The effectiveness of smoking cessation, alcohol reduction, diet and physical activity interventions in changing behaviours during pregnancy: A systematic review of systematic reviews

Heslehurst, Nicola; Hayes, Louise; Jones, Dan; Newham, James; Olajide, Joan; McLeman, Louise A.; McParlin, Catherine; Brún, Caroline De; Azevedo, Liane B.

doi:10.1371/journal.pone.0232774

Cited by 30 publications

(27 citation statements)

References 67 publications

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“…By focusing on the health-related outcomes, we are missing essential behavioural information that has a direct impact on effectiveness. We discussed, in our previous paper [ 23 ], how important it is to measure behaviours to advance our understanding of the mechanisms within intervention research. If a behaviour-change intervention is not effective at reducing health-related risk, and the behaviour itself is not measured, then we are left questioning whether the behaviours are not relevant and we should cease trying to intervene to change that target behaviour.…”

Section: Discussionmentioning

confidence: 99%

“…However, the lack of effect could be due to the intervention failing to change the target behaviour (either at all or to the magnitude required to have a clinically important impact on health outcomes), in which case, are there alternative behaviour-change strategies which could be explored with a greater potential to impact health outcomes? We previously reported [ 23 ] that systematic reviews reported the effectiveness of interventions at changing maternal behaviours in 100% of the smoking and alcohol reviews identified, but for only 18% of diet and/or physical activity reviews. We see the opposite trend in this paper, where 66% of diet and/or physical activity systematic reviews reported a meta-analysis of health-related outcomes, compared with only 9% of the smoking reviews and no alcohol reviews.…”

Section: Discussionmentioning

confidence: 99%

“…The methods used for this systematic review of systematic reviews are published in the first paper in this programme of systematic reviews [ 23 ]. The methods are also summarised here, alongside details on the search updates and amendments to the inclusion criteria specific to the context of the aim of this paper.…”

Section: Methodsmentioning

confidence: 99%

“…The wider aims of this programme of systematic reviews of systematic reviews are to (1) examine the effectiveness of interventions on changing maternal behaviours in pregnancy, (2) examine the effectiveness of interventions on improving health-related outcomes for women and infants, and (3) explore any shared behavioural techniques or content of interventions that may be associated with effectiveness across these behaviours. We have published a systematic review of systematic reviews addressing aim 1 [ 23 ]. This paper reports a systematic review of systematic reviews addressing aim 2.…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Smoking Cessation, Alcohol Reduction, Diet and Physical Activity Interventions in Improving Maternal and Infant Health Outcomes: A Systematic Review of Meta-Analyses

et al. 2021

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Diet, physical activity, smoking and alcohol behaviour-change interventions delivered in pregnancy aim to prevent adverse pregnancy outcomes. This review reports a synthesis of evidence from meta-analyses on the effectiveness of interventions at reducing risk of adverse health outcomes. Sixty-five systematic reviews (63 diet and physical activity; 2 smoking) reporting 602 meta-analyses, published since 2011, were identified; no data were identified for alcohol interventions. A wide range of outcomes were reported, including gestational weight gain, hypertensive disorders, gestational diabetes (GDM) and fetal growth. There was consistent evidence from diet and physical activity interventions for a significantly reduced mean gestational weight gain (ranging from −0.21 kg (95% confidence interval −0.34, −0.08) to −5.77 kg (95% CI −9.34, −2.21). There was evidence from larger diet and physical activity meta-analyses for a significant reduction in postnatal weight retention, caesarean delivery, preeclampsia, hypertension, GDM and preterm delivery, and for smoking interventions to significantly increase birth weight. There was no statistically significant evidence of interventions having an effect on low or high birthweight, neonatal intensive care unit admission, Apgar score or mortality outcomes. Priority areas for future research to capitalise on pregnancy as an opportunity to improve the lifelong wellbeing of women and their children are highlighted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Smoking Cessation, Alcohol Reduction, Diet and Physical Activity Interventions in Improving Maternal and Infant Health Outcomes: A Systematic Review of Meta-Analyses

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“…DNA methylation that mediates between smoking and lower birth weight can also be a factor linking this unfavorable fetal outcome with adverse long-term health outcomes [35,36]. It should also be taken into account that smoking women may lead a different lifestyle that includes, for example, an unhealthy diet and other "unhealthy" behaviors [37].…”

Section: Discussionmentioning

confidence: 99%

Smoking and Smoking Cessation in the Risk for Fetal Growth Restriction and Low Birth Weight and Additive Effect of Maternal Obesity

Lewandowska

Więckowska

Sztorc

et al. 2020

JCM

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Many studies have shown that neonates of smoking mothers have a lower birth weight, but several issues remain poorly studied, e.g., the effects of giving up smoking or the combined effects of smoking and maternal obesity. Therefore, we evaluated a prospective cohort of 912 mothers in a single pregnancy, recruited in Poland, in 2015−2016. In the cohort, we recorded 72 (7.9%) newborns with birth weight <10th percentile, 21 (2.3%) fetal growth restriction (FGR) cases, and 60 (6.6%) low birth weight (LBW, <2500 g) newborns. In the cohort, 168 (18.4%) women smoked before pregnancy; the mean number of cigarettes/day was 10.8 (1–30), and the mean number of years of cigarette smoking was 8.5 (1–25). Among smokers, 57 (6.3%) women smoked in the first trimester. Adjusted odds ratio (AOR) of newborn outcomes (with 95% confidence intervals, CI) was calculated in multi-dimensional logistic regressions. Compared to participants who had never smoked, smoking before pregnancy was associated with a higher odds ratio of birth weight <10th percentile (AOR = 1.93, CI: 1.08–3.44, p = 0.027), but the result for LBW (AOR = 2.76, CI: 1.05–7.26, p = 0.039) and FGR (AOR = 1.13, CI: 0.38–3.36, p = 0.822) had the wider confidence interval or was insignificant. Effects of smoking cessation before pregnancy were statistically insignificant for the studied outcomes. Smoking in the first trimester was associated with a higher risk of birth weight <10th percentile (AOR = 4.68, CI: 2.28–9.62, p < 0.001), LBW (AOR = 6.42, CI: 1.84–22.36, p = 0.004), and FGR (AOR = 3.60, CI: 0.96–13.49, p = 0.057). Smoking cessation in the second/third trimester was associated with a higher odds ratio of birth weight <10th percentile (AOR = 4.54, CI: 1.58–13.02, p = 0.005), FGR (AOR = 3.36, CI: 0.6–18.74, p = 0.167), and LBW (AOR = 2.14, CI: 0.62–7.36), p = 0.229), to a similar degree to smoking in the first trimester. The odds ratios were higher in the subgroup of pre-pregnancy body mass index ≥25 kg/m2 for the risk of birth weight <10th percentile (AOR = 6.39, CI: 2.01–20.34, p = 0.002) and FGR (AOR = 6.25, CI: 0.86–45.59, p = 0.071). The length of cigarette smoking time was also the risk factor for studied outcomes. Conclusions: Smoking in the first trimester increased the studied risks, and the coexistence of excessive maternal weight increased the effects. Smoking cessation during the second/third trimester did not have a protective effect.

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How effects on health equity are assessed in systematic reviews of interventions

Welch

Dewidar

Ghogomu

et al. 2022

Cochrane Database of Systematic Reviews

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The effectiveness of smoking cessation, alcohol reduction, diet and physical activity interventions in changing behaviours during pregnancy: A systematic review of systematic reviews

Cited by 30 publications

References 67 publications

The Effectiveness of Smoking Cessation, Alcohol Reduction, Diet and Physical Activity Interventions in Improving Maternal and Infant Health Outcomes: A Systematic Review of Meta-Analyses

The Effectiveness of Smoking Cessation, Alcohol Reduction, Diet and Physical Activity Interventions in Improving Maternal and Infant Health Outcomes: A Systematic Review of Meta-Analyses

Smoking and Smoking Cessation in the Risk for Fetal Growth Restriction and Low Birth Weight and Additive Effect of Maternal Obesity

How effects on health equity are assessed in systematic reviews of interventions

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