Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting

Abstract

The aim of this review of reviews was to collate the latest evidence from systematic reviews about the maternal and child health outcomes of being exposed to tobacco and nicotine during pregnancy; the effectiveness of interventions designed to reduce these exposures, and barriers to and facilitators of smoking cessation during pregnancy. Two databases were searched to obtain systematic reviews published from 2010 to 2019. Pertinent data from 76 articles were summarized using a narrative synthesis (PROSPERO reference: CRD42018085896). Exposure to smoke or tobacco in other forms during pregnancy is associated with an increased risk of obstetric complications and adverse health outcomes for children exposed in-utero. Counselling interventions are modestly effective, while incentive-based interventions appear to substantially increase smoking cessation. Nicotine replacement therapy is effective during pregnancy but the evidence is not conclusive. Predictors and barriers to smoking cessation in pregnancy are also discussed. Smoking during pregnancy poses substantial risk to mother’s and child’s health. Psychosocial interventions and nicotine replacement therapy (NRT) appear to be effective in helping pregnant women quit smoking. Barriers to smoking cessation must be identified and steps taken to eradicate them in order to reduce smoking among pregnant women. More research is needed on smoking cessation medications and e-cigarettes.

Maternal Morbidity and Mortality: Are We Getting to the “Heart” of the Matter?

“…Women with chronic conditions ( e.g ., hypertension, diabetes, and renal, lung, and autoimmune diseases 72–75 ), obese women, 3 , 59 , 60 and smokers 76 are at higher risk for pregnancy complications; these same factors also are associated with CVD. 58 Some nonmodifiable factors—such as race, education, geography, and age—are also associated with elevated risk for APOs and future CVD ( Fig.…”

Epigenetic Alterations of Maternal Tobacco Smoking during Pregnancy: A Narrative Review

“…Women smoking tobacco during pregnancy are more likely to experience pneumonia, influenza, bronchitis, and myocardial infection than non-smoking pregnant women. They are also more likely to experience pregnancy complications such as ectopic pregnancy, placenta prævia, intrauterine growth restriction, and delivery issues including preterm birth [ 15 , 16 , 17 , 18 , 19 ]. However, maternal tobacco smoking during pregnancy has been consistently associated with lower risks of pre-eclampsia, probably through vascular protective effects of carbon monoxide [ 18 ].…”

Factors Associated with Prenatal Smoking Cessation Interventions among Public Health Nurses in Japan

“…After birth, the risk for sudden infant death syndrome is increased among the offspring of women who smoked during or after pregnancy [ 11 ]. Into childhood, offspring may experience increased risks of respiratory problems, cancers, neurodevelopmental and behavioral problems, as well as increased long-term risks of non-communicable diseases [ 12 ]. In addition, maternal exposure to second-hand smoke during pregnancy has been reported to be associated with spontaneous abortion, stillbirth, preterm birth, small for gestational age, low birth weight, neonatal asphyxia and neural tube defects [ 13 , 14 , 15 , 16 , 17 , 18 ].…”