Smoking Cessation in Pregnancy: A Review of Postpartum Relapse Prevention Strategies

Abstract

Objective: Review and examine existing research, current strategies, and directions for future research on smoking cessation relapse and relapse prevention in pregnancy and postpartum.Methods: A MEDLINE/PubMed search in 2002 and 2003 for articles containing the key words "smoking," "pregnancy," "cessation," and "cessation relapse prevention" and references of retrieved papers yielded a review of more than 500 articles. Only 14 of these addressed program-based strategies to increase cessation among pregnant women through relapse prevention programs.Conclusion: Although there is much information on the rationale and strategies for smoking cessation for pregnant women, fewer studies exist on how to prevent relapse. Throughout the past decade, tobacco use has remained the single most important modifiable cause of poor pregnancy outcome in the United States. Smoking accounts for 20% of deliveries of infants with low birth weights, 8% of preterm births, and 5% of all perinatal deaths. Smoking during pregnancy and in postpartum contributes to sudden infant death syndrome and changes in brain and nervous system development. The direct medical costs of a complicated birth for a smoker are 66% higher than for nonsmokers. 1 Relapse rates range from 70% to 85% among women who smoke but quit at some time during their pregnancy. A recent 10-year study (1987 to 1996) of 8808 pregnant women and 178,499 nonpregnant women of childbearing age indicated that the prevalence of current smoking has decreased significantly among both pregnant (16.3% to 11.8%) and nonpregnant women (26.7% to 23.6%).2 This drop in smoking over time among pregnant women was primarily caused by the overall decline in smoking initiation rates among women of childbearing age, not by an increased rate of smoking cessation related to pregnancy.Although one fifth of pregnant smokers spontaneously quit by the time of their first antenatal visit, 3 and pregnant women are half as likely as nonpregnant women to be smokers, 2 an estimated 20.4% of women smokers continue smoking throughout their pregnancies. 4 For women who do quit during pregnancy and who received a planned intervention, between 6.2% and 37.2% remained smoke-free. The range of relapse rates is broad because of the varying success of the cessation intervention strategy. Between 29% and 85% of women who get a planned intervention relapse after delivery. 5-16Although there is much information on why and how pregnant women should quit, fewer data exist on how to prevent relapse. This article is a literature review on relapse and relapse prevention in pregnancy; we looked at existing research, current strategies, and directions for future research.

Tobacco Use and Exposure to Secondhand Smoke Among Pregnant Women in the Dominican Republic: An Exploratory Look into Attitudes, Beliefs, Perceptions, and Practices

“…Data from the Global Youth Tobacco Survey (GYTS) indicate that historical gender differences in smoking uptake and prevalence among girls (aged 13-15 years) are changing, with girls smoking just as much and sometimes more than boys in many parts of the world (GYTS Collaborating Group, 2003). Postpartum smoking relapse, although not a specific aim of this study, is an important area of concern since review of existing research has shown postpartum smoking relapse rates to range from 70% to 85% among women who smoke but quit sometime during pregnancy (Fang et al, 2004). Approximately 7% of respondents in this study reported intent to begin or resume smoking after pregnancy, representing an area for further research.…”

Preventing postpartum smoking relapse among diverse low-income women: A randomized clinical trial

“…Treatments that effectively address postpartum smoking relapse prevention among women with higher prequit smoking rates, potentially indicative of greater dependence on tobacco, are essential as these women are at increased risk of postpartum relapse compared with less dependent women (Fang et al, 2004;Ripley-Moffitt et al, 2008;Severson, Andrews, Lichtenstein, Wall, & Zoref, 1995). Telephone-based smoking cessation interventions have previously shown more promise among less dependent pregnant women (Ershoff et al, 1999;Rigotti et al, 2006).…”

Das Fetale Tabaksyndrom – Ein Statement der Österreichischen Gesellschaften für Allgemein- und Familienmedizin (ÖGAM), Gynäkologie und Geburtshilfe (ÖGGG), Hygiene, Mikrobiologie und Präventivmedizin (ÖGHMP), Kinder- und Jugendheilkunde (ÖGKJ) sowie Pneumologie (ÖGP)

“…Die gleichzeitige verhaltensmodifi zierende Behandlung des Partners erhöhte in mehreren Studien die Erfolgsrate der Raucherentwöhnung während der Schwangerschaft [179][180][181]. Der Partner scheint schließlich auch bei der Rückfalls-prävention eine entscheidende Rolle zu spielen [182].…”