Re-starting smoking in the postpartum period after receiving a smoking cessation intervention: a systematic review

Matthew Jones, Sarah Lewis, Steve Parrott, Stephen Wormall, Tim Coleman, Matthew Jones, Sarah Lewis, Steve Parrott, Stephen Wormall, Tim Coleman

Abstract

Aims: In pregnant smoking cessation trial participants, to estimate (1) among women abstinent at the end of pregnancy, the proportion who re-start smoking at time-points afterwards (primary analysis) and (2) among all trial participants, the proportion smoking at the end of pregnancy and at selected time-points during the postpartum period (secondary analysis).

Methods: Trials identified from two Cochrane reviews plus searches of Medline and EMBASE. Twenty-seven trials were included. The included trials were randomized or quasi-randomized trials of within-pregnancy cessation interventions given to smokers who reported abstinence both at end of pregnancy and at one or more defined time-points after birth. Outcomes were validated biochemically and self-reported continuous abstinence from smoking and 7-day point prevalence abstinence. The primary random-effects meta-analysis used longitudinal data to estimate mean pooled proportions of re-starting smoking; a secondary analysis used cross-sectional data to estimate the mean proportions smoking at different postpartum time-points. Subgroup analyses were performed on biochemically validated abstinence.

Results: The pooled mean proportion re-starting at 6 months postpartum was 43% [95% confidence interval (CI) = 16-72%, I(2) = 96.7%] (11 trials, 571 abstinent women). The pooled mean proportion smoking at the end of pregnancy was 87% (95% CI = 84-90%, I(2) = 93.2%) and 94% (95% CI = 92-96%, I(2) = 88%) at 6 months postpartum (23 trials, 9262 trial participants). Findings were similar when using biochemically validated abstinence.

Conclusions: In clinical trials of smoking cessation interventions during pregnancy only 13% are abstinent at term. Of these, 43% re-start by 6 months postpartum.

Keywords: Meta-analysis; postpartum period; pregnancy; randomized controlled trial; re-starting smoking; smoking; smoking cessation; smoking cessation interventions; systematic review; tobacco.

© 2016 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) diagram
Figure 2
Figure 2
Forest plot of the proportion of women re‐starting smoking using continuous abstinence, with studies ordered by weighting (highest weighting first)
Figure 3
Figure 3
Forest plot of the proportion of women smoking among all trial participants based on 7‐day point prevalence abstinence, with studies ordered by weighting (highest weighting first)

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