Congenital heart defects (CHDs) are the most prevalent of all birth disabilities and the leading cause of death in the first year of life. The etiology of CHDs is complex and underlies the interaction of environmental exposures and genetic factors. However, there is growing evidence that active and passive smoking of parents is associated with an increased risk of CHD in their offspring not only during gestation but even during the early period before pregnancy. Most studies in the past had focused on the pregnancy period, mainly during the first trimester. Nowadays, there is a trend regarding preconception research that predominately focuses on maternal modifiable risks and health behaviors associated with pregnancy and offspring outcomes. Therefore, the smoking habits of parents, along with their exposure to passive smoking during the periconceptional and pregnancy periods, are of great importance. Research findings indicate that the risk for a cardiovascular congenital disability is increased with the level of fetal tobacco, suggesting a dose effect and increased risk in certain CHD subtypes. Moreover, the literature has focused mainly on maternal smoking. Still, several recently published papers indicate a possible association between both parents’ periconceptional smoking habits, indicating that paternal smoking has a clear association as well. This presentation aims to update current knowledge regarding the cardiovascular teratogenic effect of passive and active smoking and to present current trends regarding the time that parents quit smoking to avoid congenital disabilities and the effect of the knowledge gap on their decision. The current evidence and the trends underline once again the importance of population-based prevention strategies, with a special focus on the youth population, to encourage both parents (men and women) to quit smoking early before the decision to become parents, to avoid birth malformations and to support a healthy pregnancy and offspring health.