Smoking Cessation Interventions in Pregnancy and Postpartum Care

OBJECTIVE:

The Vanderbilt Evidence-based Practice Center systematically reviewed evidence about smoking cessation interventions in pregnant and postpartum women.

DATA SOURCES:

We searched MEDLINE®, CINAHL®, and PsycINFO® for randomized controlled trials (RCTs) on interventions and prospective studies on patient characteristics published in English.

REVIEW METHODS:

We dually reviewed abstracts and full texts. Studies were excluded if they did not address a Key Question, were not an eligible study design, or did not report biochemically validated smoking cessation outcomes. Data were extracted into evidence tables and summarized qualitatively. A meta-analysis of effectiveness data assessed relative impact of components in smoking cessation interventions.

RESULTS:

We included 59 unique studies reported in 72 publications. Of the 56 RCTs, 13 were good, 15 fair, and 28 poor quality. Studies evaluated counseling-based interventions, educational materials, nicotine replacement therapy (NRT), peer support, multicomponent interventions, and other unique interventions. Multicomponent approaches were most likely to be effective, but results were inconsistent. In the meta-analysis, incentives demonstrated the strongest effect; other components with a greater than 80-percent likelihood of success were feedback about biologic measures, information, personal followup, NRT, and quit guides. Findings regarding infant outcomes were inconsistent or did not reach statistical significance. No serious harms were identified in four studies that reported adverse events.

CONCLUSIONS:

Across interventions, data are sparse to evaluate sustained cessation among pregnant and postpartum women. This review suggests that approaches that combine multiple components will have the best likelihood of success. Selecting which components to include is more complex and should be based on the particular considerations of the clinical setting, including patient characteristics and resource allocation, but incentives demonstrated the greatest effect among components studied. Infant outcomes are limited to data collected at time of birth; no studies assessed longer term or child outcomes. Harms data were rarely reported.