The aim of this structured review was to discuss knowledge of nicotine use during pregnancy and long-term effects on children's cardiovascular function. PubMed and MEDLINE were searched for original papers that covered various forms of nicotine exposure during pregnancy and this identified 314 papers published in English from inception of the databases to 1 March 2021. The research focus was prenatal exposure that had long-term effects on the cardiovascular system. The search was expanded from the reference list of the selected papers, which identified another 17 papers. The 34 original papers that were included covered 172,696 subjects from foetuses to 19 years of age. Cardiovascular autonomic dysfunction was discussed in 12 of the papers and 16 studies reported on blood pressure. The remaining studies covered structural or functional changes in arterial wall or heart. There were convincing data on autonomic dysfunction and increased blood pressure. Some data were conflicting and problems with misclassification of exposure were evident. Prenatal nicotine exposure was associated with long-term developmental changes in the cardiovascular system and regulation. There were no safe periods, doses or nicotine products during pregnancy and women should abstain when planning a pregnancy. © 2021 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.