Background
Few studies have been carried out in Spain examining the use of tobacco amongst expectant mothers and its effect on birth weight.

Aims
To observe the proportion of expectant mothers who smoke during their pregnancy, and the impact of tobacco consumption on maternal and birth weight. We also aimed to identify the trimester of pregnancy in which tobacco use produced the greatest reduction in birth weight.

Methods
Prospective observational study in Spain. A random sampling strategy was used to select health centres and participant women. A total of 137 individuals were enrolled in the study. Exposure to tobacco was measured through a self-reported questionnaire. Regressions were performed to obtain a predictive model for birth weight related to smoking.

Findings
Overall, 35% of study participants were smokers during the pre-gestational period (27% in the first trimester, 21.9% in the second and 21.2% in the third). 38.7% of smoking cessation attempts took place in the third-trimester. Pregnant women who smoked up to the third trimester had a higher risk of giving birth to a baby under 3000 g, compared to non-smokers (OR = 5.94, CI 95%: 1.94–18.16). Each additional unit of tobacco consumed daily in the 3rd trimester led to a 32 g reduction in birth weight.

Conclusion
An important proportion of pregnant women in Spain smoke during pregnancy. Pregnant women exposed to tobacco have newborns with lower birth weight. Smoking during the 3rd trimester of pregnancy is associated with the greatest risk of lower birth weight.