Recommended cessation counselling for pregnant women who smoke: a review of the evidence

Abstract

Objective-To review the evidence base underlying recommended cessation counselling for pregnant women who smoke, as it applies to the steps identified in the Agency for Healthcare Research and Quality's publication, Treating tobacco use and dependence: a clinical practice guideline. Data sources-Secondary analysis of literature reviews and meta-analyses. Data synthesis-A brief cessation counselling session of 5-15 minutes, when delivered by a trained provider with the provision of pregnancy specific, self help materials, significantly increases rates of cessation among pregnant smokers. This low intensity intervention achieves a modest but clinically significant eVect on cessation rates, with an average risk ratio of 1.7 (95% confidence interval 1.3 to 2.2). There are five components of the recommended method-"ask, advise, assess, assist, and arrange". Conclusions-We recommend these evidence based procedures be adopted by all prenatal care providers. The use of this evidence based intervention is feasible in most oYce or clinic settings oVering prenatal care and can be implemented without inhibiting other important aspects of prenatal care or disrupting patient flow. If implemented widely, this approach has the potential to achieve an important reduction in a number of adverse maternal, infant, and pregnancy outcomes and to reduce associated, excess health care costs. (Tobacco Control 2000;9(Suppl III):iii80-iii84)

Factors relating to the uptake of interventions for smoking cessation among pregnant women: A systematic review and qualitative synthesis

“…Studies indicate that many pregnant women are reluctant to disclose smoking status, with the suggestion that deception rates could be as high as 23% (Price et al, 1991). It has been reported that clinician interaction skills are key in accurate disclosure (Melvin et al 2000), suggesting the need for suitable training.…”

Helping pregnant smokers quit: meeting the challenge in the next decade

“…8 Health care professionals can take advantage of women's unique quitting motivation by reinforcing knowledge that quitting smoking will reduce health risks to the fetus, and reviewing the important postpartum benefits for both the mother and child. 3 4 9 Moreover, as outlined in the paper by Melvin and colleagues, 23 the past 15 years of intervention research has established that brief (5-15 minutes) medical quitting advice and counselling combined with pregnancy tailored self help material provided in the course of routine prenatal care produces quit rates that are significantly higher than those achieved with usual care (that is, 14-16% v 5-6%, including among the most underserved, low income women. 17 20 21 24 Given the substantial savings associated with averting low birth weight deliveries, these "best practice" interventions have also proven highly cost eVective.…”

Clinical trials and tribulations: Lessons learned from recruiting pregnant ex-smokers for relapse prevention

“…Of course, by resuming smoking, the mother also reexposes herself to the myriad health risks associated with tobacco use. Given the high rate of self-quitting among pregnant smokers, as well as the success of interventions designed to motivate pregnant women to quit smoking (Melvin et al, 2000), pregnancy and the early postpartum period appear to offer unique opportunities to provide smoking relapseprevention interventions, although such efforts have met with at best modest success to date (Mullen, 2004).…”

“…Of course, by resuming smoking, the mother also reexposes herself to the myriad health risks associated with tobacco use. Given the high rate of self-quitting among pregnant smokers, as well as the success of interventions designed to motivate pregnant women to quit smoking (Melvin et al, 2000), pregnancy and the early postpartum period appear to offer unique opportunities to provide smoking relapseprevention interventions, although such efforts have met with at best modest success to date (Mullen, 2004).Recruiting participants for clinical trials can be challenging in general (e.g., Harris et al, 2003;Ross et al, 1999), and this has been particularly the case for smoking cessation trials of pregnant women, which often have difficulty meeting accrual goals (e.g., Cinciripini et al, 2000;Emmons et al, 2000;Goldenberg et al, 2000; Pollak et al, 2006;Ruggiero et al, 2003;Solomon et al, 2000;Strecher et al, 2000). Trials focusing on relapse prevention with this population have the additional challenge of recruiting from a yet smaller proportion of the population: pregnant women who smoked prior to their pregnancy but are currently abstaining from smoking.…”