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Smoking Cessation Interventions in Pregnancy and Postpartum Care
Evidence Reports/Technology Assessments, No. 214
Investigators: Frances E Likis, DrPH, NP, CNM, Jeffrey C Andrews, MD, Christopher J Fonnesbeck, PhD, Katherine E Hartmann, MD, PhD, Rebecca N Jerome, MLIS, MPH, Shannon A Potter, MLIS, Tanya S Surawicz, MPH, and Melissa L McPheeters, PhD, MPH.
Author Information and AffiliationsStructured Abstract
Objective:
The Vanderbilt Evidence-based Practice Center systematically reviewed evidence about smoking cessation interventions in pregnant and postpartum women.
Data sources:
We searched MEDLINE®, CINAHL®, and PsycINFO® for randomized controlled trials (RCTs) on interventions and prospective studies on patient characteristics published in English.
Review methods:
We dually reviewed abstracts and full texts. Studies were excluded if they did not address a Key Question, were not an eligible study design, or did not report biochemically validated smoking cessation outcomes. Data were extracted into evidence tables and summarized qualitatively. A meta-analysis of effectiveness data assessed relative impact of components in smoking cessation interventions.
Results:
We included 59 unique studies reported in 72 publications. Of the 56 RCTs, 13 were good, 15 fair, and 28 poor quality. Studies evaluated counseling-based interventions, educational materials, nicotine replacement therapy (NRT), peer support, multicomponent interventions, and other unique interventions. Multicomponent approaches were most likely to be effective, but results were inconsistent. In the meta-analysis, incentives demonstrated the strongest effect; other components with a greater than 80-percent likelihood of success were feedback about biologic measures, information, personal followup, NRT, and quit guides. Findings regarding infant outcomes were inconsistent or did not reach statistical significance. No serious harms were identified in four studies that reported adverse events.
Conclusions:
Across interventions, data are sparse to evaluate sustained cessation among pregnant and postpartum women. This review suggests that approaches that combine multiple components will have the best likelihood of success. Selecting which components to include is more complex and should be based on the particular considerations of the clinical setting, including patient characteristics and resource allocation, but incentives demonstrated the greatest effect among components studied. Infant outcomes are limited to data collected at time of birth; no studies assessed longer term or child outcomes. Harms data were rarely reported.
Contents
- Preface
- Acknowledgments
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- Introduction
- Results of Literature Searches
- Description of Included Studies
- Key Question 1 Intervention Outcomes for Pregnant and Postpartum Women
- Key Question 2 Intervention Effects on Infant Outcomes
- Key Question 3 Intervention Harms for Pregnant and Postpartum Women
- Key Question 4 Effectiveness of Intervention Components
- Key Question 5 Effect of Patient Characteristics on Effectiveness
- Discussion
- References
- Abbreviations and Acronyms
- Appendix A Literature Search Strategies
- Appendix B Screening Forms
- Appendix C Cochrane Risk of Bias Tool
- Appendix D Cochrane Risk of Bias Criteria
- Appendix E Newcastle-Ottawa Quality Assessment Scale
- Appendix F Thresholds for Quality Assessment
- Appendix G Reasons for Exclusion
- Appendix H Evidence Tables
- Appendix I Risk of Bias and Quality Score for Individual Studies
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10065-I. Prepared by: Vanderbilt Evidence-based Practice Center, Nashville, TN
Suggested citation:
Likis FE, Andrews JC, Fonnesbeck CJ, Hartmann KE, Jerome RN, Potter SA, Surawicz TS, McPheeters ML. Smoking Cessation Interventions in Pregnancy and Postpartum Care. Evidence Report/Technology Assessment No.214. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 14-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2014. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10065-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
This report may periodically be assessed for the urgency to update. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at: www.effectivehealthcare.ahrq.gov. Search on the title of the report.
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