Impact of Maternal Smoking During Pregnancy on Fetal and Neonatal Neurobehavioral Development: A Narrative Review

Maternal smoking during pregnancy (MSDP) remains a common source of prenatal drug exposure worldwide. MSDP has been shown to increase fetal health risks and interfere with fetal development. Although newborns prenatally exposed to other substances (e.g., opiates, benzodiazepines) have been shown to have increased stress and withdrawal symptoms, few studies have explored the effect of MSDP on the fetal and neonatal periods.

We performed a comprehensive search for empirical research articles investigating the effects of MSDP on fetal and neonatal neurobehavior and signs of abstinence in PubMed and PsycINFO databases. Our search yielded 11 fetal and 14 neonatal empirical articles published between 1980 and 2025.

In the fetal period, MSDP-exposed fetuses showed decreased fetal heart rate variability, and fetal movement and reactivity vs unexposed fetuses. In the early neonatal period (birth to five days), MSDP-exposed newborns showed increased excitability, irritability, need for handling, arousal, and alertness. In the late neonatal period (10 to 35 days), studies found MSDP to have an effect on neonatal self-regulation, attention, quality of movement, abnormalities in reflexes, lethargy, need for handling, and stress signs.

Our review of the literature revealed that MSDP has been associated with alterations in behavior suggestive of potential abstinence symptoms, especially found for excitability, irritability, hypertonicity, attention, reflex abnormalities, and stress/abstinence signs. Additional rigorous research needs to delineate the impact of MSDP on fetal and neonatal signs of abstinence to improve infant health.