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Systematic Review
Tobacco smoking is a leading preventable cause of pregnancy complications with serious long‐term impacts on women and babies. This update is needed to incorporate new evidence and ensure that guidance on psychosocial interventions in pregnancy remains current for policy and practice.
The authors included 127 studies (including 145 study arms) with 47,361 participants.
Smoking abstinence during late pregnancy
All psychosocial interventions, compared with all comparator types, probably result in an important increase in the likelihood of smoking abstinence during late pregnancy (RR 1.41, 95% CI 1.30 to 1.54; I² = 47%; 117 studies, 33,694 participants; moderate‐certainty evidence) and in the early postpartum period (0 to five months) (RR 1.33, 95% CI 1.18 to 1.50; I² = 28%; 42 studies, 11,977 participants; moderate‐certainty evidence). Similar effects were observed for counseling compared to usual care (RR 1.51, 95% CI 1.26 to 1.82; I² = 51%; 32 studies, 12,920 participants; moderate‐certainty evidence) and financial incentives compared to alternative interventions (RR 2.03, 95% CI 1.38 to 2.98; I² = 58%; 7 studies, 1837 participants; moderate‐certainty evidence). Health education compared with usual care may result in an important increase in the likelihood of smoking abstinence during late pregnancy (RR 1.62, 95% CI 1.22 to 2.14; I² = 0%; 10 studies, 2137 participants; low‐certainty evidence). Similar effects were observed for feedback compared to usual care (RR 2.17, 95% CI 0.79 to 5.92; I² = 54%; 4 studies, 442 participants; low‐certainty evidence) and social support compared to less intensive interventions (RR 1.21, 95% CI 0.93 to 1.58; I² = 0%; 7 studies, 781 participants; low‐certainty evidence). Exercise compared to usual care probably results in little to no difference in the likelihood of smoking abstinence during late pregnancy (RR 1.20, 95% CI 0.72 to 2.01; 1 study, 785 participants; moderate‐certainty evidence) and the evidence was very uncertain about the effect of active compared to passive dissemination of a smoking cessation on the likelihood of smoking abstinence during late pregnancy (RR 1.63, 95% CI 0.62 to 4.32; 1 study, 194 participants; very low‐certainty evidence).
Counseling and financial incentives probably support women to stop smoking, while health education, feedback, and social support may support women to stop smoking in late pregnancy, by an amount likely to be important.
The authors confidence in the evidence is limited due to study limitations and imprecision. Several studies were unclear regarding random sequence generation and allocation concealment. For some outcomes, the 95% confidence intervals crossed the thresholds for important effects, leading to downgrading for imprecision.