Psychosocial interventions for supporting women to stop smoking in pregnancy

Abstract

Background Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and increasing in low- to middle-income countries. Objectives To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. Search methods In this fifth update, we searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data. Selection criteria Randomised controlled trials, cluster-randomised trials, randomised cross-over trials, and quasi-randomised controlled trials (with allocation by maternal birth date or hospital record number) of psychosocial smoking cessation interventions during pregnancy. Data collection and analysis Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, and subgroup analyses and sensitivity analysis were conducted in SPSS. Main results Eighty-six trials were included in this updated review, with 77 trials (involving over 29,000 women) providing data on smoking abstinence in late pregnancy. In separate comparisons, counselling interventions demonstrated a significant effect compared with usual care (27 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.75), and a borderline effect compared with less intensive interventions (16 studies; average RR 1.35, 95% CI 1.00 to 1.82). However, a significant effect was only seen in subsets where counselling was provided in conjunction with other strategies. It was unclear whether any type of counselling strategy is more effective than others (one study; RR 1.15, 95% CI 0.86 to 1.53). In studies comparing counselling and usual care (the largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy (eight studies; average RR 1.06, 95% CI 0.93 to 1.21). However, a clear effect was seen in smoking abstinence at zero to five months postpartum (10 studies; average RR 1.76, 95% CI 1.05 to 2.95), a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77), and a significant effect at 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), but not in the longer term. In other comparisons, the effect was not significantly different from the null effect for most secondary outcomes, but sample sizes were small. Incentive-based interventions had the largest effect size compared with a less intensive intervention (one study; RR 3.64, 95% CI 1.84 to 7.23) and an alternative intervention (one study; RR 4.05, 95% CI 1.48 to 11.11). Feedback interventions demonstrated a significa...

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

“…Studies that proactively involve social networks in smoking cessation have mainly centred on the general adult population 182 and remain under-researched in pregnancy. Only five such studies were identified in the most recent Cochrane review 183 of psychosocial interventions to support women to stop smoking in pregnancy. Evidence from this review suggested that social support interventions appeared effective when provided by peers (five studies: average risk ratio 1.49, 95% confidence interval 1.01 to 2.10), but the effect was unclear in a single trial of support provided by partners.…”

Are secondhand smoke-related diseases of children associated with parental smoking cessation? Determinants of parental smoking cessation in a population-based cohort study

“…(IV) New sibling and sibling number were associated with maternal smoking cessation at follow-up, while these were not associated with paternal cessation. This is probably because pregnancy is an event that may make the mother quit smoking (Chamberlain et al, 2013;Schneider et al, 2010). The different result between mother and father is reasonable because pregnancy occurs only in women and some pregnant women live apart from their partner during the perinatal period in Japan (Ohga et al, 2005).…”

Celebrating and honouring midwifery in New Zealand

“…These interventions include the use of NRT, smoking cessation counselling, online resources, financial or material incentives and a range of actions by health professionals working directly with pregnant women, such as integrating smoking cessation guidelines into practice (Bowden, Oag, Smith, & Miller, 2010;Chamberlain et al, 2013;Fendall et al, 2012;Greaves et al, 2011;Hill, Young, Carter, & Lang, 2013;McLeod, Benn, et al, 2003).…”

“…Cessation support methods include the use of psychosocial interventions (such as multi-sessional counselling) and Nicotine Replacement Therapy (NRT). Although some studies have demonstrated an increase in cessation rates with the use of specific support services, others have shown little or no effect (Chamberlain et al, 2013). In particular, the use of NRT has been shown to have little effect on cessation rates in pregnant women (Cooper et al, 2014).…”