Cigarette smoking continues to be the main preventable cause of premature death in industrialised countries. It is estimated globally to kill 3 million people annually and this figure is expected to rise to 10 million per year within the next 30–40 years. In the UK alone, smoking is responsible for 120,000 premature deaths per year and in the US the death toll from smoking is running at approximately 420,000. Most of the harm from cigarette smoking results from decades of exposure. Thus deaths generally do not occur in substantial numbers until the smoker has reached 40 years of age. However, there are some circumstances in which smoking has acute effects which can lead to serious illness or death. One of these is prior to surgery, where smoking is strongly associated with adverse post-operative outcomes. The other is during pregnancy. This review examines the health consequences of smoking as it relates to pregnancy, the effects of stopping smoking at this time, the prevalence of smoking and smoking cessation in pregnancy and factors associated with these and finally the effectiveness of interventions aimed at tackling this problem.