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Cited by 650Smoking 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, Porter, Jessie, Coleman, Tim, Perlen, Susan M, Thomas, James, McKenzie, Joanne E·2017·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd001055.pub5PMC PMC6472671
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Abstract

BACKGROUND: Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, 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 is 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 sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. SELECTION CRITERIA: Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials 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, with meta-regression conducted in STATA 14. MAIN RESULTS: = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. AUTHORS' CONCLUSIONS: Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.

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  • When all 26 studies that reported mean birthweight were combined, there was evidence that infants born to women receiving behavioral smoking cessation interventions were associated with a higher mean birthweight of 55.60 grams, compared with women in the usual care control groups (mean difference 55.60 g [95% CI, 29.82 to 81.38]; 26 trials; n=11,338).

    “When all 26 studies that reported mean birthweight were combined, there was evidence that infants born to women receiving behavioral smoking cessation interventions were associated with a higher mean birthweight of 55.60 grams (g), compared with women in the usual care control groups (mean difference [MD] 55.60 g [95% CI, 29.82 to 81.38]; 26 trials; n=11,338) ([eTable 6](#SD1)).[111](#R111)”

    From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [111]

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  • Within the Cochrane review on behavioral interventions among pregnant women, of the 120 study groups included in the review, 97 groups reported the primary outcome measure of smoking abstinence in late pregnancy, up to and including the period of hospitalization for birth.

    “Within the Cochrane review on behavioral interventions among pregnant women, of the 120 study groups included in the review, 97 groups reported the primary outcome measure of smoking abstinence in late pregnancy, up to and including the period of hospitalization for birth.[111](#R111)”

    From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [111]

  • One hundred and two randomized clinical trials were included in a 2017 review that addressed the effects of behavioral smoking cessation interventions during pregnancy on smoking behavior and perinatal health outcomes.

    “One hundred and two RCTs were included in a 2017 review that addressed the effects of behavioral smoking cessation interventions during pregnancy on smoking behavior and perinatal health outcomes.[111](#R111)”

    From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [111]

  • Behavioral smoking cessation interventions were found to have minimal adverse effects.

    “Behavioral smoking cessation interventions were found to have minimal adverse effects.”

    From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [111]

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  1. Catherine Chamberlain is receiving an Australian National Health and Medical Research Council Early Career Fellowship (1088813). She was also awarded an NIHR Cochrane Review Incentive Scheme award (15/81/18) to support the preparation of this updated review. Catherine Chamberlain is also an author on the Cochrane Review entitled 'Pharmacological Interventions to promote smoking cessation in pregnancy" (Coleman 2015).

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Authors
Chamberlain, C., O'Mara-Eves, A., Porter, J., Coleman, T., Perlen, S. M., Thomas, J., & McKenzie, J. E.
Affiliations
  • The University of Melbourne (AU)
  • University College London; EPPI-Centre, Social Science Research Unit, UCL Institute of Education; 18 Woburn Square London UK WC1H 0NR
  • University of Nottingham (GB)
  • Murdoch Children's Research Institute (AU)
  • University College London (GB)
  • Monash University (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2017-02-14
Volume
2020
Issue
3
Pages
CD001055-CD001055
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd001055.pub5
PMC
PMC6472671
OpenAlex
W2152176221
Cited by
650
References
726
Citations by year
2026: 22 · 2025: 32 · 2024: 47 · 2023: 53 · 2022: 63 · 2021: 55 · 2020: 59 · 2019: 61 · 2018: 50 · 2017: 64 · 2016: 50 · 2015: 57 · 2014: 32 · 2013: 3 · 2012: 1
FWCI
7.85
Type
journal article
Language
en
Update notices
new_version (2026-04-21)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (publishedVersion)
  • Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by)
  • UCL Discovery (University College London) (submittedVersion)
  • Figshare (submittedVersion)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
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, social support, peer support, partner support, exercise intervention, perinatal outcomes, low birth weight, birth weight, neonatal intensive care admission, preterm birth, stillbirth, maternal smoking, intervention intensity, implementation quality, low- and middle-income countries, maternal health
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, Exercise, Randomized Controlled Trials as Topic, Smoking Cessation, Feedback, Psychological, Pregnant People, Pregnant Women

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