TABLE 23.

Promotion of Smoking Cessation During Pregnancy

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Secker-Walker et al410US; urban setting; RCT399 pregnant women were recruited for the study. Intervention women (n = 197) received structured advice from their physician and referral to individual behavior-change counseling by trained nurses during prenatal care, while control women (n = 202) received brief advice to stop smoking and a quit-smoking booklet at their first visit.40% of the women in the intervention group stopped smoking or reduced smoking to ≥50% of the baseline level compared to 25% in the control group (P = .02).No significant effect of the intervention was seen on birth weight or LBW rate.
Wisborg et al407Denmark; urban hospital setting; QT3156 women were recruited for the study. Pregnant women in the intervention group (n = 527) were given individual advice and a leaflet about smoking cessation at the first antenatal visit at ∼16 wk of gestation. The control group (n = 2629) did not receive this education.No difference was found between the intervention and control groups in the rate of smoking cessation.No effect was seen on birth weight or preterm birth rate.
Lefevre et al414Sweden; multicenter trial; RCTWomen in the screened group (n = 7617) had 2 screening ultrasound evaluations to assess fetal growth to assess whether screening would encourage smoking cessation. No specific smoking cessation education was provided in addition to the ultrasound. A control group (n = 7534) was also studied for pregnancy outcomes.No effect of the intervention was seen on PMR, birth weight or preterm birth rate compared to the control group.
Li et al411US; urban setting; RCT814 pregnant women were recruited for the study. Women in the intervention arm (n = 400) were given formal counseling, a guidebook, individual smoking cessation reinforcement and social support. Women in the control group (n = 414) received standard written risk information and verbal advice to quit. Women in both groups were subdivided and analyzed according to outcome: quitters (quit smoking), reducers (reduced number of daily cigarettes), and no-changers (no change in smoking habits). Mothers who had never smoked were used as a comparison group.There was a 14.3% quit rate among women in the experimental group versus an 8.4% quit rate among the control women.The mean birth weight of infants born to the quitters was 241 g heavier than those born to no-changers (P = .008) and reducers (P = .04). The adjusted mean birth weight of infants born to reducers was 92 g heavier than among the no-changers (P = .08). LBW was about 2 times more likely among the infants born to reducers or no-changers, compared with mothers who never smoked, but this finding was not statistically significant. Interestingly, the percentage of LBW infants born to the quitter group (10.3%) was comparable to the group that had never smoked (10.9%).
Haddow et al413US; multiple sites; RCTWomen in the intervention group (n = 2848 pregnant smokers) were objectively educated (using serum cotinine level for interpretation of the need for smoking cessation), and effectiveness of education was assessed by comparison of cotinine levels in women in the intervention and control groups.No effect was seen on NMR, IMR, birth weight, LBW or preterm birth rates.
Hjalmarson et al408UK; urban hospital setting; RCTWomen in the intervention arm (n = 492) were given a smoking cessation manual that detailed ways and means of tackling and quitting the habit. Controls (n = 231) were not given the manual.50% more women in the intervention arm had continuous abstinence.No significant effect was seen on birth weight, LBW or preterm birth rates.
Macarthur et al412UK; urban hospital setting; RCTSupplementary health education about smoking in pregnancy was given to women in the intervention group (n = 493) while those in the control group (n = 489) received only routine advice.The mean daily reduction in number of cigarettes smoked in the intervention group and the control group was 2.2 vs 1.1, respectively.The firstborn infants in the intervention group were heavier (mean difference 68 g, P < .06) and longer (mean difference 0.75 cm, P < .01) than those in the control group.
Sexton et al409US; urban setting; RCT935 pregnant smokers were randomized to either an intervention or a control group. Women in the intervention group received staff assistance for smoking cessation.The reported quitting rate at the eighth month of pregnancy was 43% compared with 20% in the treatment and control groups, respectively (P < .01).No differences were seen in fetal mortality or gestational age, but infants in the intervention arm were heavier (mean difference 92 g, P < .05) and longer (mean difference 0.6 cm, P < .05) than those in the control group.