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Cited by 252Smoking Behavior and CessationPrenatal Substance Exposure EffectsReproductive Health and Contraception

Psychosocial interventions for supporting women to stop smoking in pregnancy

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Chamberlain, Catherine, O'Mara-Eves, Alison, Oliver, Sandy, Caird, Jenny R, Perlen, Susan M, Eades, Sandra J, Thomas, James·2013·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd001055.pub4PMC PMC4022453
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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Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data.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 significant effect only when compared with usual care and provided in conjunction with other strategies, such as counselling (two studies; average RR 4.39, 95% CI 1.89 to 10.21), but the effect was unclear when compared with a less intensive intervention (two studies; average RR 1.19, 95% CI 0.45 to 3.12).The effect of health education was unclear when compared with usual care (three studies; average RR 1.51, 95% CI 0.64 to 3.59) or less intensive interventions (two studies; average RR 1.50, 95% CI 0.97 to 2.31).Social support interventions appeared effective when provided by peers (five studies; average RR 1.49, 95% CI 1.01 to 2.19), but the effect was unclear in a single trial of support provided by partners.The effects were mixed where the smoking interventions were provided as part of broader interventions to improve maternal health, rather than targeted smoking cessation interventions.Subgroup analyses on primary outcome for all studies showed the intensity of interventions and comparisons has increased over time, with higher intensity interventions more likely to have higher intensity comparisons. While there was no significant difference, trials where the comparison group received usual care had the largest pooled effect size (37 studies; average RR 1.34, 95% CI 1.25 to 1.44), with lower effect sizes when the comparison group received less intensive interventions (30 studies; average RR 1.20, 95% CI 1.08 to 1.31), or alternative interventions (two studies; average RR 1.26, 95% CI 0.98 to 1.53). More recent studies included in this update had a lower effect size (20 studies; average RR 1.26, 95% CI 1.00 to 1.59), I(2)= 3%, compared to those in the previous version of the review (50 studies; average RR 1.50, 95% CI 1.30 to 1.73). There were similar effect sizes in trials with biochemically validated smoking abstinence (49 studies; average RR 1.43, 95% CI 1.22 to 1.67) and those with self-reported abstinence (20

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  1. Hiett A Brazus S Hedberg J Brown H Smoking cessation program effectiveness during pregnancy American Journal of Obstetrics and Gynecology 2000 182 1 Pt 2 S150
  2. Bailey JW Loeb BK Waage G A randomized trial of smoking intervention during pregnancy 1983 58 Proceedings of the American Public Health Association 111th Annual Meeting Dallas, Texas, USA 1983 Nov 15 * [published data only] Loeb BK Waage G Bailey J Smoking intervention in pregnancy 1983 389 95 Proceedings of the Fifth World Conference on Smoking and Health Winnipeg, Canada. Ottawa 1983 July Canadian Council on Smoking and Health
  3. Malchodi CS Oncken C Dornelas EA Caramanica L Gregonis E The effects of peer counselling on smoking cessation and reduction Obstetrics & Gynecology 2003 101 3 504 10 12636954
  4. McBride CM Baucom DH Peterson BL Pollak KI Palmer C Westman E Prenatal and postpartum smoking abstinence: a partner assisted approach American Journal of Preventive Medicine 2004 27 3 232 8 15450636
  5. Stotts AL DeLaune KA Schmitz JM Grabowski J Impact of a motivational intervention on mechanisms of change in low-income pregnant women Addictive Behaviors 2004 29 8 1649 57 15451133
  6. Strecher VJ Bishop KR Bernhardt J Thorp JM Cheuvrout B Potts P Quits for keeps: tailored smoking cessation guides for pregnancy and beyond Tobacco Control 2000 9 Suppl 3 iii78 iii79 10982916 PMC1766311
  7. * [published data only] Thornton L Smoking and pregnancy: feasibility and effectiveness of a smoking intervention programme among pregnant women [thesis] 1997 Dept of Public Health Dublin Thornton L Gogan C McKenna P The rotunda stop smoking programme [abstract] Irish Journal of Medical Science 1998 167 Suppl 9 28
  8. Aranda Regules JM Mateos Vilchez P Gonzalez Villalba A Sanchez F de Dios Luna del Castillo J Validity of smoking measurements during pregnancy: specificity, sensitivity and cut-off points Revista Espanola de Salud Publica 2008 82 5 535 45 19039506 * [published data only] Vilches P Consumption of tobacco in pregnant women: Proposal of a psychological intervention model in the public health system of Andalucia. [Consumo de tabaco en mujeres gestantes: propuesta de un modelo de intervención psicológica en el sistema sanitario público de Andalucía] Doctoral Thesis 2009 Univesidad di Malaga
  9. Dixon LE Aimer P Fletcher L Guilliland K Hendry C Smoke free outcomes with maternity lead maternity carers: An analysis of smoking during pregnancy from the New Zealand College of Midwives Midwifery database 2004 -2007 New Zealand College of Midwives Journal 2009 40 13 9
  10. Emmons K Sorensen G Klar N Digianni L Barclay G Schmidt K Healthy baby second-hand smoke study Tobacco Control 2000 9 Suppl 3 iii58 iii60 10982908 PMC1766303
  11. Gillies PA Power FL Turner ID Madely R Successful antismoking interventions in pregnancy-behaviour change, “clinical indicators” or both? 1990 952 8 Proceedings of the 7th World Conference on Tobacco & Health; 1990 Perth, Australia. Perth Health Department of Western Australia
  12. Grange G Borgne A Ouazana A Valensi P L’Hullier JP Aubin JP Obstetrical ultrasound screening and motivation to stop smoking [Echographies obstetricales et motivation du tabac] Journal de Gynécologie, Obstétrique et Biologie de la Reproduction 2005 34 7 Pt 1 674 8 16270005
  13. Lowe JB Balanda KP Clare G Evaluation of antenatal smoking cessation programs for pregnant women Australian and New Zealand Journal of Public Health 1998 22 55 9 9599853
  14. Shakespeare R The development and evaluation of a smoking cessation counselling training programme for midwives 1990 950 1 Proceedings of the 7th World Conference on Tobacco & Health; 1990; Perth Australia. Perth Health Department of Western Australia
  15. Blasco Oliete M Sanz Cuesta T Girbés Fontana M Pascual Malanda M Ortiz Valdepeñas J Garcia Lopez L Effectiveness of two health interventions to get pregnant women to give up smoking [Efectividad de dos intervenciones sanitarias para conseguir el abandono del consumo de tabaco.] Atencion Primaria 2004 33 5 277 83 15033097 PMC7668639
  16. Everett KD Debnam KJ Gwede CK Smoking behaviors of women and men in a smoking cessation clinical trial during pregnancy Annals of Behavioral Medicine 2008 35 Suppl 1 S199
  17. Berg CJ Park ER Chang Y Rigotti NA Is concern about post-cessation weight gain a barrier to smoking cessation among pregnant women? Nicotine and Tobacco Research 2008 10 1159 63 18629725
  18. Blalock JA Fouladi RT Wetter DW Cinciripini PM Depression in pregnant women seeking smoking cessation treatment Addictive Behaviors 2005 30 6 1195 208 15925128
  19. Bonollo DP Zapka JG Stoddard AM Ma Y Pbert L Ockene JK Treating nicotine dependence during pregnancy and postpartum: understanding clinician knowledge and performance Patient Education and Counselling 2002 48 265 74 12477611
  20. Cabana C Rand C Powel N Why don’t physicians follow clinical practice guidelines? JAMA 1999 282 1458 65 10535437
  21. Disantis KI Collins BN McCoy AC Associations among breastfeeding, smoking relapse, and prenatal factors in a brief postpartum smoking intervention Acta Obstetricia et Gynecologica 2010 89 582 6 PMC3767151 20235894
  22. Dixon L Aimer P Fletcher L Guilliland K Hendry C Smoke free outcomes with midwife lead maternity carers: an analysis of smoking during pregnancy from the New Zealand College of Midwives Midwifery database 2004-2007 New Zealand College of Midwives Journal 2009 40 13 9
  23. England LJ Kendrick JS Wilson HG Merritt RK Gargiullo PM Zahniser SC Effects of smoking reduction during pregnancy on the birth weight of term infants American Journal of Epidemiology 2001 154 694 701 11590081
  24. Ershoff DH Lairson DR Mullen PD Quinn VP Pregnancy and medical cost outcomes of a self-help prenatal smoking cessation program in an HMO Public Health Reports 1990 105 4 340 7 2116634 PMC1580090
  25. Fox NL Sexton M Hebel JR Thompson B The reliability of self-reports of smoking and alcohol consumption by pregnant women Addictive Behaviors 1989 14 2 187 95 2658483
  26. Haug K Fugelli P Aaro LE Recruitment and participation of General Practitioners in a multipractice study of smoking cessation Scandinavian Journal of Primary Health Care 1992 10 3 206 10 1410951
  27. Higgins ST Silverman K Heil SH Contingency Management in Substance Abuse Treatment 2008 The Guilford Press New York
  28. Johnston V Thomas DP McDonnell J Andrews RM Maternal smoking and smoking in the household during pregnancy and postpartum: findings from an Indigenous cohort in the Northern Territory Medical Journal of Australia 2011 194 556 9 21644912
  29. Lipsey MW Wilson DB Practical Meta-Analysis Applied Social Research Methods Series 2001 SAGE Thousand Oaks, CA 9th Edition
  30. Oliver S Bagnall AM Thomas J Shepherd J Sowden A White I accessed 2008 RCTs for policy interventions? a review of reviews and meta-regression Methodology Programme University of Birmingham http://www.pcpoh.bham.ac.uk/publichealth/methodology/projects/RM03.JH09.SO.shtml 20338119
  31. Palipudi KM Asma S Gupta PC Dhirendra S Tobacco use during pregnancy: An investigation from a National Household Survey 2009 Proceedings of the 57th Session of the International Statistical Institute Durban, South Africa 2009 August 16-22
  32. Panjari M Bell R Astbury J Bishop S Dalais F Rice G Women who spontaneously quit smoking in early pregnancy Australian New Zealand Journal of Obstetrics and Gynaecology 1997 37 3 271 9325503
  33. Schmidt S Nicotine addiction Journal of Addictive Nursing 2004 15 2 15
  34. Secker-Walker RH Solomon LJ Flynn BS LePage SS Crammond JE Worden JK Training obstetric and family practice residents to give smoking cessation advice during prenatal care American Journal of Obstetrics and Gynecology 1992 166 5 1356 63 1595791
  35. Small R Mothers in a New Country (MINC) [thesis] 2000 LaTrobe University Victoria
  36. Ueffing E Tugwell P Welch V Petticrew M Kristjansson E for the Cochrane Health Equity Field Version 2012-10-04 Equity Checklist for Systematic Review Authors 2009 http://equity.cochrane.org/our-publications
  37. Valanis B Lichtenstein E Mullooly JP Labuhn K Brody K Severson H Maternal smoking cessation and relapse prevention during health care visits American Journal of Preventive Medicine 2001 20 1 8 11137767
  38. Windsor RA Li CQ Boyd NR Hartmann KE The use of significant reduction rates to evaluate health education methods for pregnant smokers Health Education & Behavior 1999 26 5 648 62 10533170
  39. Windsor RA Whiteside HP Solomon LJ Donatelle RJ Cinciripini PM McIlvain HE A process evaluation for patient education programs for pregnant smokers Tobacco Control 2000 9 Suppl 3 iii28 iii35 PMC1766292 10982902
  40. Wong S Ordean A Kahan M Substance use in pregnancy: SOGC clinical practice guideline International Journal of Obstetrics and Gynecology 2011 114 2 190 202 21870360
  41. Lumley J Enkin MW Keirse MJNC Renfrew MJ Neilson JP Crowther C Advice as a strategy for reducing smoking in pregnancy. [revised 02 October 1993] Pregnancy and Childbirth Module The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration 1995 Issue 2 Update Software Oxford
  42. Lumley J Enkin MW Keirse MJNC Renfrew MJ Neilson JP Crowther C Behavioural strategies for reducing smoking in pregnancy. [revised 27 September 1993] Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration 1995 Issue 2 Update Software Oxford
  43. Lumley J Enkin MW Keirse MJNC Renfrew MJ Neilson JP Crowther C Counselling for reducing smoking in pregnancy. [revised 02 October 1993] Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration 1995 Issue 2 Update Software Oxford
  44. Lumley J Enkin MW Keirse MJNC Renfrew MJ Neilson JP Crowther C Feedback as a strategy for reducing smoking in pregnancy. [revised 27 September 1993] Pregnancy and Childbirth Module The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration 1995 Issue 2 Update Software Oxford
  45. Lumley J Enkin MW Keirse MJNC Renfrew MJ Neilson JP Crowther C Strategies for reducing smoking in pregnancy. [revised 02 October 1993] Pregnancy and Childbirth Module The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration 1995 Issue 2 Update Software Oxford

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Authors
Chamberlain, C., O'Mara-Eves, A., Oliver, S., Caird, J. R., Perlen, S. M., Eades, S. J., & Thomas, J.
Affiliations
  • Monash University (AU)
  • University of London (GB)
  • Murdoch Children's Research Institute (AU)
  • The University of Sydney (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2013-10-23
Issue
10
Pages
CD001055-CD001055
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd001055.pub4
PMC
PMC4022453
OpenAlex
W4231476961
Cited by
251
References
597
Citations by year
2026: 2 · 2025: 5 · 2024: 14 · 2023: 14 · 2022: 9 · 2021: 13 · 2020: 18 · 2019: 18 · 2018: 19 · 2017: 34 · 2016: 40 · 2015: 47 · 2014: 18
Type
reference entry
Language
en
Update notices
new_version (2017-02-14)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute for Health and Care Research (12/183/17)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
smoking cessation during pregnancy, psychosocial interventions, smoking during pregnancy, counseling intervention, smoking abstinence, smoking relapse, perinatal outcomes, low birth weight, preterm birth, stillbirth, postpartum smoking, maternal smoking cessation, low- and middle-income countries, usual care comparison
MeSH terms
Counseling, Female, Health Education, Humans, Infant, Low Birth Weight, Infant, Newborn, Obstetric Labor, Premature, Motivation, Patient Education as Topic, Pregnancy, Pregnancy Outcome, Social Support, Randomized Controlled Trials as Topic, Smoking Cessation

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