A Cochrane review included 88 studies with over 28 000 subjects 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 and abstinence in late pregnancy compared with usual care and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). A clear effect was seen in smoking abstinence in postpartum . Women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight, and a 22% reduction in neonatal intensive care admissions .
| Interventions and comparisons | Relative effect (95% CI) | Risk with comparison | Risk with main intervention (95% CI) | № of participants (studies) Quality of evidence |
|---|---|---|---|---|
| Counselling vs usual care | RR 1.44 (1.19 to 1.73) | 9 per 100 | 13 per 100 (11 to 16) | 12 432 (30) High |
| Health education vs usual care | RR 1.59 (0.99 to 2.55) | 8 per 100 | 12 per 100 (8 to 20) | 629 (5) Moderate |
| Feedback vs usual care | RR 4.39 (1.89 to 10.21) | 4 per 100 | 17 per 100 (7 to 39) | 355 (2) Moderate |
| Incentives vs alternative interventions | RR 2.36 (1.36 to 4.09) | 16 per 100 | 37 per 100 (21 to 64) | 212 (4) High |
| Exercise vs usual care | RR 1.20 (0.72 to 2.01) | 6 per 100 | 8 per 100 (5 to 13) | 785 (1) Moderate |
| Social support vs less intensive interventions | RR 1.21 (0.93 to 1.58) | 19 per 100 | 23 per 100 (18 to 31) | 781 (7) High |
| Outcome | Relative effect (95% CI) | Risk with control | Risk with Interventions (95% CI) | № of participants (studies) Quality of evidence |
|---|---|---|---|---|
| Abstinence in late pregnancy: self-reported and biochemically validated | RR 1.35 (1.23 to 1.48) | 12 per 100 | 16 per 100 (15 to 18) | 26 637 (97) Moderate |
| Abstinence at 0 to 5 months postpartum | RR 1.32 (1.17 to 1.50) | 131 per 1000 | 173 per 1000 (153 to 196) | 8366 (35) High |
| Low birthweight (under 2500 g) | RR 0.83 (0.72 to 0.94) | 92 per 1000 | 76 per 1000 (66 to 87) | 9402 (18) High |
| Preterm birth (under 37 weeks) | RR 0.93 (0.77 to 1.11) | 72 per 1000 | 67 per 1000 (55 to 80) | 9222 (19) High |
| Mean birthweight (g) | - | The mean birthweight (g) was 0 | MD 55.60 higher (29.82 higher to 81.38 higher) | 11 338 (26) High |
| NICU admissions | RR 0.78 (0.61 to 0.98) | 118 per 1000 | 92 per 1000 (72 to 116) | 2100 (8) High |
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