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Objective: To examine the prevalence and correlates of tobacco use during pregnancy in a rural area of India.Methods: In the present cross-sectional study, 400 women who gave birth between June 20, 2011, and June 19, 2012, were enrolled in the district of Pakur in Jharkhand, using multistage cluster sampling. Information on tobacco use, awareness of associated adverse health effects, and exposure to secondhand smoke was collected by interview. Multiple logistic regression analysis was used to find correlates of tobacco use.Results: Overall, 59 (14.8%, 95% confidence interval [CI] 11.0%-18.7%) women reported tobacco use during pregnancy. Awareness of the adverse health effects of tobacco during pregnancy was poor for 213 (53.3%) women. Tobacco use during pregnancy was significantly associated with an age of 25 years or older (odds ratio [OR] 8.20, 95% CI 2.48-27.15; P = 0.001) and poor awareness of adverse health effects (OR 4.48, 95% CI 2.03-9.90; P < 0.001).Conclusion: There is an urgent need to prevent tobacco use among pregnant women in India and to offer tobacco cessation services during prenatal checkups to those who continue tobacco use during pregnancy. [ABSTRACT FROM AUTHOR]