Abstract
Women who are generally part of socially disadvantaged and economically marginalized groups are especially susceptible to smoking during pregnancy but smoking rates are underreported in both research and interventions. While there is evidence to support the short-term efficacy of nicotine replacement therapy (NRT) use in pregnancy, long-term abstinence rates are modest. Current health strategies and interventions designed to diminish smoking in pregnancy have adopted a simplified approach to maternal smoking—one that suggests that they have a similar degree of choice to non-pregnant smokers regarding the avoidance of risk factors, and overlooks individual predictors of non-adherence. As a result, interventions have been ineffective among this high-risk group. For this reason, this paper addresses the multiple and interacting determinants that must be considered when developing and implementing effective strategies that lead to successful smoking cessation: socioeconomic status (SES), nicotine dependence, social support, culture, mental health, and health services. Based on our review of the literature, we conclude that tailoring cessation programs for pregnant smokers may ultimately optimize NRT efficacy and reduce the prevalence of maternal smoking.
Highlights
The proportion of women who smoke during pregnancy in high-income countries has declined, it remains an international public health priority
According to the Smoking and Nicotine in Pregnancy (SNAP) trial, the largest nicotine replacement therapy (NRT) randomized control trial conducted in pregnancy far, smoking cessation treatment failure in pregnancy may stem from a low adherence rate [6]
We focus on six key factors that are predictive of maternal smoking: socioeconomic status (SES), nicotine dependence, social support, culture, mental health, and health services
Summary
The proportion of women who smoke during pregnancy in high-income countries has declined, it remains an international public health priority. The economic burden of tobacco-related morbidity and mortality is substantial [1,2], contributing significantly to socioeconomic inequalities in stillbirths and infant deaths (38% and 31% respectively), as shown in a retrospective cohort study of mothers with varying degrees of socioeconomic deprivation [3]. This is in accordance with an observational study by Bauld, Judge and Platt [4], whereby despite low overall efficacy, smoking cessation services have had a disproportionate effect in the most disadvantaged groups, possibly reducing the social gradient. Of the 981 participants followed up at delivery, only 7.2% (35/485) of women assigned to receive NRT and 2.8% (14/496)
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