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Although the proportion of women who smoke during pregnancy in high-income countries has declined, it remains an international public health priority.The economic burden of tobacco-related morbidity and mortality is substantial [1,2], contributing significantly to socioeconomic inequalities in stillbirths and infant deaths (38% and 31% respectively), as shown in a retrospective cohort study of mothers with varying degrees of socioeconomic deprivation [3].It is imperative that health professionals acknowledge the difficulties encountered by underserved minority pregnant smokers when developing and implementing cessation strategies such as lack of childcare, transportation, psychosocial barriers [13], insufficient knowledge of health risks and cessation methods, and lack of culturally appropriate quit support [14].In order to so, anti-smoking interventions will need to adopt a positive rather than punitive approach and respect individual values, capabilities and circumstances to achieve compliance in women [13,14].Current health strategies and interventions designed to diminish smoking in pregnancy have adopted a simplified approach to maternal smoking—one that suggests that they have a similar degree of choice to non-pregnant smokers regarding the avoidance of risk factors, and overlooks individual predictors of non-adherence.

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Cigarette smoking is a marker of social disadvantage in high-income countries and has been cited as one of the most important contributing factors of health inequality between the rich and poor [29].

Unfortunately, this is not uniform across all sectors of society.

Low socioeconomic groups have experienced a much slower rate of decline relative to those of higher socioeconomic standing [16].

Nevertheless, promising results were reported in a randomized trial in which a combination of cognitive behavioural therapy (CBT) and NRT increased cessation rates nearly threefold compared to CBT alone [8].

However, recruitment was stopped early due to higher risk of negative birth outcomes in the CBT NRT group, which was later reported to have resulted from a greater history of preterm births in the CBT NRT group.

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