Smoking or using tobacco in any form is deadly serious. Globally, many people smoke. It is unacceptable that many pregnant women are exposed to tobacco because they themselves smoke or someone in their home does, affecting their lives, those of their growing children and the development of their unborn fetuses with smoke and all the damaging by-products resulting from cigarette use, including nicotine and carbon monoxide as well as many other toxic substances. Tobacco products are heavily marketed, glamorized and connected to positive images to attract young people, who are most likely to become addicted. As smoking rates have fallen in some high-income countries where preventive public health measures and the effect of policies such as increased taxation may be more effective, marketing and expectations for higher sales of cigarettes from multi-national corporations have been shifted to low and middle income countries (LMICs). Smoking and second hand smoking (SHS) take on more dire proportions in crammed and already unhealthy living conditions, which are unfortunately frequent in LMICs. The adverse effects of these exposures threaten to undermine recent improvements in maternal and child health in these countries and will result in increased rates of chronic diseases, disability and premature death in women and in the most vulnerable populations of the world. Smoking is associated with increased risks for other adverse exposures such as alcohol and drug use and to violence against women. This global epidemic currently in progress results from the strategies of the multi-national companies and many national tobacco industries which have targeted women and girls in LMICs as an untapped and potentially vast market. Governments must consider and weight the adverse economic consequences from the adverse effects of tobacco on the health of populations, which clearly outweigh any short term revenues resulting from sales of tobacco products. It is imperative countries actively participate in the World Health Organization Framework Convention on Tobacco Control, as clearly noted in the commentary by Michele Bloch and colleagues in this issue of AOGS: ‘Tobacco Use and Secondhand Smoke Exposure Among Pregnant Women in Low- and Middle-Income Countries: A Call to Action’. There are environmental concerns as well, not to be forgotten in the wake of the Copenhagen meeting last December. A new focus on this issue is urgently needed. What may be done to reduce smoking, not only among pregnant women, but considering that women and their fetuses are at the highest risks for short and long term adverse effects resulting from tobacco exposure, and especially in LMICs? This issue of AOGS is a special theme issue devoted to this matter. It contains a series of articles resulting firstly from the proceedings of a symposium held in Bethesda, Maryland, USA between 8 and 10 September 2008. It was convened by the Global Network for Perinatal and Reproductive Health (http://www.gnprh.org), together with the U.S. Centers for Disease Control and Prevention and the U.S. National Cancer Institute, entitled ‘Tobacco Exposure During Pregnancy in Low and Middle-Income Countries: Establishing Research Priorities’ and from an international call for contributions, which resulted in a large number of scientific reports and original articles of excellent quality. The response we received to this call for submissions went beyond our initial expectations and confirmed our understanding of the need for a forum where this neglected topic can be brought to the global attention. We will publish additional submissions in future issues of AOGS and AOGS will remain open to be a conduit for additional discussion on this topic. This issue of AOGS, to our knowledge, is the first dedicated to this topic in global literature. We hope that interest will be generated at a global scale and that more research is conducted and comments be published in response to this initiative on a much wider scale than in this journal alone. The Guest Editorial (pp. 416–417) by the new Director of the World Health Organisation in Europe, Zsuszanna Jakab, an expert with a solid background and commitment to public health, gives a secure start to the arguments, which then are elaborated in the commentary by Bloch and her colleagues who discuss the central points of the topic with a global public health and policy perspective. These are followed by three reports from the September 2008 meeting of experts whose names are listed in the manuscripts. An overview by Cheryl Oncken and her colleagues on ‘Interventions to promote tobacco cessation and reduce SHS exposure during pregnancy in high-, low-, and middle-income counties’ defines what is known in terms of possible effective interventions. It is followed by an excellent study on common forms of tobacco exposure, other than cigarette smoking, in LMICs, by Lucinda England and colleagues entitled: ‘Description of non-cigarette tobacco use by women and characterization of risks for adverse pregnancy outcomes resulting from such use’ and complemented with a detailed review by Mimi Nichter and colleagues on ‘Social and cultural factors influencing pregnant women's use of tobacco and exposure to SHS’. These three topics were selected by all the experts convened at this meeting as the most urgent ones to initiate this dialogue. These three reports summarize current information from global sources and make recommendations on a research agenda to be urgently developed. We join the investigators and scientists, public health experts and policy makers involved in these manuscripts presented in this special issue of AOGS and as ably noted by Bloch and her colleagues in a ‘A call to action’ for funding support, scientific inquiry, and evidence-based interventions to prevent and reduce tobacco use and SHS exposure among pregnant women. We need to join forces to prevent the full scale of the ongoing epidemic and prevent disability and disease in the most vulnerable populations, women and children.