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Williams, A., Nkombo, Y., Nkodia, G., Leonardson, G., & Burd, L. (2014). Prevalence of smoking during pregnancy in the Republic of the Congo: Maternal smoking is associated with increased risk of prenatal alcohol exposure. The International Journal Of Alcohol And Drug Research, 3(1), 105-111 . doi:10.7895/ijadr.v3i1.131 Aims: Development of useful estimates of rates of maternal smoking during pregnancy, and the impact of smoking on rates and duration of maternal alcohol use during pregnancy. Design: A prospective study utilizing systematic screening of consecutive pregnant women. Setting: Ten prenatal care sites in Brazzaville, Congo’s largest city, where 50% of live births in the Congo occur. Women were asked to report the number of cigarettes smoked per day. Findings: From the 10 sites, 3,099 women were screened and 5.5% ( n = 172) reported smoking. The mean number of cigarettes smoked per day was 1.1 and only 11% ( n = 19) of the women reported smoking two or more cigarettes per day during pregnancy. Smoking during pregnancy was associated with a 4.9-fold increase in prenatal alcohol exposure during pregnancy. We found that 93% of the women who smoked also used alcohol during pregnancy. Conclusions: While the prevalence of smoking and the average number of cigarettes smoked per day were both low, smoking at any level results in a huge increase in risk for maternal alcohol use during pregnancy. The trend across the developing world is for increasing rates of smoking among women and children. Since the number of cigarettes smoked per day was low, smoking cessation programs and public health warnings may be useful in further reducing rates of smoking during pregnancy and, thus, risk for prenatal alcohol exposure in the Congo. We believe this is the first report quantifying the risk of smoking and prenatal alcohol use in a population of pregnant women.