Smoking cessation in pregnancy has been shown to reduce low birth weight, preterm birth, and infant morbidities. The effectiveness and safety profile of current cessation approaches in pregnancy are presented. The highest cessation rates are associated with counseling and behavioral interventions. Further studies are needed to evaluate the safety and efficacy of pharmacotherapy in pregnancy including nicotine replacement therapy, bupropion and the recently approved drug Varenicline. The risks and benefits of nicotine replacement therapy in heavy smokers and bupropion are discussed. Data on fetal risk are not yet available for Varenicline.