Intervention Review

Interventions for promoting smoking cessation during pregnancy

  1. Judith Lumley2,
  2. Catherine Chamberlain1,*,
  3. Therese Dowswell3,
  4. Sandy Oliver4,
  5. Laura Oakley5,
  6. Lyndsey Watson2

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 3 DEC 2008

DOI: 10.1002/14651858.CD001055.pub3

Database Title

Additional Information

How to Cite

Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub3.

Author Information

  1. 1

    Southern Health, 3Centres Collaboration, Women and Children's Program, Clayton South, Victoria, Australia

  2. 2

    La Trobe University, Mother and Child Health Research, Melbourne, Victoria, Australia

  3. 3

    The University of Liverpool, Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, Liverpool, UK

  4. 4

    Institute of Education, University of London, Social Science Research Unit, London, UK

  5. 5

    London School of Hygiene and Tropical Medicine, Non-communicable Disease Epidemiology Unit, London, UK

*Catherine Chamberlain, 3Centres Collaboration, Women and Children's Program, Southern Health, Locked Bag 29, Clayton South, Victoria, 3169, Australia. chamberl@ihug.com.au.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 JUL 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies. Smoking in pregnancy is decreasing in high-income countries and increasing in low- to middle-income countries and is strongly associated with poverty, low educational attainment, poor social support and psychological illness.

Objectives

To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2008), the Cochrane Tobacco Addiction Group's Trials Register (June 2008), EMBASE, PsycLIT, and CINAHL (all from January 2003 to June 2008). We contacted trial authors to locate additional unpublished data.

Selection criteria

Randomised controlled trials where smoking cessation during pregnancy was a primary aim of the intervention.

Data collection and analysis

Trials were identified and data extracted by one person and checked by a second. Subgroup analysis was conducted to assess the effect of risk of trial bias, intensity of the intervention and main intervention strategy used.

Main results

Seventy-two trials are included. Fifty-six randomised controlled trials (over 20,000 pregnant women) and nine cluster-randomised trials (over 5000 pregnant women) provided data on smoking cessation outcomes.

There was a significant reduction in smoking in late pregnancy following interventions (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.96), an absolute difference of six in 100 women who stopped smoking during pregnancy. However, there is significant heterogeneity in the combined data (I2 > 60%). In the trials with the lowest risk of bias, the interventions had less effect (RR 0.97, 95% CI 0.94 to 0.99), and lower heterogeneity (I2 = 36%). Eight trials of smoking relapse prevention (over 1000 women) showed no statistically significant reduction in relapse.

Smoking cessation interventions reduced low birthweight (RR 0.83, 95% CI 0.73 to 0.95) and preterm birth (RR 0.86, 95% CI 0.74 to 0.98), and there was a 53.91g (95% CI 10.44 g to 95.38 g) increase in mean birthweight. There were no statistically significant differences in neonatal intensive care unit admissions, very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power.

Authors' conclusions

Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and preterm birth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions to help women to stop smoking in pregnancy

Smoking during pregnancy increases the risk of the mother having complications during pregnancy and the baby being born too small (with low birthweight) and too early (prematurely, before 37 weeks). Low birthweight has been associated with coronary heart disease, type 2 diabetes, and being overweight in adulthood. Tobacco smoking also has serious long-term health risks for both the women and their babies. Tobacco smoking during pregnancy is relatively common, although the trend is toward becoming less frequent in high-income countries and more so in low to middle-income countries. Many mothers find it hard to stop or reduce smoking during pregnancy even knowing the benefits of doing so as the nicotine in tobacco is very addictive. Smoking in pregnancy is also strongly associated with poverty, low levels of education, poor social support, depression and psychological illness.

The interventions offered to promote smoking cessation in pregnancy are generally given individually and include cognitive behaviour and motivational interviewing; offering incentives; interventions based on stages of change; giving feedback to the mothers on fetal health status or nicotine by-products measurements; nicotine replacement therapy, bupropion or other medications. The review of trials found a total of 72 controlled trials involving over 25,000 women. These were conducted from 1975 to 2008 and nearly all were in high-income countries. Interventions were effective in helping women to stop smoking during pregnancy (overall by approximately 6%). The most effective intervention appeared to be providing incentives, which helped around 24% of women to quit smoking during pregnancy. The smoking cessation interventions reduced the number of babies with low birthweight and preterm births, confirming that smoking cessation can reduce the adverse effects of smoking on newborn infants.

Women in the control groups of most trials received information about the risks of smoking in pregnancy and were advised to quit as part of usual care. The intensity of both that information and the interventions has increased over time.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

懷孕期間促進戒菸的措施

吸菸仍是一個可能造成低出生體重，早產和周產期死亡的可預防性因素。

目標

評估懷孕期間實施戒菸計畫對胎兒,新生兒,母親和家庭健康的影響。

搜尋策略

我們搜尋the Cochrane Pregnancy and Childbirth Group trials register 以及the Cochrane Tobacco Addiction Group trials register(2003年七月), MEDLINE(2002年一月到2003年七月), EMBASE (2002年一月到2003年七月), PsychLIT (2002年一月到2003年七月) INAHL (2002年一月到2003年七月) nd AUSTHEALTH (2002年一月到2003年)。我們從試驗作者取得更多未公佈的資料,並親自搜尋這些認定試驗與近期相關產科期刊的所有參考資料。

選擇標準

懷孕期間戒菸計畫的隨機和半隨機試驗。

資料收集與分析

四位審查員各自獨立評估試驗品質和提取資料。

主要結論

本篇文章包含了64個試驗。51個隨機對照試驗(20931位孕婦)和6個集群隨機試驗(超過7500位孕婦)提供了關於戒菸和/或周產期預後的相關資料。縱使在整個懷孕過程中,排除在措施上強度,和提醒者與激勵方案介入程度的真實差異,不論是強力介入或僅經常性關切,對受試者的平均影響程度都有隨時間增強的現象。在包含的48個試驗當中實施戒菸計畫的群體都有顯著減少吸菸的情況: (RR 0.94, 95% CI 0.93 to 0.95)。在36個試驗險示已有效戒菸的孕婦也有類似的減少情況(0.94, 95% CI 0.92 to 0.95)。戒菸措施降低了低出生體重(R .81, 95% CI 0.70 to 0.94)以及早產(RR 0.84, 95% CI 0.72 to 0.98)的情況,而且在平均出生體重方面增加了33克(95% CI 11 g to 55 g)。目前在在極低出生體重,死產,周產期或新生兒死亡率都沒有統計學上的顯著差異,但這些分析的效力是非常有限的。有兩個試驗是以獎勵加上社會支持作為策略,結果比起其他策略產生了更顯著減少孕婦吸菸的情況(RR 0.77, 95% CI 0.72 to 0.82)。五個有關防治戒菸後再吸菸的試驗(超過800位孕婦),發現在防治再吸菸的努力,沒有統計學上顯著的效果。

作者結論

懷孕期間的戒菸計畫可以減少繼續吸菸孕婦的比例,並降低低出生體重和早產的情況。針對周產期死亡率或極低出生體重的減少,這些試驗仍沒有足夠的檢測能力。

翻譯人

本摘要由周產期醫學會(Taiwan Society of Perinatology)林孝祖翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

支持婦女在懷孕期間戒菸的策略,有助於嬰兒的健康。懷孕期間吸菸是很普遍的,特別在低收入和社會資源貧乏的地區。孕婦吸菸會增加低出生體重和早產的危險。嬰兒常常掙扎著應付子宮外的生活而且可能在往後的生活中因健康不佳而受苦。由於吸菸可以幫助孕婦疏解壓力,即使知道戒菸的好處,很多母親在懷孕期間仍然很難停止或減少吸菸。協助和支持孕婦戒菸的有效策略,可以減少早產兒的發生,並改善胎兒的出生體重。

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