Tobacco use and exposure are serious public health problems that threaten to undermine improvements in maternal and child health, and add to already existing poor pregnancy outcomes in many low- and middle-income countries. The purpose of this study is to explore factors that characterize tobacco use and cessation during pregnancy among women in the Dominican Republic. This study was part of a larger trial and includes a sample of women who participated in baseline surveillance and community assessments (n = 613). Descriptive, bivariate, and multivariable analyses were conducted. Overall, 93.31 % (n = 572) of women experienced a past/current pregnancy and 22.44 % (n = 127) smoked during a past or current pregnancy. Among women who had smoked, 34.13 % (n = 43) stopped smoking due to a pregnancy, and 46.03 % (n = 58) were advised by a health care provider to quit smoking because of pregnancy. Women who were older, Catholic, and had a mother who used tobacco were three times more likely to smoke during a past or current pregnancy. Inability to read or write was also significantly associated with smoking during pregnancy. Women who were able to read and write and were from a tobacco growing community were three times more likely to quit smoking during pregnancy. This study provides a preliminary understanding of factors influencing tobacco use and cessation among pregnant women in the Dominican Republic. It also informs a critical area for public health research and intervention, indicating opportunities to engage the health care provider community in intervening with pregnant women and their families.