Abstract Nicotine use during pregnancy remains a widespread problem in obstetrics, leading to complications such as intrauterine growth restriction, preterm birth, stillbirth, and sudden infant death syndrome. Consistent education by medical personnel is essential, as no medication or supplement has been found to prevent the dangers of nicotine use during pregnancy. If a pregnant woman is unable to quit nicotine despite intensive efforts, vitamin C, with its antioxidant properties, may help mitigate these risks, as suggested by some studies. This review summarizes current knowledge based on publications related to vitamin C, nicotine, and pregnancy. Research was conducted on the medical literature platforms PubMed and Cochrane Library, using all relevant studies to provide a comprehensive overview of the topic. The identified studies primarily examined the impact of maternal smoking and nicotine on placental function, as well as the respiratory, cardiac, neuronal, and bone systems of the offspring. They suggest that vitamin C has a generally positive preventive or protective effect, though no study has shown complete compensation for the damage caused by nicotine. Nicotine abstinence remains the most crucial preventive measure. If this is not achievable despite intensive efforts by medical personnel, vitamin C supplementation during pregnancy may be considered. With a very low side effect profile, a daily dose of up to 500 mg can be recommended. However, further studies are necessary to provide reliable data on the effectiveness and appropriate dosage, given an ethically justifiable study approach.Plain language summary This review looks at how vitamin C might protect against the harmful effects of smoking during pregnancy, based on previously published scientific papers. Why was the study done? Nicotine use during pregnancy poses significant risks, including restricted fetal growth, preterm birth, stillbirth, and sudden infant death syndrome. Despite efforts to educate pregnant women about these dangers, nicotine use remains common. No medication or supplement has yet been identified to effectively counteract these risks. However, there is emerging research suggesting that vitamin C, known for its antioxidant properties, could help reduce the negative impacts of nicotine use during pregnancy. This review was conducted to explore the current state of research on this topic. What did the researchers do? The authors reviewed existing studies that focused on the effects of maternal nicotine use and the potential protective role of vitamin C supplementation. The studies primarily examined the impact on the placenta, as well as the respiratory, cardiac, and neuronal systems of offspring exposed to maternal smoking. They sought to determine whether vitamin C could prevent or reduce the harm caused by nicotine exposure during pregnancy. What did the researchers find? The studies reviewed showed generally positive results, indicating that vitamin C supplementation may have a protective effect against some of the damage caused by nicotine use during pregnancy. However, none of the studies demonstrated complete compensation for the harm caused by nicotine. The researchers suggested that a daily dose of 500 mg of vitamin C during pregnancy might offer some benefit, particularly for women who feel unable to quit smoking. At this dosage, no significant side effects are expected. What do the findings mean? While the best way to prevent nicotine-related complications during pregnancy is still to quit smoking, vitamin C supplementation may be a helpful adjunctive measure for pregnant women who struggle to stop smoking. The findings point to the need for further research to better understand the effectiveness and appropriate dosage of vitamin C, using ethically sound study designs to explore this potential intervention
