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Meta-Analysis
. 2023 Nov:176:107654.
doi: 10.1016/j.ypmed.2023.107654. Epub 2023 Jul 31.

Contingency management interventions for abstinence from cigarette smoking in pregnancy and postpartum: A systematic review and meta-analysis

Loren S Kock  1 , Tyler G Erath  2 , Sulamunn R M Coleman  2 , Stephen T Higgins  2 , Sarah H Heil  2
Affiliations
Meta-Analysis

Contingency management interventions for abstinence from cigarette smoking in pregnancy and postpartum: A systematic review and meta-analysis

Loren S Kock et al. Prev Med. 2023 Nov.

Abstract

Contingency management is one of the most effective treatments for substance use disorders in not-pregnant people. The most recent quantitative review of its efficacy among pregnant and postpartum women who smoke cigarettes concluded with moderate certainty that those receiving contingent financial incentives were twice as likely to be abstinent compared with controls. We aimed to update and extend previous reviews. Five databases were systematically searched for randomized controlled trials (RCTs) published before December 2022 that assessed the effectiveness of incentives for abstinence from substance use. Data from trials of smoking abstinence were pooled using a random-effects meta-analysis model (restricted maximum likelihood). Results are reported as risk-ratios (RRs) with 95% confidence intervals (CIs). This study is registered with PROSPERO, CRD42022372291. Twelve RCTs (3136) pregnant women) were included. There was high certainty evidence that women receiving incentives were more likely to be abstinent than controls at the last antepartum assessment (12 RCTs; RR = 2.43, 95% CI 2.04-2.91, n = 2941, I2 = 0.0%) and moderate certainty evidence at the longest postpartum assessment while incentives were still available (five RCTs; RR = 2.72, 1.47-5.02, n = 659, I2 = 44.5%), and at the longest postpartum follow-up after incentives were discontinued (six RCTs; RR = 1.93, 1.08-3.46, n = 1753, I2 = 51.8%). Pregnant women receiving incentives are twice as likely to achieve smoking abstinence during pregnancy suggesting this intervention should be standard care for pregnant women who smoke. The results also demonstrate that abstinence continues into the postpartum period, including after incentives are discontinued, but more trials measuring outcomes in the postpartum period are needed to strengthen this conclusion.

Keywords: Abstinence; Cigarettes; Contingency management; Incentives; Postpartum; Pregnancy; Smoking; Tobacco.

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Conflict of interest statement

Declaration of Competing Interest The authors have no conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
PRISMA flow diagram illustrating study selection.
Figure 2:
Figure 2:. Forest plot comparing incentive interventions for smoking abstinence at last assessment during pregnancy vs. control or usual care.
*Month of pregnancy when last assessment during pregnancy was completed. Dash (−) indicates could not be calculated.
Figure 3:
Figure 3:. Forest plot comparing incentive interventions for smoking abstinence at the longest postpartum assessment while incentives were still available vs. control or usual care.
*Month indicates the month postpartum when this assessment was completed.
Figure 4:
Figure 4:. Forest plot comparing incentive interventions for smoking abstinence at the longest postpartum assessment after incentives were discontinued vs. control or usual care.
*Month indicates the month postpartum when this assessment was completed.
See this image and copyright information in PMC

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