Smoking during pregnancy is a public health problem because of the many adverse effects associated with it. These include intrauterine growth restriction, placenta previa, abruptio placentae, decreased maternal thyroid function, preterm premature rupture of membranes, low birth weight, perinatal mortality, and ectopic pregnancy. An estimated 5-8% of pre-term deliveries, 13-19% of term deliveries of infants with low birth weight, 23-34% cases of sudden infant death syndrome (SIDS), and 5-7% of preterm-related infant deaths can be attributed to prenatal maternal smoking. The risks of smoking during pregnancy extend beyond pregnancy-related complications. Children born to mothers who smoke during pregnancy are at an increased risk of asthma, infantile colic, and childhood obesity. Cigarette smoking and tobacco use during pregnancy have been associated with adverse pregnancy outcomes, including spontaneous pregnancy loss, placental abruption, preterm delivery and low birth weight. In addition, smoking during pregnancy impacts fetal and neonatal development, increase infections rate and is associated with an increased risk for long term pediatric cardiovascular morbidity of the offspring. Identifying maternal tobacco product use allows for targeted interventions. Cessation of tobacco use and prevention of secondhand smoke exposure are key clinical intervention strategies during pregnancy and are recommended by obstetrical guidelines. Inquiry into tobacco use and smoke exposure should be a routine part of the prenatal visit and clinicians should provide pregnancy-tailored counseling for those who smoke. National guidelines from Australia, the UK, New Zealand and Canada recommend the use of nicotine replacement therapy (NRT) by pregnant women who have been unable to quit smoking without medication. According to the American College of Obstetrics and Gynecology, nicotine replacement therapy use in pregnancy has not been sufficiently evaluated to determine safety or efficacy and should only be used under supervision, after a risk benefit analysis. The aim of this review is to provide an overview of current guidelines regarding NRT use in pregnancy, considering the existing evidence base on safety, efficacy and effectiveness.