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Meta-Analysis
. 2009 Jul 8:(3):CD001055.
doi: 10.1002/14651858.CD001055.pub3.

Interventions for promoting smoking cessation during pregnancy

Judith Lumley  1 , Catherine Chamberlain, Therese Dowswell, Sandy Oliver, Laura Oakley, Lyndsey Watson
Affiliations
Meta-Analysis

Interventions for promoting smoking cessation during pregnancy

Judith Lumley et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies. Smoking in pregnancy is decreasing in high-income countries and increasing in low- to middle-income countries and is strongly associated with poverty, low educational attainment, poor social support and psychological illness.

Objectives: To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2008), the Cochrane Tobacco Addiction Group's Trials Register (June 2008), EMBASE, PsycLIT, and CINAHL (all from January 2003 to June 2008). We contacted trial authors to locate additional unpublished data.

Selection criteria: Randomised controlled trials where smoking cessation during pregnancy was a primary aim of the intervention.

Data collection and analysis: Trials were identified and data extracted by one person and checked by a second. Subgroup analysis was conducted to assess the effect of risk of trial bias, intensity of the intervention and main intervention strategy used.

Main results: Seventy-two trials are included. Fifty-six randomised controlled trials (over 20,000 pregnant women) and nine cluster-randomised trials (over 5000 pregnant women) provided data on smoking cessation outcomes.There was a significant reduction in smoking in late pregnancy following interventions (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.96), an absolute difference of six in 100 women who stopped smoking during pregnancy. However, there is significant heterogeneity in the combined data (I(2) > 60%). In the trials with the lowest risk of bias, the interventions had less effect (RR 0.97, 95% CI 0.94 to 0.99), and lower heterogeneity (I(2) = 36%). Eight trials of smoking relapse prevention (over 1000 women) showed no statistically significant reduction in relapse.Smoking cessation interventions reduced low birthweight (RR 0.83, 95% CI 0.73 to 0.95) and preterm birth (RR 0.86, 95% CI 0.74 to 0.98), and there was a 53.91g (95% CI 10.44 g to 95.38 g) increase in mean birthweight. There were no statistically significant differences in neonatal intensive care unit admissions, very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power.

Authors' conclusions: Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and preterm birth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported.

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Figures

Figure 1
Figure 1
Figure 2
Figure 2. Risk of bias summary: review authors’ judgments about each risk of bias item for each included study.
Figure 3
Figure 3. Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

    1. Albrecht S, Cassidy B, Salamie D, Reynolds M. What’s happening. A smoking cessation intervention for pregnant adolescents: implications for nurse practitioners. Journal of American Academy of Nurse Practitioners. 1999;11(4):155–9. - PubMed
    1. Albrecht S, Cornelius M, Braxter B, Reynolds M, Stone C, Cassidy B. An assessment of nicotine dependence among pregnant adolescents. Journal of Substance Abuse Treatment. 1999;16(4):337–44. - PubMed
    1. Albrecht S, Stone CA, Payne L, Reynolds MD. A preliminary study of the use of peer support in smoking cessation programs for pregnant adolescents. Journal of the American Academy of Nurse Practitioners. 1998;10:119–25. - PubMed
    1. Albrecht SA, Higgins LW, Stone C. Factors relating to pregnant adolescents’ decisions to complete a smoking cessation intervention. Journal of Pediatric Nursing. 1999;14(5):322–8. - PubMed
    1. Baric L, MacArthur C, Sherwood M. A study of health education aspects of smoking in pregnancy. International Journal of Health Education. 1976;19(2 Suppl):1–17.

References to studies excluded from this review

    1. Albrecht SA, Caruthers D, Patrick T, Reynolds M, Salamie D, Higgins LW, et al. A randomised controlled trial of a smoking cessation intervention for pregnant adolescents. Nursing Research. 2006;55(6):402–10. - PubMed
    1. Albrecht SA, Higgins LW, LeBow H. Knowledge about the deletrious effects of smoking and its relationship to smoking cessation among pregnant adolescents. Adolescence. 2000;35(140):710–7. - PubMed
    1. Albrecht SA, Patrick T, Kim Y, Caruthers D. A randomised controlled trial of a smoking cessation intervention for pregnant adolescents; Society for Research on Nicotine and Tobacco 9th Annual Meeting; New Orleans, Louisiana. 19-23 February 2003.p. 91.
    1. Boshier A, Wilton LV, Shakir SAW. Evaluation of the safety of bupropion (Zyban) for smoking cessation from experience gained in general practice use in England in 2000. European Journal of Clinical Pharmacology. 2003;59:767–73. - PubMed
    1. Britton GRA, Brinthaupt J, Stehle JM, James GD. The effectiveness of a nurse-managed perinatal smoking cessation program implemented in a rural county. Nicotine and Tobacco Research. 2006;8(1):13–28. - PubMed

References to studies awaiting assessment

    1. Blasco Oliete M, Sanz Cuesta T, Girbes Fontana M, Pascual Malanda M, Ortiz Valdepenas J, Garcia Lopez L. Effectiveness of two health interventions to get pregnant women to give up smoking [Efectividad de dos intervenciones sanitarias para conseguir el abandono del consumo de tabaco.] Atencion Primaria. 2004;33(5):277–83. - PMC - PubMed

References to ongoing studies

    1. Coleman T. Double-blind, randomised, placebo-controlled trial of nicotine replacement therapy in pregnancy (ongoing trial) National Research Register; [accessed 6 July 2006]. www.nrr.nhs.uk.
    1. Coleman T, Antoniak M, Britton J, Thornton J, Lewis S, Watts K. Recruiting pregnant smokers for a placebo-randomised controlled trial of nicotine replacement therapy. BMC Health Services Research. 2004;4:29. - PMC - PubMed
    1. Coleman T, Thornton J, Britton J, Lewis S, Watts K, Coughtrie MW, et al. Protocol for the smoking, nicotine and pregnancy (snap) trial: double-blind, placebo-randomised, controlled trial of nicotine replacement therapy in pregnancy. BMC Health Services Research. 2007;7:2. - PMC - PubMed
    1. Blake S, El-Mohandes A, Schwartz D, El-Khorazaty N, Gantz M, Joseph J, et al. Promoting smoking cessation during pregnancy and preventing postpartum relapse [abstract]; Pediatric Academic Societies Annual Meeting; Washington DC, USA. 14-17 May 2005; Abstract no: 3074.
    1. Blake S, Joseph J, Schwartz D, El-Khorazaty N, Gantz M, El-Mohandes A, et al. Preventing prenatal and postpartum environmental tobacco smoke (ETS) exposure [abstract]; Pediatric Academic Societies Annual Meeting; Washington DC, USA. 14-17 May 2005; Abstract no: 2353.

Additional references

    1. Abatemarco DJ, Steinberg MB, Delnevo CD. Midwives’ knowledge, perceptions, beliefs, and practice supports regarding tobacco dependence treatment. Journal of Midwifery & Women’s Health. 2007;52:451–7. - PubMed
    1. Abbot NC, Stead LF, White AR, Barnes J. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews. 1998;(2) DOI: 10.1002/14651858.CD001008. - PubMed
    1. Adams K, Melvin C. Costs of maternal conditions attributable to smoking during pregnancy. American Journal of Preventive Medicine. 1998;15(3):212–9. - PubMed
    1. Andreski P, Breslau N. Maternal smoking among blacks and whites. Social Science and Medicine. 1995;41:227–33. - PubMed
    1. Aveyard R, West R. Managing smoking cessation. BMJ. 2007;335:37–41. - PMC - PubMed

References to other published versions of this review

    1. Lumley J. Advice as a strategy for reducing smoking in pregnancy [revised 02 October 1993] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C, editors. Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration. 2. Oxford: Update Software; 1995.
    1. Lumley J. Behavioural strategies for reducing smoking in pregnancy [revised 27 September 1993] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C, editors. Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration. 2. Oxford: Update Software; 1995.
    1. Lumley J. Counselling for reducing smoking in pregnancy [revised 02 October 1993] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C, editors. Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration. 2. Update Software; Oxford: 1995.
    1. Lumley J. Feedback as a strategy for reducing smoking in pregnancy [revised 27 September 1993] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C, editors. Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration. 2. Update Software; Oxford: 1995.
    1. Lumley J. Strategies for reducing smoking in pregnancy [revised 02 October 1993] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C, editors. Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration. 2. Update Software; Oxford: 1995.