Cigarette smoking results in more than 480,000 premature deaths each year and accounts for approximately 1 in every 5 deaths. In pregnant women, smoking increases the risk for congenital anomalies and perinatal complications, such as preterm birth, fetal growth restriction, and placental abruption, and more. This journal provides recommendations from the U.S. Preventive Services Task Force on counseling and interventions to prevent tobacco use and tobacco-related disease in adults, including pregnant women.