Psychosocial interventions for supporting women to stop smoking in pregnancy.

Abstract

Smoking during pregnancy increases the risk of the mother having complications during pregnancy and the baby being born with low birthweight and preterm (before 37 weeks). Tobacco smoking during pregnancy is relatively common, although the trend is towards it becoming less frequent in high-income countries and more frequent in low- to middle-income countries. The review showed that psychosocial interventions to support women to stop smoking increased the proportion of women who stopped smoking in late pregnancy and reduced the number of low birthweight and preterm births. There did not appear to be any adverse effects from the psychosocial interventions, and three studies measured an improvement in women's psychological wellbeing. The review includes 86 randomised controlled trials, with data from seventy-seven trials (involving over 29,000 women). Nearly all studies were in high-income countries. The intervention that supported the most women to stop smoking in pregnancy appeared to be providing incentives. However, these results are based on only four trials with a small number of women (all in the US), and they only seemed to help women stop smoking when provided intensively (three trials). Counselling also appeared to be effective in supporting women to quit, but only when combined with other strategies (27 trials). The effectiveness of counselling was less clear when women in the control group received a less intensive smoking intervention (16 trials). Feedback also appeared to help women quit, but only when compared with usual care and combined with other strategies (two studies). It was unclear whether health education alone helped women quit, but the numbers of women involved in these trials were comparatively small. The evidence for social support was mixed; for instance, targeted peer support appeared to help women quit (five trials) but in one trial partner support did not. Women also reported that peer and partner support could be both helpful and unhelpful. Increasing the frequency and duration of the intervention did not appear to increase the effectiveness. Interventions appeared to be as effective for women who were poor, as those who were not; but there is insufficient evidence that the interventions were effective for ethnic (five trials) and aboriginal women (two trials). Trials where the interventions became part of routine pregnancy care did not appear to help more women to quit, which suggests there are challenges to translating this evidence into practice