Abstract
AimsTo estimate the effectiveness of pregnancy smoking cessation support delivered by short message service (SMS) text message and key parameters needed to plan a definitive trial.DesignMulti‐centre, parallel‐group, single‐blinded, individual randomized controlled trial.SettingSixteen antenatal clinics in England.ParticipantsFour hundred and seven participants were randomized to the intervention (n = 203) or usual care (n = 204). Eligible women were < 25 weeks gestation, smoked at least one daily cigarette (> 5 pre‐pregnancy), were able to receive and understand English SMS texts and were not already using text‐based cessation support.InterventionAll participants received a smoking cessation leaflet; intervention participants also received a 12‐week programme of individually tailored, automated, interactive, self‐help smoking cessation text messages (MiQuit).Outcome measurementsSeven smoking outcomes, including validated continuous abstinence from 4 weeks post‐randomization until 36 weeks gestation, design parameters for a future trial and cost‐per‐quitter.FindingsUsing the validated, continuous abstinence outcome, 5.4% (11 of 203) of MiQuit participants were abstinent versus 2.0% (four of 204) of usual care participants [odds ratio (OR) = 2.7, 95% confidence interval (CI) = 0.93–9.35]. The Bayes factor for this outcome was 2.23. Completeness of follow‐up at 36 weeks gestation was similar in both groups; provision of self‐report smoking data was 64% (MiQuit) and 65% (usual care) and abstinence validation rates were 56% (MiQuit) and 61% (usual care). The incremental cost‐per‐quitter was £133.53 (95% CI = –£395.78 to 843.62).ConclusionsThere was some evidence, although not conclusive, that a text‐messaging programme may increase cessation rates in pregnant smokers when provided alongside routine NHS cessation care.
Highlights
Smoking in pregnancy is associated strongly with pregnancy complications, including miscarriage [1], spontaneous preterm birth [2], small for gestational age [2] and stillbirth [3,4]
Two hundred and thirty (57%) provided smoking outcome data at both time-points (55% MiQuit, 58% usual care) and 254 (62%) gave data used for smoking outcome 1 on abstinence between 4 weeks and late pregnancy (61% MiQuit, 64% usual care)
For smoking outcome 1, 15 participants were classified as abstinent; 11 of (5.4%) were in the MiQuit group and four of (2.0%) in the usual care group
Summary
Smoking in pregnancy is associated strongly with pregnancy complications, including miscarriage [1], spontaneous preterm birth [2], small for gestational age [2] and stillbirth [3,4]. To maximize the potential of self-help support for helping pregnant smokers to stop, we have developed an individually tailored short message service (SMS) text messaging intervention for pregnant smokers, called MiQuit. We planned a full trial to detect such an effect on smoking cessation until the end of pregnancy, and estimated this could require 3–4000 participants This large, pilot RCT was conducted to investigate the feasibility of undertaking a much larger multi-centre RCT in UK National Health Service (NHS) settings to determine whether or not MiQuit can impact upon cessation throughout pregnancy. The current trial would provide estimates of effectiveness and cost-effectiveness, with the latter enabling comparisons with other cessation interventions
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