OBJECTIVE: to use empirical data to assess the theoretical relevance of using a salutogenic, instead of a pathogenic, perspective to prevent smoking during pregnancy. DESIGN: quantitative study, a questionnaire was completed during the first trimester of pregnancy and an interview was conducted after the baby was born. SETTING: a geographically defined area in the south-east of Sweden. PARTICIPANTS: all 395 women in the study area who were pregnant during the study period 1994-1995. FINDINGS: the women were categorised according to their smoking habits. A significant difference in the sense of coherence (SOC) score was shown between smoking and non-smoking women in indicators of bad health. Women who relapsed to smoking showed a lower level of SOC, particularly in the manageability component, than others. The SOC score was higher in the whole study group than in other comparable, non-pregnant populations. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: a salutogenic perspective could be used in antenatal care as a basis for encouraging pregnant women to stop smoking. This could enhance the SOC by making smoking more understandable for the woman, by discussing smoking as a way of coping, and by encouraging the woman's own capacity and motivation to stop smoking. Starting a dialogue about smoking from the woman's point of view could do this, with the midwife and the woman exploring together the woman's thoughts about the smoking problem.