While many people know smoking causes cancer, heart disease and other major health problems, smoking during pregnancy causes additional fetal health complications including birth defects, premature birth and infant death. Cigarettes contain carbon monoxide and nicotine, both of which can cause a decrease in oxygen delivery to the fetus' developing tissues causing organs like the brain, lungs, kidneys and ears not to develop properly. If children are exposed to these toxins through secondhand smoke after birth, they are more likely to experience severe health problems such as ear infections, cataracts, lung cancer and heart disease. It is also known that nicotine is found in high concentrations in breast milk which allows it to be transferred to infants as they breastfeed. Approximately 15 to 20 percent of pregnant women smoke tobacco during pregnancy despite the strong public-health campaign over the last few decades. Because of the risks and potential negative pregnancy outcomes, pharmacists have the duty to assess the patient's willingness to quit smoking (during and after pregnancy) and, if receptive, offer counseling and create a plan for cessation. Nonpharmacologic treatment is the best option for smoking cessation for women who are pregnant as it does not expose the fetus to any additional medications. The "5 R's" are often used to influence any patient, including pregnant women, to consider quitting smoking and to provide them with the right direction to successfully quit. Nonpharmacologic options are the most important for pregnant patients as pharmacologic treatments have not been studied sufficiently to determine safety for the fetus.