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

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

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%, I2 = 96.7%] (11 trials, 571 abstinent women). The pooled mean proportion smoking at the end of pregnancy was 87% (95% CI = 84–90%, I2 = 93.2%) and 94% (95% CI = 92–96%, I2 = 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.

• Journal Article Type: Article
• Acceptance Date: Jan 4, 2016
• Online Publication Date: Mar 16, 2016
• Publication Date: May 9, 2016
• Deposit Date: Mar 21, 2016
• Publicly Available Date: Mar 21, 2016
• Journal: Addiction
• Print ISSN: 0965-2140
• Electronic ISSN: 1360-0443
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 111
• Issue: 6
• Pages: 981-990
• DOI: https://doi.org/10.1111/add.13309
• Keywords: Meta-analysis, postpartum period, pregnancy, randomized controlled trial, re-starting smoking, smoking,smoking cessation, smoking cessation interventions, systematic review, tobacco
• Public URL: https://nottingham-repository.worktribe.com/output/790806
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/add.13309/abstract
• Additional Information: This is the peer reviewed version of the following article: Jones, M., Lewis, S., Parrott, S., Wormall, S., and Coleman, T. (2016) Re-starting smoking in the postpartum period after receiving a smoking cessation intervention: a systematic review. Addiction, 111: 981–990, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/add.13309/abstract . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.