The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials
ABSTRACT Pregnant smokers are often prescribed counselling as part of multicomponent cessation interventions. However, the isolated effect of counselling in this population remains unclear, and individual randomised controlled trials (RCTs) are inconclusive.
To conduct a meta-analysis of RCTs examining counselling in pregnant smokers.
We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline and PsycINFO databases for RCTs evaluating smoking cessation counselling.
We included RCTs conducted in pregnant women in which the effect of counselling could be isolated and those that reported biochemically validated abstinence at 6 or 12 months after the target quit date.
Overall estimates were derived using random effects meta-analysis models.
Our search identified eight RCTs (n = 3290 women), all of which examined abstinence at 6 months. The proportion of women that remained abstinent at the end of follow up was modest, ranging from 4 to 24% among those randomised to counselling and from 2 to 21% among control women. The absolute difference in abstinence reached a maximum of only 4%. Summary estimates are inconclusive because of wide confidence intervals, albeit with little evidence to suggest that counselling is efficacious at promoting abstinence (odds ratio 1.08, 95% confidence interval 0.84-1.40). There was no evidence to suggest that efficacy differed by counselling type.
Available data from RCTs examining the isolated effect of smoking cessation counselling in pregnant women are limited but sufficient to rule out large treatment effects. Future RCTs should examine pharmacological therapies in this population.
Full-textDOI: · Available from: Michèle Tremblay, Jun 27, 2014
Article: Prévention du RCIU vasculaire[Show abstract] [Hide abstract]
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ABSTRACT: Smoking is the most important preventable cause of adverse outcomes in pregnancy. However, most smokers who become pregnant continue to smoke and most of those who quit relapse after delivery. This article explores the relationship between smoking and pregnancy, and reviews the evidence for best practice intervention by general practitioners. Continuing to smoke during pregnancy is strongly associated with socioeconomic disadvantage, mental illness and Aboriginal and Torres Strait Islander populations. Quitting is more difficult for these groups and interventions assist only sixin every 100 pregnant smokers to quit. Behavioural counselling is the first-line treatment. Nicotine replacement therapy (NRT) can be offered if the smoker is unable to quit without it, although its efficacy is uncertain. Adequate doses of nicotine and good adherance may be required for the best results. The use of NRT in pregnancy is likely to be less harmful than continuing to smoke. Women should be encouraged to quit smoking before becoming pregnant.Australian family physician 01/2014; 43(1):46-51. · 0.67 Impact Factor
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ABSTRACT: Smoking cigarettes throughout pregnancy is one of the single most important avoidable causes of adverse pregnancy outcomes and it represents the first major environmental risk of the unborn. If compared with other risk factors in the perinatal period, exposure to tobacco smoke is considered to be amongst the most harmful and it is associated with high rates of long and short term morbidity and mortality for mother and child. A variety of adverse pregnancy outcomes are linked with cigarette consumption before and during pregnancy. Maternal prenatal cigarette smoke disturbs the equilibrium among the oxidant and antioxidant system, has negative impact on the genetic and cellular level of both mother and fetus and causes a large quantity of diseases in the unborn child. These smoking-induced damages for the unborn offspring manifest themselves at various times in life and for most only a very limited range of causal treatment exists. Education, support and assistance are of high importance to decrease maternal and fetal morbidity and mortality, as there are few other avoidable factors which influence a child's health that profoundly throughout its life. It is imperative that smoking control should be seen as a public health priority.International Journal of Environmental Research and Public Health 12/2013; 10(12):6485-99. DOI:10.3390/ijerph10126485 · 1.99 Impact Factor