Introduction:
Tobacco consumption during pregnancy is a significant public health concern due to its adverse effects on both maternal and fetal health. Roma women, a marginalized ethnic group in Europe, face unique challenges that may impact smoking behavior and, therefore, cessation efforts. This systematic review seeks to comprehensively synthesize the existing literature on tobacco use patterns and intervention programs designed specifically for Roma women during pregnancy.

Methods:
A comprehensive systematic search used the PICO acronym and relevant MeSH terms. Adhering to the PRISMA guidelines, relevant articles published between 2014 and 2024 were systematically searched for in the online databases PubMed/Medline, Google Scholar, Scopus, and Web of Science.

Results:
Culturally tailored and community-based interventions were most effective in reducing smoking among pregnant Roma women, with significant reductions observed in studies that included specific counseling and educational programs. Mobile health (mHealth) interventions showed modest success, particularly in rural areas. However, persistent barriers such as stress, low socioeconomic status, and limited access to healthcare continued to impede smoking cessation efforts. The studies emphasized the importance of addressing cultural and social factors to improve cessation outcomes in this population.

Conclusions:
This systematic review underscores the nascent evidence base for smoking cessation interventions targeting Roma women in Europe. While culturally tailored approaches show promise, further research is needed to refine and adapt these interventions to address the distinctive socio-cultural dynamics that shape smoking behaviors within this population. Future studies should prioritize rigorous methodologies and comprehensive outcome assessments to inform evidence-based strategies that aim to reduce smoking prevalence and enhance maternal and newborn health outcomes among Roma communities.