Reducing Secondhand Smoke Exposure Among Nonsmoking Pregnant Women: A Systematic Review

Abstract

Introduction Exposure to secondhand smoke (SHS) in pregnancy leads to an increased risk of stillbirths, congenital malformations, and low birth weight. There is a lack of evidence about how best to achieve reductions in SHS exposure among nonsmoking pregnant women. This work systematically reviews individual or household interventions to reduce pregnant women’s exposure to SHS. Methods MEDLINE, EMBASE, and CINAHL databases were searched from their dates of inception to April 17, 2019. Studies were included if: participants were nonsmoking pregnant women; involved an intervention to reduce SHS exposure or encourage partner quitting; and measured SHS exposure of pregnant women and/or recorded quit rates among partners. The UK National Institute for Health & Care Excellence (NICE) Quality Appraisal checklist was used to determine internal and external validity. Results Nine studies met the inclusion criteria. Educational interventions were primarily targeted at the pregnant woman to change her or others’ behavior, with only two studies involving the partner who smoked. Intervention delivery was mixed, spanning brief discussions through to more involving sessions with role play. The effective interventions involved multiple follow-ups. There was no standardized method of assessing exposure to SHS. Many of the included studies had moderate to high risk of bias. Conclusion There is mixed evidence for interventions aimed at reducing pregnant women’s exposure to SHS, though multi-component interventions seem to be more effective. The effectiveness of family-centered approaches involving creating smoke-free homes alongside partner smoking cessation, perhaps involving pharmacological support and/or financial incentives, should be explored. Implications • Measures to protect nonsmoking pregnant women from SHS tend to place the responsibility for “avoidance” on the woman. • There is little work that seeks to involve the smoking partner or other smokers in protecting pregnant women from SHS. • Interventions to create smoke-free homes and/or smoking partner cessation need to be developed: pharmacological and financial support should be explored.

Associations of Education and Income With Secondhand Smoke Exposure Among Non-Smoking Pregnant Women in Japan: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

“…According to WHO guidelines, health care providers should give partners and other household members advice and information about the risks to pregnant women from SHS exposure and, if possible, also provide them with cessation support [25]. Effective interventions to create smoke-free homes alongside smoking cessation for them, perhaps involving nancial incentives, need to be developed [35,36]. On the other hand, we also found that working women, who had higher equivalent household income, were more likely to be exposed to SHS than were non-working women.…”

Effectiveness of a Comic Book Intervention in Preventing Second-hand Smoke Exposure for Pregnant Indonesian Women: A Randomised Controlled Trial

“…Tong et al [18] and Nwosu et al [19] conducted systematic reviews on interventions to reduce SHS exposure among non-smoking pregnant women. Tong et al [18] did not nd pharmacological and psychosocial interventions to be effective in preventing SHS exposure for pregnant women in prenatal care settings, owing to the low-quality study designs, as evaluated based on US Preventative Task Force criteria.…”

“…Tong et al [18] did not nd pharmacological and psychosocial interventions to be effective in preventing SHS exposure for pregnant women in prenatal care settings, owing to the low-quality study designs, as evaluated based on US Preventative Task Force criteria. Nwosu et al [19] reviewed nine individual-and householdlevel interventions aimed at preventing pregnant women's SHS exposure that t the following inclusion criteria 'employed educational intervention using direct teaching or counselling, brochures, posters, role-play, and /or video' [19] . Various measurements were used to assess the interventions, including self-reported behaviours, number of cigarettes smoked, and biochemical markers of SHS exposure in pregnant women [19] .…”

“…Nwosu et al [19] reviewed nine individual-and householdlevel interventions aimed at preventing pregnant women's SHS exposure that t the following inclusion criteria 'employed educational intervention using direct teaching or counselling, brochures, posters, role-play, and /or video' [19] . Various measurements were used to assess the interventions, including self-reported behaviours, number of cigarettes smoked, and biochemical markers of SHS exposure in pregnant women [19] . Among the nine, only two studies were evaluated to have low risk of bias, as most studies did not report blinding information, concealment of allocation, or study population selection [19] .…”

“…Various measurements were used to assess the interventions, including self-reported behaviours, number of cigarettes smoked, and biochemical markers of SHS exposure in pregnant women [19] . Among the nine, only two studies were evaluated to have low risk of bias, as most studies did not report blinding information, concealment of allocation, or study population selection [19] .…”