Although a smaller proportion of children die today than at any other time within the last 100 years, stillbirth and infant death are still a major concern, and the search for preventable causes is of the utmost importance. Exposure to tobacco smoke in utero is one of the possible preventable factors with potential influence on stillbirth and infant death. Smoking reduces fetal oxygenation through increased blood levels of carboxyhemoglobin and through impairment of oxygen unloading (1). Nicotine also causes vasoconstriction (2), which, along with the reduced prosta- cyclin synthesis (3), increases vascular resistance and decreases fetal blood flow (4, 5). Exposure to smoking in utero may thus cause damage to the developing organs, making them vulnerable to disease, or it may interfere with the immune system, predisposing the child to infectious or other diseases.