence 3
  
  How it applies
  PubMed abstract of the USPSTF 2021 statement.
  
  Retrieved
  2026-10-14T18:18:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  3745ae7e6024e6141d1bea59b2cb79113d2dd865c5a2531fb9276a0e08f8a558
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
3. Supports Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
  
  Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-01-19 · DOI: 10.1001/jama.2020.25019 · PMID: 33464343
  
  Locator
  Abstract, EVIDENCE ASSESSMENT, sentence 2
  
  How it applies
  PubMed abstract of the USPSTF 2021 statement.
  
  Retrieved
  2026-10-14T18:18:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  3745ae7e6024e6141d1bea59b2cb79113d2dd865c5a2531fb9276a0e08f8a558
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
4. Background Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
  
  Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-01-19 · DOI: 10.1001/jama.2020.25019 · PMID: 33464343
  
  Locator
  Abstract, POPULATION, sentence 1
  
  How it applies
  Population, objective and background on harms of smoking in pregnancy.
  
  Retrieved
  2026-10-14T18:18:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  3745ae7e6024e6141d1bea59b2cb79113d2dd865c5a2531fb9276a0e08f8a558
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
5. Background Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
  
  Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-01-19 · DOI: 10.1001/jama.2020.25019 · PMID: 33464343
  
  Locator
  Abstract, OBJECTIVE, sentence 1
  
  How it applies
  Population, objective and background on harms of smoking in pregnancy.
  
  Retrieved
  2026-10-14T18:18:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  3745ae7e6024e6141d1bea59b2cb79113d2dd865c5a2531fb9276a0e08f8a558
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
6. Background Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
  
  Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-01-19 · DOI: 10.1001/jama.2020.25019 · PMID: 33464343
  
  Locator
  Abstract, IMPORTANCE, sentence 3
  
  How it applies
  Population, objective and background on harms of smoking in pregnancy.
  
  Retrieved
  2026-10-14T18:18:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  3745ae7e6024e6141d1bea59b2cb79113d2dd865c5a2531fb9276a0e08f8a558
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
Recommendation Guidance Certainty not assessed

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant persons, because few studies are available. It labels this an I statement.
Applies to Maternal
- Pregnant persons who use tobacco. The USPSTF statement applies to adults 18 years or older, including pregnant persons.
- Primary care (the review evaluated primary care interventions).
- United States (statement of the US Preventive Services Task Force); the abstract names no country.
- Pregnancy
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Not applicable (recommendation context)
Certainty method
Not assessed

Limitations
An I statement is a statement about the evidence, not a recommendation against medicines. The same USPSTF statement also concludes that the evidence on e-cigarettes for smoking cessation in adults, including pregnant persons, is insufficient (an I statement); that is outside this claim’s population. The PubMed abstract prints each grade after its statement, so the I for the pharmacotherapy statement appears at the start of the next sentence.

Last checked
2026-10-14

Next evidence check due
Not scheduled
Sources and citations (3)
1. Supports Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
  
  Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-01-19 · DOI: 10.1001/jama.2020.25019 · PMID: 33464343
  
  Locator
  Abstract, EVIDENCE ASSESSMENT, sentence 3
  
  How it applies
  PubMed abstract of the USPSTF 2021 statement.
  
  Retrieved
  2026-10-14T18:18:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  3745ae7e6024e6141d1bea59b2cb79113d2dd865c5a2531fb9276a0e08f8a558
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Supports Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
  
  Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-01-19 · DOI: 10.1001/jama.2020.25019 · PMID: 33464343
  
  Locator
  Abstract, RECOMMENDATIONS, sentence 3
  
  How it applies
  PubMed abstract of the USPSTF 2021 statement.
  
  Retrieved
  2026-10-14T18:18:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  3745ae7e6024e6141d1bea59b2cb79113d2dd865c5a2531fb9276a0e08f8a558
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
3. Supports Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
  
  Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-01-19 · DOI: 10.1001/jama.2020.25019 · PMID: 33464343
  
  Locator
  Abstract, RECOMMENDATIONS, sentence 4
  
  How it applies
  PubMed abstract of the USPSTF 2021 statement.
  
  Retrieved
  2026-10-14T18:18:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  3745ae7e6024e6141d1bea59b2cb79113d2dd865c5a2531fb9276a0e08f8a558
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Guidance

Recommended: Help to stop smoking in pregnancy

Applies to Maternal

Pregnant persons who use tobacco. The USPSTF statement applies to adults 18 years or older, including pregnant persons.
Primary care (the review evaluated primary care interventions).
United States (statement of the US Preventive Services Task Force); the abstract names no country.
Pregnancy
Gestational age Not reported
Postnatal age Not reported

Follow-up Not applicable (recommendation context)

Issued by: U.S. Preventive Services Task Force
Guideline: USPSTF 2021: interventions for tobacco smoking cessation in adults, including pregnant persons; Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions (USPSTF final recommendation statement page), edition Final recommendation statement page as fetched on 2026-10-14 (mx-uspstf-tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions.html). The date under the title is January 19, 2021.
Strength: A recommendation (USPSTF letter grades: A, B, C and D recommendations, and the I statement for when the evidence is insufficient to recommend for or against. The grade reflects the Task Force's certainty about net benefit. These are not GRADE strength labels.)
Effective: 2021-01-19 (The date under the title of the USPSTF final recommendation statement page, January 19, 2021. The statement was also published in JAMA, which has its own issue date.)
Jurisdictions: United States; note: United States (the issuer is a United States task force).
Supersession: Not checked

Basis: The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco. It grades this an A recommendation and concludes with high certainty that the net benefit of behavioral interventions for tobacco smoking cessation on perinatal outcomes and smoking cessation in pregnant persons is substantial.
Limitations. The PubMed abstract prints each grade after its statement, so the A for the pregnancy statement appears at the start of the next sentence. The same statement covers all adults 18 years or older, including pregnant persons; this claim is about the pregnancy part only. The abstract gives no benefit numbers for pregnant persons. USPSTF certainty levels are the task force’s own wording and not a GRADE rating, so certainty is not assessed.

Evidence is insufficient to recommend for or against: Help to stop smoking in pregnancy