Smoking cessation in pregnancy: do effective programmes exist?

Abstract

Smoking has been described as the most important cause of poor pregnancy outcome in Western countries. None the less, evidence indicates that health care providers do not routinely provide smoking cessation interventions to pregnant women. The US Surgeon General has recommended that programmes to reduce smoking during pregnancy should be expanded in the public and private sectors. A review of the literature located 20 controlled evaluations of smoking cessation interventions in pregnancy. The studies were rated using the methodological criteria outlined by Windsor and Orleans (1986). Twelve of the studies were judged methodologically inadequate and excluded from the review. The remaining studies were found to support the efficacy of cognitive behavioural smoking cessation programmes in pregnancy. There was insufficient evidence to determine whether advice, feedback or nurse home-visitation programmes increased smoking cessation rates in pregnancy under ideal conditions. None of the methodologically adequate cognitive behavioural studies fulfilled the criteria necessary for a smoking cessation programme to be incorporated into routine antenatal care. Importantly, in only two studies were the smoking cessation interventions delivered by usual care doctors or midwives. The findings indicate that it is unsurprising that health care providers do not routinely deliver smoking cessation programmes to pregnant smokers. Future research and programme needs are discussed.