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Meta-Analysis
. 2019 Aug 18;9(8):e026037.
doi: 10.1136/bmjopen-2018-026037.

What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis

Gillian Sandra Gould  1   2 , Laura Twyman  3 , Leah Stevenson  3 , Gabrielle R Gribbin  3 , Billie Bonevski  3 , Kerrin Palazzi  2 , Yael Bar Zeev  3
Affiliations
Meta-Analysis

What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis

Gillian Sandra Gould et al. BMJ Open. .

Abstract

Background: Pregnancy is an opportunity for health providers to support women to stop smoking.

Objectives: Identify the pooled prevalence for health providers in providing components of smoking cessation care to women who smoke during pregnancy.

Design: A systematic review synthesising original articles that reported on (1) prevalence of health providers' performing the 5As ('Ask', 'Advise', 'Assess', 'Assist', 'Arrange'), prescribing nicotine replacement therapy (NRT) and (2) factors associated with smoking cessation care.

Data sources: MEDLINE, EMBASE, CINAHL and PsycINFO databases searched using 'smoking', 'pregnancy' and 'health provider practices'.

Eligibility criteria for selecting studies: Studies included any design except interventions (self-report, audit, observed consultations and women's reports), in English, with no date restriction, up to June 2017.

Participants: Health providers of any profession.

Data extraction, appraisal and analysis: Data were extracted, then appraised with the Hawker tool. Meta-analyses pooled percentages for performing each of the 5As and prescribing NRT, using, for example, 'often/always' and 'always/all'. Meta-regressions were performed of 5As for 'often/always'.

Results: Of 3933 papers, 54 were included (n=29 225 participants): 33 for meta-analysis. Health providers included general practitioners, obstetricians, midwives and others from 10 countries. Pooled percentages of studies reporting practices 'often/always' were: 'Ask' (n=9) 91.6% (95% CI 88.2% to 95%); 'Advise' (n=7) 90% (95% CI 72.5% to 99.3%), 'Assess' (n=3) 79.2% (95% CI 76.5% to 81.8%), 'Assist (cessation support)' (n=5) 59.1% (95% CI 56% to 62.2%), 'Arrange (referral)' (n=6) 33.3% (95% CI 20.4% to 46.2%) and 'prescribing NRT' (n=6) 25.4% (95% CI 12.8% to 38%). Heterogeneity (I2) was 95.9%-99.1%. Meta-regressions for 'Arrange' were significant for year (p=0.013) and country (p=0.037).

Conclusions: Health providers 'Ask', 'Advise' and 'Assess' most pregnant women about smoking. 'Assist', 'Arrange' and 'prescribing NRT' are reported at lower rates: strategies to improve these should be considered.

Prospero registration number: CRD42015029989.

Keywords: healthcare providers; maternal health; pregnancy; smoking; smoking cessation.

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Conflict of interest statement

Competing interests: GSG reports grants from National Health and Medical Research Council, grants from Cancer Institute New South Wales, grants from Hunter Cancer Research Alliance, during the conduct of the study; grants from National Health and Medical Research Council, grants from Hunter New England Central Coast Primary Health Network, grants from Cancer Australia and Cure Cancer Australia, grants from Ministry of Health NSW, grants from John Hunter Hospital Charitable Trust, outside the submitted work. YBZ reports grants and others from Hunter Cancer Research Alliance, during the conduct of the study; personal fees from Novartis NCH, personal fees from Pfizer Israel LTD, outside the submitted work.

Figures

Figure 1
Figure 1
PRISMA flow chart of included studies.
Figure 2
Figure 2
Comparison of pooled percentages of selected categories of ‘often/always’. NRT, nicotine replacement therapy.
See this image and copyright information in PMC

References

    1. Hofhuis W, de Jongste JC, Merkus PJFM. Adverse health effects of prenatal and postnatal tobacco smoke exposure on children. Arch Dis Child 2003;88:1086–90. 10.1136/adc.88.12.1086 - DOI - PMC - PubMed
    1. U.S. Department of Health and Human Services The health consequences of Smoking—50 years of progress: a report of the surgeon General. Rockville, MD: Public Health Service Office of the Surgeon General, 2014.
    1. Cornelius MD, Leech SL, Goldschmidt L, et al. . Prenatal tobacco exposure: is it a risk factor for early tobacco experimentation? Nicotine Tob Res 2000;2:45–52. 10.1080/14622200050011295 - DOI - PubMed
    1. Lange S, Probst C, Rehm J, et al. . National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis. Lancet Glob Health 2018;6:e769–76. 10.1016/S2214-109X(18)30223-7 - DOI - PubMed
    1. McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res 2003;18:156–70. 10.1093/her/18.2.156 - DOI - PubMed

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