Tobacco use during pregnancy is associated with adverse child outcomes. There is evidence that religiosity/spirituality is associated with less tobacco use. This study aims to investigate the association further, including an assessment of overall religiousness and specific aspects of religiosity/spirituality. 404 pregnant women receiving prenatal care in three southern obstetrics practices were surveyed regarding religiosity/ spirituality, other psychosocial characteristics, and recent tobacco. Recent tobacco use was reported by 8% of study participants. In multivariable modeling, black race (OR = 0.32), social support (OR = 0.92), and overall religiousness (OR = 0.57) were significantly associated with lower odds of reporting recent tobacco use. Participation in organized religious activities and self-rated religiosity were the religious/spiritual measures most strongly associated with lower odds of tobacco use. More religious/spiritual women appear to be less likely to use tobacco during pregnancy. Additional research is needed to investigate potential pathways for this association.