410 Psychosocial interventions effective for smoking cessation in pregnancy

April 06, 2014

PEARLS 410, November 2013, written by Brian R McAvoy

Clinical question
How effective are psychosocial interventions for smoking cessation in pregnant women?

Bottom line
Psychosocial interventions assisted women to stop smoking in pregnancy (NNT* 19), and reduced preterm births (NNT 71) and low birthweight infants (NNT 61). Interventions were non-pharmacological strategies that used cognitive-behavioural, motivational and supportive therapies, including counselling, health education, feedback, financial incentives and social support from peers and/or partners. Incentives had the largest effect size, but only when provided intensively. Counselling was effective when provided in conjunction with other strategies or tailored to individual women, but it was unclear whether any types of counselling were more effective than others. 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 was insufficient evidence the interventions were effective for indigenous women and women from minority ethnic groups. Contrary to concerns women may be upset by offering support to stop smoking, this review suggested women expected and appreciated the support, and interventions were more likely to improve women's psychological wellbeing than to worsen it.
*NNT= number needed to treat to benefit one individual.

Caveat
The studies were of mixed quality and there was substantial heterogeneity among trial results. Most of the included studies were carried out in high-income countries and it is not clear whether the results are applicable in other contexts. The review included a relatively large number of studies focusing on educational and counselling interventions but relatively few on other approaches (eg, incentives and peer support).

Context
Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth 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.

Cochrane Systematic Review
Chamberlain C et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Reviews, 2013, Issue 10. Art. No.: CD001055.DOI: 10.1002/14651858. CD001055.pub4. This review contains 86 studies involving over 29,000 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.