Chamberlain, Catherine and O'Mara-Eves, Alison and Porter, Jessie and Coleman, Tim and Perlen ...

536 Pages·2017·6.01 MB·English

by  Christine Middleton

CochraneDatabaseofSystematicReviews
Psychosocial interventions for supporting women to stop
smoking in pregnancy (Review)
ChamberlainC,O’Mara-EvesA,PorterJ,ColemanT,PerlenSM,ThomasJ,McKenzieJE
ChamberlainC,O’Mara-EvesA,PorterJ,ColemanT,PerlenSM,ThomasJ,McKenzieJE.
Psychosocialinterventionsforsupportingwomentostopsmokinginpregnancy.
CochraneDatabaseofSystematicReviews2017,Issue2.Art.No.:CD001055.
DOI:10.1002/14651858.CD001055.pub5.
www.cochranelibrary.com
Psychosocialinterventionsforsupportingwomentostopsmokinginpregnancy(Review)
Copyright©2017TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAINLANGUAGESUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
SUMMARYOFFINDINGSFORTHEMAINCOMPARISON . . . . . . . . . . . . . . . . . . . 4
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Figure1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Figure3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Figure4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Figure5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Figure6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Figure7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
ADDITIONALSUMMARYOFFINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 44
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
AUTHORS’CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
CHARACTERISTICSOFSTUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
DATAANDANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Analysis1.1.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome1Abstinenceinlate
pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358
Analysis1.2.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome2Abstinenceinlate
pregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . . . . . . . 360
Analysis1.3.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome3Continuedabstinence
(relapseprevention)inlatepregnancyforspontaneousquitters. . . . . . . . . . . . . . . . . . 362
Analysis1.4.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome4Abstinenceat0to5
monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Analysis1.5.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome5Abstinenceat6to11
monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
Analysis1.6.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome6Abstinenceat12to17
monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Analysis1.7.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome7Abstinenceat18+
monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
Analysis1.8.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome8Reductioninlate
pregnancy:biochemicallyvalidated. . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Analysis1.9.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome9Reductioninlate
pregnancy:selfreported(variousdefinitions). . . . . . . . . . . . . . . . . . . . . . . . 368
Analysis1.10.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome10Biochemicalmeasures
inlatepregnancy:meancotinine. . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Analysis1.11.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome11Meancigarettesper
dayinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370
Analysis1.12.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome12NICUadmissions. 371
Analysis1.13.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome13Verylowbirthweight
infants(<1500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372
Analysis1.14.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome14Pretermbirths. 373
Analysis1.15.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome15Meanbirthweight. 374
Analysis1.16.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome16Perinataldeaths. 375
Analysis1.17.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome17Stillbirths. . . 376
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Analysis1.18.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome18Neonataldeaths. 377
Analysis1.19.Comparison1Smokingcessationinterventions:counsellingvsusualcare,Outcome19Lowbirthweight
infants(<2500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
Analysis2.1.Comparison 2Smokingcessationinterventions:counsellingvslessintensiveintervention, Outcome1
Abstinenceinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Analysis2.2.Comparison 2Smokingcessationinterventions:counsellingvslessintensiveintervention, Outcome2
Abstinenceinlatepregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . 381
Analysis2.3.Comparison 2Smokingcessationinterventions:counsellingvslessintensiveintervention, Outcome3
Continuedabstinence(relapseprevention)inlatepregnancy(spontaneousquitters). . . . . . . . . . 382
Analysis2.4.Comparison 2Smokingcessationinterventions:counsellingvslessintensiveintervention, Outcome4
Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . 383
Analysis2.5.Comparison 2Smokingcessationinterventions:counsellingvslessintensiveintervention, Outcome5
Abstinenceat6to11monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . 385
Analysis2.6.Comparison 2Smokingcessationinterventions:counsellingvslessintensiveintervention, Outcome6
Abstinenceat12to17monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . 386
Analysis2.7.Comparison 2Smokingcessationinterventions:counsellingvslessintensiveintervention, Outcome7
Reductioninlatepregnancy:biochemicallyvalidated. . . . . . . . . . . . . . . . . . . . . 387
Analysis2.8.Comparison 2Smokingcessationinterventions:counsellingvslessintensiveintervention, Outcome8
Reductioninlatepregnancy:self-reported>50%. . . . . . . . . . . . . . . . . . . . . . 388
Analysis2.9.Comparison2Smokingcessationinterventions:counsellingvslessintensiveintervention,Outcome9Mean
cigarettesperdayinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Analysis2.10.Comparison2Smokingcessationinterventions:counsellingvslessintensiveintervention,Outcome10Low
birthweightinfants(<2500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390
Analysis2.11.Comparison2Smokingcessationinterventions:counsellingvslessintensiveintervention,Outcome11
Pretermbirths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Analysis2.12.Comparison2Smokingcessationinterventions:counsellingvslessintensiveintervention,Outcome12
Meanbirthweight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
Analysis2.13.Comparison2Smokingcessationinterventions:counsellingvslessintensiveintervention,Outcome13
Stillbirths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Analysis3.1.Comparison3Smokingcessationinterventions:counsellingvsalternativeintervention,Outcome1Abstinence
inlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Analysis3.2.Comparison3Smokingcessationinterventions:counsellingvsalternativeintervention,Outcome2Abstinence
inlatepregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . . . . . 394
Analysis3.3.Comparison3Smokingcessationinterventions:counsellingvsalternativeintervention,Outcome3Abstinence
at0to5monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Analysis3.4.Comparison3Smokingcessationinterventions:counsellingvsalternativeintervention,Outcome4Abstinence
at6to11monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
Analysis4.1.Comparison4Smokingcessationinterventions:healtheducationvsusualcare,Outcome1Abstinenceinlate
pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Analysis4.2.Comparison4Smokingcessationinterventions:healtheducationvsusualcare,Outcome2Abstinenceinlate
pregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . . . . . . . 398
Analysis4.3.Comparison4Smokingcessationinterventions:healtheducationvsusualcare,Outcome3Continued
abstinence(Relapseprevention)inlatepregnancyforspontaneousquitters. . . . . . . . . . . . . 399
Analysis4.4.Comparison4Smokingcessationinterventions:healtheducationvsusualcare,Outcome4Abstinenceat0to
5monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Analysis4.5.Comparison4Smokingcessationinterventions:healtheducationvsusualcare,Outcome5Meancigarettes
perdayinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Analysis4.6.Comparison4Smokingcessationinterventions:healtheducationvsusualcare,Outcome6Lowbirth
weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
Analysis4.7.Comparison4Smokingcessationinterventions:healtheducationvsusualcare,Outcome7Pretermbirths(<
37weeks). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Analysis 4.8. Comparison 4Smoking cessation interventions: healtheducation vs usual care, Outcome 8 Mean
birthweight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
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Analysis4.9. Comparison 4Smokingcessationinterventions: healtheducationvsusual care,Outcome9Perinatal
deaths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
Analysis5.1.Comparison5Smokingcessationinterventions:healtheducationvslessintensiveintervention,Outcome1
Abstinenceinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Analysis5.2.Comparison5Smokingcessationinterventions:healtheducationvslessintensiveintervention,Outcome2
Abstinenceinlatepregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . 406
Analysis5.3.Comparison5Smokingcessationinterventions:healtheducationvslessintensiveintervention,Outcome3
Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . 407
Analysis5.4.Comparison5Smokingcessationinterventions:healtheducationvslessintensiveintervention,Outcome4
Meancigarettesperdayinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . 408
Analysis5.5.Comparison5Smokingcessationinterventions:healtheducationvslessintensiveintervention,Outcome5
Lowbirthweight(<2500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
Analysis5.6.Comparison5Smokingcessationinterventions:healtheducationvslessintensiveintervention,Outcome6
Pretermbirths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Analysis5.7.Comparison5Smokingcessationinterventions:healtheducationvslessintensiveintervention,Outcome7
Meanbirthweight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
Analysis6.1.Comparison6Smokingcessationinterventions:healtheducationvsalternativeintervention,Outcome1
Abstinenceinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
Analysis6.2.Comparison6Smokingcessationinterventions:healtheducationvsalternativeintervention,Outcome2
Abstinenceinlatepregnancy:biochemicallyvalidated. . . . . . . . . . . . . . . . . . . . . 411
Analysis7.1.Comparison7Smokingcessationinterventions: feedbackvsusualcare,Outcome1Abstinenceinlate
pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
Analysis7.2.Comparison7Smokingcessationinterventions: feedbackvsusualcare,Outcome2Abstinenceinlate
pregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . . . . . . . 413
Analysis7.3.Comparison7Smokingcessationinterventions: feedbackvsusual care,Outcome3Reductioninlate
pregnancy:biochemicallyvalidated. . . . . . . . . . . . . . . . . . . . . . . . . . . 414
Analysis7.4.Comparison7Smokingcessationinterventions: feedbackvsusual care,Outcome4Reductioninlate
pregnancy:self-reported(variousdefinitions). . . . . . . . . . . . . . . . . . . . . . . . 415
Analysis7.5.Comparison7Smokingcessationinterventions:feedbackvsusualcare,Outcome5Meancigarettesperdayin
latepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Analysis7.6.Comparison7Smokingcessationinterventions:feedbackvsusualcare,Outcome6Lowbirthweight(<2500
g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
Analysis7.7.Comparison7Smokingcessationinterventions:feedbackvsusualcare,Outcome7Pretermbirths. . . 417
Analysis7.8.Comparison7Smokingcessationinterventions:feedbackvsusualcare,Outcome8Meanbirthweight. 418
Analysis7.9.Comparison7Smokingcessationinterventions:feedbackvsusualcare,Outcome9Stillbirths. . . . 419
Analysis8.1.Comparison8Smokingcessationinterventions:feedbackvslessintensiveintervention,Outcome1Abstinence
inlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
Analysis8.2.Comparison8Smokingcessationinterventions:feedbackvslessintensiveintervention,Outcome2Abstinence
inlatepregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . . . . . 421
Analysis9.1.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome1Abstinenceinlate
pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
Analysis9.2.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome2Abstinenceinlate
pregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . . . . . . . . 423
Analysis9.3.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome3Abstinenceat0to5
monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
Analysis9.4.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome4Abstinenceat6to11
monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Analysis9.5.Comparison9Smokingcessationinterventions: incentivesvsusualcare,Outcome5Reductioninlate
pregnancy:biochemicallyvalidated. . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Analysis9.6.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome6Biochemicalmeasuresin
latepregnancy:meancotinine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
Analysis9.7.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome7Meancigarettesperday
inlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
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Analysis9.8.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome8Lowbirthweight. . 427
Analysis9.9.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome9Pretermbirths. . 428
Analysis9.10.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome10Meanbirthweight. 429
Analysis9.11.Comparison9Smokingcessationinterventions:incentivesvsusualcare,Outcome11NICUadmissions. 430
Analysis10.1.Comparison10Smokingcessationinterventions:incentivesvslessintensiveintervention,Outcome1
Abstinenceinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Analysis10.2.Comparison10Smokingcessationinterventions:incentivesvslessintensiveintervention,Outcome2
Abstinenceinlatepregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . 432
Analysis10.3.Comparison10Smokingcessationinterventions:incentivesvslessintensiveintervention,Outcome3
Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . 433
Analysis11.1. Comparison 11Smokingcessation interventions: incentivesvsalternativeintervention, Outcome1
Abstinenceinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434
Analysis11.2. Comparison 11Smokingcessation interventions: incentivesvsalternativeintervention, Outcome2
Abstinenceinlatepregnancy:biochemicalyvalidatedonly. . . . . . . . . . . . . . . . . . . 435
Analysis11.3. Comparison 11Smokingcessation interventions: incentivesvsalternativeintervention, Outcome3
Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . 436
Analysis11.4. Comparison 11Smokingcessation interventions: incentivesvsalternativeintervention, Outcome4
Abstinenceat6to11monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . 437
Analysis11.5.Comparison11Smokingcessationinterventions:incentivesvsalternativeintervention,Outcome5Smoking
reduction:numbersofwomenreducingsmokinginlatepregnancy(biochemicallyvalidated). . . . . . . 438
Analysis11.6.Comparison11Smokingcessationinterventions:incentivesvsalternativeintervention,Outcome6Low
birthweight(under2500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Analysis11.7.Comparison11Smokingcessationinterventions:incentivesvsalternativeintervention,Outcome7Preterm
birth(under37weeks). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440
Analysis11.8.Comparison11Smokingcessationinterventions:incentivesvsalternativeintervention,Outcome8Mean
birthweight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
Analysis11.9.Comparison11Smokingcessationinterventions:incentivesvsalternativeintervention,Outcome9NICU
admissions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442
Analysis12.1.Comparison12Smokingcessationinterventions:socialsupportvslessintensiveintervention,Outcome1
Abstinenceinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
Analysis12.2.Comparison12Smokingcessationinterventions:socialsupportvslessintensiveintervention,Outcome2
Abstinenceinlatepregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . 444
Analysis12.3.Comparison12Smokingcessationinterventions:socialsupportvslessintensiveintervention,Outcome3
Continuedabstinence(relapseprevention)inlatepregnancy. . . . . . . . . . . . . . . . . . 445
Analysis12.4.Comparison12Smokingcessationinterventions:socialsupportvslessintensiveintervention,Outcome4
Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . 446
Analysis12.5.Comparison12Smokingcessationinterventions:socialsupportvslessintensiveintervention,Outcome5
Abstinenceat6to11monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . 447
Analysis12.6.Comparison12Smokingcessationinterventions:socialsupportvslessintensiveintervention,Outcome6
Abstinenceat12to17monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . 448
Analysis12.7.Comparison12Smokingcessationinterventions:socialsupportvslessintensiveintervention,Outcome7
Smokingreduction:selfreported>50%reduction. . . . . . . . . . . . . . . . . . . . . . 449
Analysis12.8.Comparison12Smokingcessationinterventions:socialsupportvslessintensiveintervention,Outcome8
Lowbirthweight(<2500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
Analysis12.9.Comparison12Smokingcessationinterventions:socialsupportvslessintensiveintervention,Outcome9
Meanbirthweight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
Analysis13.1.Comparison13Smokingcessationinterventions:exercisevsusualcare,Outcome1Abstinenceinlate
pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
Analysis13.2.Comparison13Smokingcessationinterventions:exercisevsusualcare,Outcome2Abstinenceinlate
pregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . . . . . . . 452
Analysis13.3.Comparison13Smokingcessationinterventions:exercisevsusualcare,Outcome3Abstinenceat6to11
monthspostpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
Analysis13.4.Comparison13Smokingcessationinterventions:exercisevsusualcare,Outcome4Lowbirthweight. 454
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Analysis13.5.Comparison13Smokingcessationinterventions:exercisevsusualcare,Outcome5Pretermbirths. . 454
Analysis13.6.Comparison13Smokingcessationinterventions:exercisevsusualcare,Outcome6Meanbirthweight. 455
Analysis13.7.Comparison13Smokingcessationinterventions:exercisevsusualcare,Outcome7Stillbirths. . . . 456
Analysis13.8.Comparison13Smokingcessationinterventions:exercisevsusualcare,Outcome8Neonataldeaths. . 456
Analysis14.1.Comparison 14Smokingcessationinterventions: othervsusual care,Outcome1Abstinenceinlate
pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Analysis14.2.Comparison 14Smokingcessationinterventions: othervsusual care,Outcome2Abstinenceinlate
pregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . . . . . . . . . . . 458
Analysis15.1.Comparison15Maternalhealthinterventionwithsmokingcessationcomponent:counsellingvsusualcare,
Outcome1Abstinenceinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . . . 459
Analysis15.2.Comparison15Maternalhealthinterventionwithsmokingcessationcomponent:counsellingvsusualcare,
Outcome2Abstinenceinlatepregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . . . 460
Analysis15.3.Comparison15Maternalhealthinterventionwithsmokingcessationcomponent:counsellingvsusualcare,
Outcome3Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . . . . . . . . . 461
Analysis15.4.Comparison15Maternalhealthinterventionwithsmokingcessationcomponent:counsellingvsusualcare,
Outcome4Smokingreduction:biochemicalmeasuresinlatepregnancy. . . . . . . . . . . . . . 461
Analysis16.1.Comparison16Maternalhealthinterventionwithsmokingcessationcomponent:healtheducationvsless
intensiveintervention,Outcome1Abstinenceinlatepregnancy:biochemicallyvalidatedonly. . . . . . . 462
Analysis16.2.Comparison16Maternalhealthinterventionwithsmokingcessationcomponent:healtheducationvsless
intensiveintervention,Outcome2Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . 463
Analysis17.1.Comparison17Maternalhealthinterventionwithsmokingcessationcomponent:feedbackvsusualcare,
Outcome1Smokingabstinenceinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . 464
Analysis17.2.Comparison17Maternalhealthinterventionwithsmokingcessationcomponent:feedbackvsusualcare,
Outcome2Smokingreductioninlatepregnancy:self-reported(variousdefinitions). . . . . . . . . . 465
Analysis17.3.Comparison17Maternalhealthinterventionwithsmokingcessationcomponent:feedbackvsusualcare,
Outcome3Smokingreduction:self-reportedmeancigarettesperdaymeasuredinlatepregnancyoratdelivery. 466
Analysis18.1.Comparison18Maternalhealthinterventionwithsmokingcessationcomponent:socialsupportvsusual
care,Outcome1Abstinenceinlatepregnancy. . . . . . . . . . . . . . . . . . . . . . . 467
Analysis18.2.Comparison18Maternalhealthinterventionwithsmokingcessationcomponent:socialsupportvsusual
care,Outcome2Abstinenceinlatepregnancy:biochemicallyvalidatedonly. . . . . . . . . . . . . 468
Analysis18.3.Comparison18Maternalhealthinterventionwithsmokingcessationcomponent:socialsupportvsusual
care,Outcome3Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . . . . . . . 469
Analysis18.4.Comparison18Maternalhealthinterventionwithsmokingcessationcomponent:socialsupportvsusual
care,Outcome4Abstinenceat18+monthspostpartum. . . . . . . . . . . . . . . . . . . . 470
Analysis18.5.Comparison18Maternalhealthinterventionwithsmokingcessationcomponent:socialsupportvsusual
care,Outcome5Smokingreduction:meancigarettesperday. . . . . . . . . . . . . . . . . . 471
Analysis19.1.Comparison19Maternalhealthinterventionwithsmokingcessationcomponent:socialsupportvsless
intensiveintervention,Outcome1Abstinenceinlatepregnancy. . . . . . . . . . . . . . . . . 472
Analysis19.2.Comparison19Maternalhealthinterventionwithsmokingcessationcomponent:socialsupportvsless
intensiveintervention,Outcome2Abstinenceinlatepregnancy:biochemicallyvalidatedonly. . . . . . . 473
Analysis19.3.Comparison19Maternalhealthinterventionwithsmokingcessationcomponent:socialsupportvsless
intensiveintervention,Outcome3Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . 474
Analysis19.4.Comparison19Maternalhealthinterventionwithsmokingcessationcomponent:socialsupportvsless
intensiveintervention,Outcome4Smokingreduction:selfreportedmeancigarettesperday. . . . . . . 475
Analysis20.1.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome1Abstinenceinlatepregnancy:self-reportedandbiochemicallyvalidated. . . 476
Analysis20.2.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome2Abstinenceinlatepregnancy:biochemicallyvalidatedonly. . . . . . . 481
Analysis20.3.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome3Continuedabstinence(Relapseprevention)inlatepregnancyforspontaneous
quitters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
Analysis20.4.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome4Abstinenceat0to5monthspostpartum. . . . . . . . . . . . . 486
Psychosocialinterventionsforsupportingwomentostopsmokinginpregnancy(Review) v
Copyright©2017TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Analysis20.5.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome5Abstinenceat6to11monthspostpartum. . . . . . . . . . . . . 489
Analysis20.6.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome6Abstinenceat12to17monthspostpartum. . . . . . . . . . . . . 491
Analysis20.7.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome7Abstinenceat18+monthspostpartum. . . . . . . . . . . . . . 492
Analysis20.8.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome8Smokingreduction:numbersofwomenreducingsmokinginlatepregnancy. 493
Analysis20.9.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome9Smokingreduction:biochemicalmeasuresinlatepregnancy. . . . . . . 494
Analysis20.10.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome10Smokingreduction: self-reportedmeancigarettesperdaymeasuredinlate
pregnancyoratdelivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 496
Analysis20.11.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome11Lowbirthweight(under2500g). . . . . . . . . . . . . . . . 498
Analysis20.12.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome12Verylowbirthweight(under1500g). . . . . . . . . . . . . . 500
Analysis20.13.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome13Pretermbirth(under37weeks). . . . . . . . . . . . . . . . 501
Analysis20.14.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome14Meanbirthweight(g). . . . . . . . . . . . . . . . . . . . 503
Analysis20.15.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome15Stillbirths. . . . . . . . . . . . . . . . . . . . . . . . 505
Analysis20.16.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome16Perinataldeaths. . . . . . . . . . . . . . . . . . . . . . 506
Analysis20.17.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome17Neonataldeaths. . . . . . . . . . . . . . . . . . . . . 507
Analysis20.18.Comparison20Interventionsforsmokingcessationinpregnancyversuscontrol:subgroupedbymain
interventionstrategy,Outcome18NICUadmissions. . . . . . . . . . . . . . . . . . . . . 508
ADDITIONALTABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518
WHAT’SNEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
CONTRIBUTIONSOFAUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525
DECLARATIONSOFINTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527
SOURCESOFSUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527
DIFFERENCESBETWEENPROTOCOLANDREVIEW . . . . . . . . . . . . . . . . . . . . . 527
INDEXTERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Psychosocialinterventionsforsupportingwomentostopsmokinginpregnancy(Review) vi
Copyright©2017TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
[InterventionReview]
Psychosocial interventions for supporting women to stop
smoking in pregnancy
Catherine Chamberlain1,2,3,4, Alison O’Mara-Eves5, Jessie Porter2, Tim Coleman6, Susan M Perlen4, James Thomas5, Joanne E
McKenzie3
1Aboriginal Health Domain, Baker IDI Heart & Diabetes Institute, Melbourne, Australia. 2Melbourne School of Population and
GlobalHealth,UniversityofMelbourne,Melbourne,Australia.3SchoolofPublicHealth&PreventiveMedicine,MonashUniversity,
Melbourne,Australia.4HealthyMothersHealthyFamiliesResearchGroup,MurdochChildrensResearchInstitute,Melbourne,Aus-
tralia.5EPPI-Centre,SocialScienceResearchUnit,UCLInstituteofEducation,UniversityCollegeLondon,London,UK.6Division
ofPrimaryCare,UniversityofNottingham,Nottingham,UK
Contactaddress:CatherineChamberlain,AboriginalHealthDomain,BakerIDIHeart&DiabetesInstitute,L4/99CommercialRd,
Prahan,Melbourne,Vic,3004,[email protected],[email protected].
Editorialgroup:CochranePregnancyandChildbirthGroup.
Publicationstatusanddate:Newsearchforstudiesandcontentupdated(conclusionschanged),publishedinIssue2,2017.
Citation: ChamberlainC,O’Mara-EvesA,PorterJ,ColemanT,PerlenSM,ThomasJ,McKenzieJE.Psychosocialinterventionsfor
supportingwomentostopsmokinginpregnancy.CochraneDatabaseofSystematicReviews2017,Issue2.Art.No.:CD001055.DOI:
10.1002/14651858.CD001055.pub5.
Copyright©2017TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
ABSTRACT
Background
Tobaccosmokingremainsoneofthefewpreventablefactorsassociatedwithcomplicationsinpregnancy,andhasseriouslong-term
implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with
povertyandisincreasinginlow-tomiddle-incomecountries.
Objectives
Toassesstheeffectsofsmokingcessationinterventionsduringpregnancyonsmokingbehaviourandperinatalhealthoutcomes.
Searchmethods
In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (13 November 2015), checked
referencelistsofretrievedstudiesandcontactedtrialauthors.
Selectioncriteria
Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation
interventionsduringpregnancy.
Datacollectionandanalysis
Tworeviewauthorsindependentlyassessedtrialsforinclusionandtrialquality,andextracteddata.Directcomparisonswereconducted
inRevMan,withmeta-regressionconductedinSTATA14.
Psychosocialinterventionsforsupportingwomentostopsmokinginpregnancy(Review) 1
Copyright©2017TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Mainresults
Theoverallqualityofevidencewasmoderatetohigh,withreductionsinconfidenceduetoimprecisionandheterogeneityforsome
outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000
women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education,
feedback,incentives,socialsupport,exerciseanddissemination.
Inseparatecomparisons,thereishigh-qualityevidencethatcounsellingincreasedsmokingcessationinlatepregnancycomparedwith
usualcare(30studies;averageriskratio(RR)1.44,95%confidenceinterval(CI)1.19to1.73)andlessintensiveinterventions(18
studies;averageRR1.25,95%CI1.07to1.47).Therewasuncertaintywhethercounsellingincreasedthechanceofsmokingcessation
whenprovidedasonecomponentofabroadermaternalhealthinterventionorcomparingonetypeofcounsellingwithanother.In
studiescomparingcounsellingandusualcare(largestcomparison), itwasunclearwhetherinterventionspreventedsmokingrelapse
amongwomenwhohadstoppedsmokingspontaneouslyinearlypregnancy.However,acleareffectwasseeninsmokingabstinenceat
zerotofivemonthspostpartum(11studies;averageRR1.59,95%CI1.26to2.01)and12to17months(twostudies,averageRR
2.20,95%CI1.23to3.96),withaborderlineeffectatsixto11months(sixstudies;averageRR1.33,95%CI1.00to1.77).Inother
comparisons,theeffectwasunclearformostsecondaryoutcomes,butsamplesizesweresmall.
Evidencesuggestsaborderlineeffectofhealtheducationcomparedwithusualcare(fivestudies; averageRR1.59,95%CI0.99to
2.55),butthequalitywasdowngradedtomoderateastheeffectwasunclearwhencomparedwithlessintensiveinterventions(four
studies; average RR 1.20, 95% CI0.85 to1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when
smokingcessationhealtheducationwasprovidedasonecomponentofabroadermaternalhealthintervention.
Therewasevidencefeedbackincreasedsmoking cessation whencomparedwithusual care andprovidedinconjunction withother
strategies,suchascounselling(averageRR4.39,95%CI1.89to10.21),buttheconfidenceinthequalityofevidencewasdowngradedto
moderateasthiswasbasedononlytwostudiesandtheeffectwasuncertainwhenfeedbackwascomparedtolessintensiveinterventions
(threestudies;averageRR1.29,95%CI0.75to2.20).
High-qualityevidencesuggestsincentive-basedinterventionsareeffectivewhencomparedwithanalternative(non-contingentincentive)
intervention(fourstudies;RR2.36,95%CI1.36to4.09).Howeverpooledeffectswerenotcalculableforcomparisonswithusual
careorlessintensiveinterventions(substantialheterogeneity,I2=93%).
High-qualityevidencesuggeststheeffectisunclearinsocialsupportinterventionsprovidedbypeers(sixstudies;averageRR1.42,95%
CI0.98to2.07),inasingletrialofsupportprovidedbypartners,orwhensocialsupportforsmokingcessationwasprovidedaspart
ofabroaderinterventiontoimprovematernalhealth.
Theeffectwasunclearinsingleinterventionsofexercisecomparedtousualcare(RR1.20,95%CI0.72to2.01)anddissemination
ofcounselling(RR1.63,95%CI0.62to4.32).
Importantly,high-qualityevidencefrompooledresultsdemonstratedthatwomenwhoreceivedpsychosocialinterventionshada17%
reductionininfantsbornwithlowbirthweight,asignificantlyhighermeanbirthweight(meandifference(MD)55.60g,95%CI29.82
to81.38ghigher)anda22%reductioninneonatalintensivecareadmissions.Howeverthedifferenceinpretermbirthsandstillbirths
wasunclear.Theredidnotappeartobeadversepsychologicaleffectsfromtheinterventions.
The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-
intensity interventions more likelyto have higher-intensity comparisons, potentially explaining why no clear differenceswere seen
withincreasinginterventionintensityinmeta-regressionanalyses.Amongmeta-regressionanalyses:studiesclassifiedashaving’unclear’
implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between
trialsimplementedbyresearchers(efficacystudies),andthoseimplementedbyroutinepregnancystaff(effectivenessstudies),however
therewas uncertainty intheeffectivenessof counselling infour dissemination trialswherethefocus ontheintervention wasatan
organisationallevel.Thepooledeffectsweresimilarininterventionsprovidedforwomenclassifiedashavingpredominantlylowsocio-
economicstatus,comparedtootherwomen.Theeffectwassignificantininterventionsamongwomenfromethnicminoritygroups;
howevernotamongindigenouswomen.Thereweresimilareffectsizesintrialswithbiochemicallyvalidatedsmokingabstinenceand
thosewithself-reportedabstinence.Itwasunclearwhetherincorporatinguseofself-helpmanualsortelephonesupportincreasedthe
effectivenessofinterventions.
Authors’conclusions
Psychosocialinterventionstosupportwomentostopsmokinginpregnancycanincreasetheproportionofwomenwhostopsmoking
inlatepregnancy andtheproportionof infantsborn lowbirthweight.Counselling, feedbackandincentivesappeartobeeffective,
Psychosocialinterventionsforsupportingwomentostopsmokinginpregnancy(Review) 2
Copyright©2017TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
howeverthecharacteristicsandcontextoftheinterventionsshouldbecarefullyconsidered.Theeffectofhealtheducationandsocial
supportislessclear.Newtrialshavebeenpublishedduringthepreparationofthisreviewandwillbeincludedinthenextupdate.
PLAIN LANGUAGE SUMMARY
Psychosocialinterventionsforsupportingwomentostopsmokinginpregnancy
Whatistheissue?
Tobaccosmokingduringpregnancyincreasestheriskofthemotherhavingcomplicationsduringpregnancyandthebabybeingborn
lowbirthweight.Nicotineandothercontentsofcigarettescanhaveharmfuleffectsonthebaby’sgrowthanddevelopment.
Whyisthisimportant?
The number of women smoking in pregnancy is decreasing in high-income countries, where it is associated with poverty, but is
increasinginlow-tomiddle-incomecountries.Non-pharmacologicalinterventionsthataddressmental,emotionalorsocialfactorsare
knownaspsychosocialinterventions.Wesetouttoidentifytheevidenceontheeffectivenessofthevariouspsychosocialinterventions
tosupportpregnantwomentostopsmoking.
Whatevidencedidwefind?
Thereviewincludes102randomisedcontrolledtrialswith120interventionarms(studies)anddatafrom88randomisedcontrolled
trials(involvingover28,000women).Themaininterventionstrategieswerecategorisedascounselling(n=54),healtheducation(n=
12),feedback(n=6),incentives(n=13),socialsupport(n=7)andexercise(n=1).
Ourreviewprovidedmoderate-to-highqualityevidencethatpsychosocialinterventionsincreasedtheproportionofwomenwhohad
stoppedsmokinginlatepregnancy(by35%)andmeaninfantbirthweight(by56g),andreducedthenumberofbabiesbornwithlow
birthweight(by17%)andadmittedtoneonatalintensivecareimmediatelyafterbirth(by22%).Thepsychosocialinterventionsdid
notappeartohaveanyadverseeffects.Forsomefindingstherewereunexplaineddifferencesbetweenstudiesandsomestudieswere
small,reducingourconfidenceintheirresults.Nearlyallstudieswereconductedinhigh-incomecountries.
Counsellinginterventionshadacleareffectonstoppingsmokingcomparedwithprovidingusualcare(from30studies),andasmaller
effectwhencomparedwithlessintensiveinterventions(18studies).Nocleareffectwasseenwithcounsellingprovidedasonecomponent
ofabroaderinterventiontoimprovematernalhealthorcomparingonetypeofcounsellingwithanother.Interventionsthatprovided
feedbackhadacleareffectwhencomparedwithusualcareandwhencombinedwithotherstrategiessuchascounselling(twostudies),
butnotwhencomparedwithlessintensiveinterventions(threestudies).Interventionsbasedonfinancialincentiveshadacleareffect
whencomparedwithanalternativelikeanon-contingentincentiveintervention(fourstudies).
Healtheducationwasnotclearlyeffectivewhencomparedwithusualcare(fivestudies),orwhenitwasonecomponentofabroader
maternalhealthintervention.Socialsupportinterventionswerenotclearlyeffectivewhenprovidedbypeers(sixstudies)orinasingle
trialofsupportprovidedbypartners;orwhensocialsupportforsmokingcessationwasprovidedaspartofabroaderinterventionto
improvematernalhealth.Insinglestudies,exerciseanddisseminationofcounsellingdidnothaveacleareffectcomparedtousualcare.
Thepooledeffectsweresimilarforinterventionsprovidedtowomenwhowerepoor.Acleareffectwasalsoseenwithinterventions
amongwomenfromethnicminoritygroups,butnotamongindigenouswomen(fourstudies).Pooledresultssuggestthatinterventions
inpregnancycanalsoreducesmokingcessationafterbirth.Theeffectsonpretermbirths(19studies)andstillbirths(eightstudies)
wereunclear.
Whatdoesthismean?
Counselling, feedback and financial incentives appear to reduce the number of women smoking in late pregnancy, however the
interventionsandthecontextoftheinterventionsneedtobecarefullyconsidered.Theeffectofhealtheducationandsocialsupportis
lessclear.Mostofthestudieswerecarriedoutinhigh-incomecountriesmakingitdifficulttoassessifthefindingsareapplicabletoother
contexts.Theintensityofsupportwomenreceivedinboththeinterventionandcomparisongroupshasincreasedovertime.Manyof
thestudiesdidnotprovideinformationonthenumberofindividualwomenwhowereeligibleforinclusionorwereapproachedto
takepartinstudies,whichwouldhaveprovidedusefulinformationaboutthegeneralacceptabilityoftheinterventionsandselection
biasinthestudies.Thetimingofthefinalassessmentofsmokingstatusduringpregnancyalsovariedconsiderablyamongthestudies.
Newtrialshavebeenpublishedduringreviewpreparationwillbeincludedinthenextupdate.
Psychosocialinterventionsforsupportingwomentostopsmokinginpregnancy(Review) 3
Copyright©2017TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.