ABSTRACT This study investigated whether the higher risks of adverse pregnancy outcomes for mothers who smoked cigarettes during pregnancy differed based on whether or not they received adequate prenatal care. Data were extracted from matched birth and infant death records, obtained from the North Carolina State Center for Health and Environmental Statistics for the years 1988–1990 for Guilford County, North Carolina. The indicator of adequacy of prenatal care was a Standard Protocol of Prenatal Care recommended by the American College of Obstetricians and Gynecologists. Preterm births, low birth weights, and infant deaths were the main outcome measures. Among smokers, adequate prenatal care was associated with significantly (p < 0.05) lower rates of preterm births [rate ratio (RR) = 0.68], low birth weight among full-term births (RR = 0.49), and infant death (RR = 0.50). Among nonsmoking mothers, adequate prenatal care was also associated with significantly lower rates of preterm births (RR = 0.55) and o...