[CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy-Short Text]

Abstract

Objectives: To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy.

Methods: Systematic review of the international literature. We identified papers published between January 2003 and April 2019 in Cochrane PubMed, and Embase databases with predefined keywords. All reports published in French and English relevant to the areas of focus were included and classified according the level of evidence ranging from 1 (highest) to 4 (lowest). The strength of the recommendations was classified according to the Haute Autorité de santé, France (ranging from A, highest to C, lowest).

Results: "Counseling", involving globally all kind of non-pharmacological interventions, has a modest benefit on smoking cessation, birth weight and prematurity. Moderate physical activity did not show a significant effect on smoking cessation. The systematic use of feedback by measuring the expired air carbon monoxide concentration do not influence smoking abstinence but it may be used in establishing a therapeutic alliance. The use of self-help interventions and health education are recommended in helping pregnant smokers quit. The prescription of nicotine replacement therapies (NRT) may be offered to any pregnant woman who has failed stopping smoking without medication This prescription can be initiated by the health care professional taking care of the pregnant woman in early pregnancy. There is no scientific evidence to propose the electronic cigarette for smoking cessation to pregnant smokers; it is recommended to provide the same advice and to use methods that have already been evaluated. The use of waterpipe (shisha/narghile) during pregnancy is associated with decreased fetal growth. It is recommended not to use waterpipe during pregnancy. Breastfeeding is possible in smokers, but less often initiated by them. Although its benefit for the child's development is not demonstrated to date, breastfeeding allows the mother to reduce or stop smoking. The risk of postpartum relapse is high (up to 82% at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression.

Conclusions: Smoking during pregnancy concerns more than hundred thousand women and their children per year in France. It is a major public health burden. Health care professionals should be mobilized for reducing or even eradicating it.

Keywords: Allaitement maternel; Behaviors; Breastfeeding; Clinical trials; Comportements; Determinants; Déterminants; Epidemiology; Essais cliniques; Facteurs de risque; Grossesse; Interventions; Meta-analysis; Méta-analyse; Nicotine; Nicotine replacement therapy; Observational studies; Post-partum; Predictors; Pregnancy; Prédicteurs; Review; Revue de la littérature; Revue systématique; Risk factors; Secondhand smoke; Sevrage tabagique; Smoking; Smoking cessation; Systematic review; Tabagisme; Tabagisme passif; traitement substitutif nicotinique; Épidémiologie; Études observationnelles.