Exposure to tobacco smoke affects all stages of human reproduction. Tobacco smoking affects both male and female fecundity. Maternal cigarette smoking is associated with increased risks for ectopic pregnancy, premature rupture of membranes, abruptio placentae, placenta previa, miscarriage, stillbirth, preterm birth, low birth weight, small for gestational age, and congenital anomalies such as cleft lip. After birth, the risk for sudden infant death syndrome (SIDS) is increased among the offspring of women who smoked during or after pregnancy. The harms of tobacco use in pregnancy are not limited to smoked tobacco products only. Evidence suggests that infants born to women who use smokeless tobacco in pregnancy have a higher risk of several adverse outcomes such as stillbirth, preterm birth, and low birth weight. Additionally, maternal exposure to secondhand smoke (SHS) in pregnancy has also been associated with a modest reduction in birth weight, and can increase the risk of low birth weight (<2500 g) by 22%. There are currently no up-to-date, evidence-based guidelines for identifying and managing tobacco use and exposure to SHS in pregnancy in most of the low- and middle-income countries. Most of the existing national guidelines are from high-income countries, and although they provide advice on the management of cigarette smoking in pregnancy (probably the most prevalent form of tobacco use in those countries), they do not address other forms of smoked tobacco or use of smokeless tobacco in pregnancy. Most of these guidelines also do not discuss recommendations on avoiding exposure to SHS 16 executive summary in pregnancy, although some have addressed the smoking status of partners and other household members as a factor affecting pregnant women’s tobacco-cessation efforts and quit attempts.