The 2008 UK National Smoking Cessation Conference (UKNSSC) included a number of oral and poster presentations on the theme of smoking during pregnancy. This is a challenging area of research and practice and one in which new evidence — both about the effects of smoking in pregnancy and about smoking cessation interventions — is regularly emerging. Papers at UKNSCC explored why few women access support to stop (Felix Naughton), how best to refer women to specialist services (Joan Braithwaite), social marketing approaches (Deborah Richardson and Wendy Dudley) and physical activity for smoking cessation during pregnancy (Michael Ussher). The conference opened with a plenary presentation that explored the extent of smoking during pregnancy and women's accounts of quit attempts, cessation and relapse. It also examined what more could be done to improve access to stop smoking services for pregnant women and increase the proportion of women who quit. This article reviews some of the evidence presented at UKNSSC, focusing in particular on the need for improved identification, referral, engagement and treatment of pregnant smokers.