The objective of this study was to assess Ohio obstetricians/ gynecologists' perceptions and use of nicotine replacement therapy (NRT) with pregnant smokers. A three-wave mailing procedure was used and 154 responded (44%) to a valid and reliable 36-item questionnaire regarding: Stage of Change in using NRT, perceptions of prescribing NRT, confidence in using NRT, barriers to prescribing NRT, and use of 5 A's counseling steps. One-fourth (26%) prescribed NRT to pregnant smokers. One-third (32%) perceived NRT as safe, yet few (14%) perceived it as effective. Respondents were most likely to prescribe NRT if the patient requested it (44%). Those most likely to prescribe NRT were more likely to: perceive use of NRT in pregnancy as safe (OR = 20.0); perceive NRT as effective in pregnancy (OR = 4.3); have high confidence in their ability to effectively prescribe NRT (OR = 3.86); and believed most or some of their colleagues prescribed NRT to pregnant smokers (OR = 6.7). The majority did not prescribe NRT possibly because few respondents received cigarette smoking cessation training in medical school or their residencies. Significant revisions in professional training and more continuing medical education are needed regarding smoking cessation and use of NRT.