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Review
, 2 (2), CD001055

Psychosocial Interventions for Supporting Women to Stop Smoking in Pregnancy

Affiliations
Review

Psychosocial Interventions for Supporting Women to Stop Smoking in Pregnancy

Catherine Chamberlain et al. Cochrane Database Syst Rev.

Abstract

Background: Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries.

Objectives: To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes.

Search methods: In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors.

Selection criteria: Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy.

Data collection and analysis: Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14.

Main results: The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions.

Authors' conclusions: Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.

Conflict of interest statement

Catherine Chamberlain is receiving an Australian National Health and Medical Research Council Early Career Fellowship (1088813). She was also awarded an NIHR Cochrane Review Incentive Scheme award (15/81/18) to support the preparation of this updated review. Catherine Chamberlain is also an author on the Cochrane Review entitled 'Pharmacological Interventions to promote smoking cessation in pregnancy" (Coleman 2015).

Alison O'Mara‐Eves: none known.

Jessie Porter: none known.

Tim Coleman has, in received awards from NIHR, HTA and NIHR paid to his institution. These awards have been used to run research projects. He has also received a single payment from Pierre Fabre Laboratories, France, for speaking at an educational meeting arranged by Pierre Fabre Laboratories (who are manufacturers of nicotine replacement therapy). PFL are a manufacturer of transdermal nicotine patches ‐ the content of the presentation was not vetted and no attempt was made to influence the content of the presentation. Tim Colemans is also an author and contact person for the Cochrane Review entitled 'Pharmacological Interventions to promote smoking cessation in pregnancy" (Coleman 2015).

Susan M Perlen: none known.

James Thomas: none known.

Joanne E McKenzie: none known.

Figures

1
1
Logic model for systematic review analysis of potential factors impacting on efficacy of interventions for supporting women to stop smoking in pregnancy.
2
2
Funnel plot of comparison: 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, outcome: 20.1 Abstinence in late pregnancy: self‐reported and biochemically validated.
3
3
Flow chart of included studies
4
4
Intensity (duration) of interventions and controls over time
5
5
Intensity (frequency) of interventions and controls over times
6
6
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
7
7
'Risk of bias' summary
1.1
1.1. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 1 Abstinence in late pregnancy.
1.2
1.2. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
1.3
1.3. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 3 Continued abstinence (relapse prevention) in late pregnancy for spontaneous quitters.
1.4
1.4. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 4 Abstinence at 0 to 5 months postpartum.
1.5
1.5. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 5 Abstinence at 6 to 11 months postpartum.
1.6
1.6. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 6 Abstinence at 12 to 17 months postpartum.
1.7
1.7. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 7 Abstinence at 18+ months postpartum.
1.8
1.8. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 8 Reduction in late pregnancy: biochemically validated.
1.9
1.9. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 9 Reduction in late pregnancy: self reported (various definitions).
1.10
1.10. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 10 Biochemical measures in late pregnancy: mean cotinine.
1.11
1.11. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 11 Mean cigarettes per day in late pregnancy.
1.12
1.12. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 12 NICU admissions.
1.13
1.13. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 13 Very low birthweight infants (< 1500 g).
1.14
1.14. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 14 Preterm births.
1.15
1.15. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 15 Mean birthweight.
1.16
1.16. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 16 Perinatal deaths.
1.17
1.17. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 17 Stillbirths.
1.18
1.18. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 18 Neonatal deaths.
1.19
1.19. Analysis
Comparison 1 Smoking cessation interventions: counselling vs usual care, Outcome 19 Low birthweight infants (< 2500 g).
2.1
2.1. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 1 Abstinence in late pregnancy.
2.2
2.2. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
2.3
2.3. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 3 Continued abstinence (relapse prevention) in late pregnancy (spontaneous quitters).
2.4
2.4. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 4 Abstinence at 0 to 5 months postpartum.
2.5
2.5. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 5 Abstinence at 6 to 11 months postpartum.
2.6
2.6. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 6 Abstinence at 12 to 17 months postpartum.
2.7
2.7. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 7 Reduction in late pregnancy: biochemically validated.
2.8
2.8. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 8 Reduction in late pregnancy: self‐reported > 50%.
2.9
2.9. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 9 Mean cigarettes per day in late pregnancy.
2.10
2.10. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 10 Low birthweight infants (< 2500 g).
2.11
2.11. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 11 Preterm births.
2.12
2.12. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 12 Mean birthweight.
2.13
2.13. Analysis
Comparison 2 Smoking cessation interventions: counselling vs less intensive intervention, Outcome 13 Stillbirths.
3.1
3.1. Analysis
Comparison 3 Smoking cessation interventions: counselling vs alternative intervention, Outcome 1 Abstinence in late pregnancy.
3.2
3.2. Analysis
Comparison 3 Smoking cessation interventions: counselling vs alternative intervention, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
3.3
3.3. Analysis
Comparison 3 Smoking cessation interventions: counselling vs alternative intervention, Outcome 3 Abstinence at 0 to 5 months postpartum.
3.4
3.4. Analysis
Comparison 3 Smoking cessation interventions: counselling vs alternative intervention, Outcome 4 Abstinence at 6 to 11 months postpartum.
4.1
4.1. Analysis
Comparison 4 Smoking cessation interventions: health education vs usual care, Outcome 1 Abstinence in late pregnancy.
4.2
4.2. Analysis
Comparison 4 Smoking cessation interventions: health education vs usual care, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
4.3
4.3. Analysis
Comparison 4 Smoking cessation interventions: health education vs usual care, Outcome 3 Continued abstinence (Relapse prevention) in late pregnancy for spontaneous quitters.
4.4
4.4. Analysis
Comparison 4 Smoking cessation interventions: health education vs usual care, Outcome 4 Abstinence at 0 to 5 months postpartum.
4.5
4.5. Analysis
Comparison 4 Smoking cessation interventions: health education vs usual care, Outcome 5 Mean cigarettes per day in late pregnancy.
4.6
4.6. Analysis
Comparison 4 Smoking cessation interventions: health education vs usual care, Outcome 6 Low birth weight.
4.7
4.7. Analysis
Comparison 4 Smoking cessation interventions: health education vs usual care, Outcome 7 Preterm births (< 37 weeks).
4.8
4.8. Analysis
Comparison 4 Smoking cessation interventions: health education vs usual care, Outcome 8 Mean birthweight.
4.9
4.9. Analysis
Comparison 4 Smoking cessation interventions: health education vs usual care, Outcome 9 Perinatal deaths.
5.1
5.1. Analysis
Comparison 5 Smoking cessation interventions: health education vs less intensive intervention, Outcome 1 Abstinence in late pregnancy.
5.2
5.2. Analysis
Comparison 5 Smoking cessation interventions: health education vs less intensive intervention, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
5.3
5.3. Analysis
Comparison 5 Smoking cessation interventions: health education vs less intensive intervention, Outcome 3 Abstinence at 0 to 5 months postpartum.
5.4
5.4. Analysis
Comparison 5 Smoking cessation interventions: health education vs less intensive intervention, Outcome 4 Mean cigarettes per day in late pregnancy.
5.5
5.5. Analysis
Comparison 5 Smoking cessation interventions: health education vs less intensive intervention, Outcome 5 Low birthweight (< 2500 g).
5.6
5.6. Analysis
Comparison 5 Smoking cessation interventions: health education vs less intensive intervention, Outcome 6 Preterm births.
5.7
5.7. Analysis
Comparison 5 Smoking cessation interventions: health education vs less intensive intervention, Outcome 7 Mean birthweight.
6.1
6.1. Analysis
Comparison 6 Smoking cessation interventions: health education vs alternative intervention, Outcome 1 Abstinence in late pregnancy.
6.2
6.2. Analysis
Comparison 6 Smoking cessation interventions: health education vs alternative intervention, Outcome 2 Abstinence in late pregnancy: biochemically validated.
7.1
7.1. Analysis
Comparison 7 Smoking cessation interventions: feedback vs usual care, Outcome 1 Abstinence in late pregnancy.
7.2
7.2. Analysis
Comparison 7 Smoking cessation interventions: feedback vs usual care, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
7.3
7.3. Analysis
Comparison 7 Smoking cessation interventions: feedback vs usual care, Outcome 3 Reduction in late pregnancy: biochemically validated.
7.4
7.4. Analysis
Comparison 7 Smoking cessation interventions: feedback vs usual care, Outcome 4 Reduction in late pregnancy: self‐reported (various definitions).
7.5
7.5. Analysis
Comparison 7 Smoking cessation interventions: feedback vs usual care, Outcome 5 Mean cigarettes per day in late pregnancy.
7.6
7.6. Analysis
Comparison 7 Smoking cessation interventions: feedback vs usual care, Outcome 6 Low birthweight (< 2500 g).
7.7
7.7. Analysis
Comparison 7 Smoking cessation interventions: feedback vs usual care, Outcome 7 Preterm births.
7.8
7.8. Analysis
Comparison 7 Smoking cessation interventions: feedback vs usual care, Outcome 8 Mean birthweight.
7.9
7.9. Analysis
Comparison 7 Smoking cessation interventions: feedback vs usual care, Outcome 9 Stillbirths.
8.1
8.1. Analysis
Comparison 8 Smoking cessation interventions: feedback vs less intensive intervention, Outcome 1 Abstinence in late pregnancy.
8.2
8.2. Analysis
Comparison 8 Smoking cessation interventions: feedback vs less intensive intervention, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
9.1
9.1. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 1 Abstinence in late pregnancy.
9.2
9.2. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 2 Abstinence in late pregnancy:biochemically validated only.
9.3
9.3. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 3 Abstinence at 0 to 5 months postpartum.
9.4
9.4. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 4 Abstinence at 6 to 11 months postpartum.
9.5
9.5. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 5 Reduction in late pregnancy: biochemically validated.
9.6
9.6. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 6 Biochemical measures in late pregnancy: mean cotinine.
9.7
9.7. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 7 Mean cigarettes per day in late pregnancy.
9.8
9.8. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 8 Low birthweight.
9.9
9.9. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 9 Preterm births.
9.10
9.10. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 10 Mean birthweight.
9.11
9.11. Analysis
Comparison 9 Smoking cessation interventions: incentives vs usual care, Outcome 11 NICU admissions.
10.1
10.1. Analysis
Comparison 10 Smoking cessation interventions: incentives vs less intensive intervention, Outcome 1 Abstinence in late pregnancy.
10.2
10.2. Analysis
Comparison 10 Smoking cessation interventions: incentives vs less intensive intervention, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
10.3
10.3. Analysis
Comparison 10 Smoking cessation interventions: incentives vs less intensive intervention, Outcome 3 Abstinence at 0 to 5 months postpartum.
11.1
11.1. Analysis
Comparison 11 Smoking cessation interventions: incentives vs alternative intervention, Outcome 1 Abstinence in late pregnancy.
11.2
11.2. Analysis
Comparison 11 Smoking cessation interventions: incentives vs alternative intervention, Outcome 2 Abstinence in late pregnancy: biochemicaly validated only.
11.3
11.3. Analysis
Comparison 11 Smoking cessation interventions: incentives vs alternative intervention, Outcome 3 Abstinence at 0 to 5 months postpartum.
11.4
11.4. Analysis
Comparison 11 Smoking cessation interventions: incentives vs alternative intervention, Outcome 4 Abstinence at 6 to 11 months postpartum.
11.5
11.5. Analysis
Comparison 11 Smoking cessation interventions: incentives vs alternative intervention, Outcome 5 Smoking reduction: numbers of women reducing smoking in late pregnancy (biochemically validated).
11.6
11.6. Analysis
Comparison 11 Smoking cessation interventions: incentives vs alternative intervention, Outcome 6 Low birthweight (under 2500 g).
11.7
11.7. Analysis
Comparison 11 Smoking cessation interventions: incentives vs alternative intervention, Outcome 7 Preterm birth (under 37 weeks).
11.8
11.8. Analysis
Comparison 11 Smoking cessation interventions: incentives vs alternative intervention, Outcome 8 Mean birthweight.
11.9
11.9. Analysis
Comparison 11 Smoking cessation interventions: incentives vs alternative intervention, Outcome 9 NICU admissions.
12.1
12.1. Analysis
Comparison 12 Smoking cessation interventions: social support vs less intensive intervention, Outcome 1 Abstinence in late pregnancy.
12.2
12.2. Analysis
Comparison 12 Smoking cessation interventions: social support vs less intensive intervention, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
12.3
12.3. Analysis
Comparison 12 Smoking cessation interventions: social support vs less intensive intervention, Outcome 3 Continued abstinence (relapse prevention) in late pregnancy.
12.4
12.4. Analysis
Comparison 12 Smoking cessation interventions: social support vs less intensive intervention, Outcome 4 Abstinence at 0 to 5 months postpartum.
12.5
12.5. Analysis
Comparison 12 Smoking cessation interventions: social support vs less intensive intervention, Outcome 5 Abstinence at 6 to 11 months postpartum.
12.6
12.6. Analysis
Comparison 12 Smoking cessation interventions: social support vs less intensive intervention, Outcome 6 Abstinence at 12 to 17 months postpartum.
12.7
12.7. Analysis
Comparison 12 Smoking cessation interventions: social support vs less intensive intervention, Outcome 7 Smoking reduction: self reported > 50% reduction.
12.8
12.8. Analysis
Comparison 12 Smoking cessation interventions: social support vs less intensive intervention, Outcome 8 Low birthweight (< 2500 g).
12.9
12.9. Analysis
Comparison 12 Smoking cessation interventions: social support vs less intensive intervention, Outcome 9 Mean birthweight.
13.1
13.1. Analysis
Comparison 13 Smoking cessation interventions: exercise vs usual care, Outcome 1 Abstinence in late pregnancy.
13.2
13.2. Analysis
Comparison 13 Smoking cessation interventions: exercise vs usual care, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
13.3
13.3. Analysis
Comparison 13 Smoking cessation interventions: exercise vs usual care, Outcome 3 Abstinence at 6 to 11 months postpartum.
13.4
13.4. Analysis
Comparison 13 Smoking cessation interventions: exercise vs usual care, Outcome 4 Low birthweight.
13.5
13.5. Analysis
Comparison 13 Smoking cessation interventions: exercise vs usual care, Outcome 5 Preterm births.
13.6
13.6. Analysis
Comparison 13 Smoking cessation interventions: exercise vs usual care, Outcome 6 Mean birthweight.
13.7
13.7. Analysis
Comparison 13 Smoking cessation interventions: exercise vs usual care, Outcome 7 Stillbirths.
13.8
13.8. Analysis
Comparison 13 Smoking cessation interventions: exercise vs usual care, Outcome 8 Neonatal deaths.
14.1
14.1. Analysis
Comparison 14 Smoking cessation interventions: other vs usual care, Outcome 1 Abstinence in late pregnancy.
14.2
14.2. Analysis
Comparison 14 Smoking cessation interventions: other vs usual care, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
15.1
15.1. Analysis
Comparison 15 Maternal health intervention with smoking cessation component: counselling vs usual care, Outcome 1 Abstinence in late pregnancy.
15.2
15.2. Analysis
Comparison 15 Maternal health intervention with smoking cessation component: counselling vs usual care, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
15.3
15.3. Analysis
Comparison 15 Maternal health intervention with smoking cessation component: counselling vs usual care, Outcome 3 Abstinence at 0 to 5 months postpartum.
15.4
15.4. Analysis
Comparison 15 Maternal health intervention with smoking cessation component: counselling vs usual care, Outcome 4 Smoking reduction: biochemical measures in late pregnancy.
16.1
16.1. Analysis
Comparison 16 Maternal health intervention with smoking cessation component: health education vs less intensive intervention, Outcome 1 Abstinence in late pregnancy: biochemically validated only.
16.2
16.2. Analysis
Comparison 16 Maternal health intervention with smoking cessation component: health education vs less intensive intervention, Outcome 2 Abstinence at 0 to 5 months postpartum.
17.1
17.1. Analysis
Comparison 17 Maternal health intervention with smoking cessation component: feedback vs usual care, Outcome 1 Smoking abstinence in late pregnancy.
17.2
17.2. Analysis
Comparison 17 Maternal health intervention with smoking cessation component: feedback vs usual care, Outcome 2 Smoking reduction in late pregnancy: self‐reported (various definitions).
17.3
17.3. Analysis
Comparison 17 Maternal health intervention with smoking cessation component: feedback vs usual care, Outcome 3 Smoking reduction: self‐reported mean cigarettes per day measured in late pregnancy or at delivery.
18.1
18.1. Analysis
Comparison 18 Maternal health intervention with smoking cessation component: social support vs usual care, Outcome 1 Abstinence in late pregnancy.
18.2
18.2. Analysis
Comparison 18 Maternal health intervention with smoking cessation component: social support vs usual care, Outcome 2 Abstinence in late pregnancy:biochemically validated only.
18.3
18.3. Analysis
Comparison 18 Maternal health intervention with smoking cessation component: social support vs usual care, Outcome 3 Abstinence at 0 to 5 months postpartum.
18.4
18.4. Analysis
Comparison 18 Maternal health intervention with smoking cessation component: social support vs usual care, Outcome 4 Abstinence at 18 + months postpartum.
18.5
18.5. Analysis
Comparison 18 Maternal health intervention with smoking cessation component: social support vs usual care, Outcome 5 Smoking reduction: mean cigarettes per day.
19.1
19.1. Analysis
Comparison 19 Maternal health intervention with smoking cessation component: social support vs less intensive intervention, Outcome 1 Abstinence in late pregnancy.
19.2
19.2. Analysis
Comparison 19 Maternal health intervention with smoking cessation component: social support vs less intensive intervention, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
19.3
19.3. Analysis
Comparison 19 Maternal health intervention with smoking cessation component: social support vs less intensive intervention, Outcome 3 Abstinence at 0 to 5 months postpartum.
19.4
19.4. Analysis
Comparison 19 Maternal health intervention with smoking cessation component: social support vs less intensive intervention, Outcome 4 Smoking reduction: self reported mean cigarettes per day.
20.1
20.1. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 1 Abstinence in late pregnancy: self‐reported and biochemically validated.
20.2
20.2. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 2 Abstinence in late pregnancy: biochemically validated only.
20.3
20.3. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 3 Continued abstinence (Relapse prevention) in late pregnancy for spontaneous quitters.
20.4
20.4. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 4 Abstinence at 0 to 5 months postpartum.
20.5
20.5. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 5 Abstinence at 6 to 11 months postpartum.
20.6
20.6. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 6 Abstinence at 12 to 17 months postpartum.
20.7
20.7. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 7 Abstinence at 18+ months postpartum.
20.8
20.8. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 8 Smoking reduction: numbers of women reducing smoking in late pregnancy.
20.9
20.9. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 9 Smoking reduction: biochemical measures in late pregnancy.
20.10
20.10. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 10 Smoking reduction: self‐reported mean cigarettes per day measured in late pregnancy or at delivery.
20.11
20.11. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 11 Low birthweight (under 2500 g).
20.12
20.12. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 12 Very low birthweight (under 1500 g).
20.13
20.13. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 13 Preterm birth (under 37 weeks).
20.14
20.14. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 14 Mean birthweight (g).
20.15
20.15. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 15 Stillbirths.
20.16
20.16. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 16 Perinatal deaths.
20.17
20.17. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 17 Neonatal deaths.
20.18
20.18. Analysis
Comparison 20 Interventions for smoking cessation in pregnancy versus control: subgrouped by main intervention strategy, Outcome 18 NICU admissions.

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