This study examined the association between maternal smoking and exposure to environmental tobacco smoke (ETS) during pregnancy and infant heart rate. Participants were 62 mother-infant dyads where mother smoked during pregnancy, 47 dyads where mother did not smoke during pregnancy but was exposed to ETS and 47 dyads where mother did not smoke and was not exposed to ETS. Average heart rate (HR) and respiratory sinus arrhythmia (RSA) were assessed at 2-4 weeks of age during sleep. Infants in both exposure groups had higher HR and lower RSA than nonexposed infants. Furthermore, boys in both exposure groups had higher HR and lower RSA than girls. These results highlight the importance of considering prenatal ETS exposure and infant gender when assessing infant outcomes.