Self‐help smoking cessation interventions in pregnancy: a systematic review and meta‐analysis

Abstract

Aims Self-help smoking cessation interventions for pregnant smokers are of importance due to their potential to be wide-reaching, low-cost and their appeal to pregnant smokers who are interested in quitting smoking. To date, however, there has been no systematic assessment of their efficacy. This systematic review aimed to assess the efficacy of self-help interventions for pregnant smokers and to investigate whether self-help material intensity, type or delivery are associated with cessation. Methods The literature was searched for randomized and quasi-randomized controlled trials of self-help smoking cessation interventions for pregnant smokers without significant cessation counselling. Fifteen trials met the inclusion criteria and relevant data were extracted independently. Results The primary metaanalysis pooled 12 trials comparing usual care (median quit rate 4.9%) with self-help (median quit rate 13.2%) and yielded a pooled odds ratio (OR) of 1.83 [95% confidence interval (CI) 1.23-2.73], indicating that self-help interventions on average nearly double the odds of quitting compared with standard care. However, a further meta-analysis failed to find evidence that intervention materials of greater intensity increase quitting significantly over materials of lesser intensity (pooled OR = 1.25, 95% CI 0.81-1.94). There was insufficient evidence to determine whether the tailoring of materials or levels of one-to-one contact were related to intervention efficacy. Conclusions Self-help interventions appear to be more effective than standard care although, due mainly to a lack of trials, it is unclear whether more sophisticated and intensive approaches increase intervention effectiveness.

Large multi-centre pilot randomized controlled trial testing a low-cost, tailored, self-help smoking cessation text message intervention for pregnant smokers (MiQuit)

“…Precision estimates for detecting between‐group differences in quit rates were calculated for ranges of treatment effects [i.e. odds ratio (OR)] and usual care group quit rates 19 for example, these showed that if a 5% usual care group quit rate occurred in late pregnancy, with 400 participants the trial would estimate an OR of 1.8 (as noted in a previous review) 12 with 80% confidence intervals (CIs) of 1.06–3.05) 19.…”

“…After undertaking the planned analyses, we decided to generate a Bayes factor from smoking outcome 1, using an online calculator 33 with an expected effect size of OR = 1.83 taken from a relevant systematic review 12. We used a conservative approach for estimation using a half‐normal distribution, where the mode at 0 indicated no intervention effect and the standard deviation equal to the expected effect size.…”

“…Structured self‐help support helps pregnant smokers to stop 11, 12. Mobile phone text messaging is a simple way of providing self‐help support and is effective for non‐pregnant smokers 13.…”

Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomized controlled trial

“…Smoking in pregnancy is the main preventable cause of poor birth outcomes, including miscarriage, stillbirth, prematurity and low birth weight 1, 2, 3, 4, 5, 6. Smoking also presents immediate risks for the mother, including placental abruption 7, as well as the long‐term risks reported for smokers in general.…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…229,230 The impact of brief advice in special populations (e.g. pregnant women, 216,231,232 adolescents, 233 patients with mental health problems, [234][235][236] ) is less clear. Providing support during a quit attempt increases the chance of success up to five-fold.…”