Interventions for promoting smoking cessation during pregnancy

Judith Lumley; Sandy Oliver; Catherine Chamberlain; Laura Oakley

doi:10.1002/14651858.CD001055.pub2

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Figure 1

Median intensity score over time

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Analysis 1.1

Comparison 1 All trials, Outcome 1 Continued smoking in late pregnancy.

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Analysis 1.2

Comparison 1 All trials, Outcome 2 Mean birthweight.

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Analysis 1.3

Comparison 1 All trials, Outcome 3 Low birthweight (under 2500 g).

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Analysis 1.4

Comparison 1 All trials, Outcome 4 Very low birthweight (under 1500 g).

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Analysis 1.5

Comparison 1 All trials, Outcome 5 Preterm birth (under 37 or under 36 weeks).

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Analysis 1.7

Comparison 1 All trials, Outcome 7 Stillbirths.

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Analysis 1.8

Comparison 1 All trials, Outcome 8 Neonatal deaths.

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Analysis 1.9

Comparison 1 All trials, Outcome 9 Perinatal deaths.

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Analysis 2.1

Comparison 2 Trials with biochemically validated smoking cessation, Outcome 1 Continued smoking in late pregnancy.

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Analysis 3.1

Comparison 3 Interventions with high quality scores, Outcome 1 Continued smoking in late pregnancy.

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Analysis 4.1

Comparison 4 Interventions of high intensity with high quality scores and biochemically validated smoking cessation, Outcome 1 Continued smoking in late pregnancy.

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Analysis 5.1

Comparison 5 Trials subgrouped by intervention intensity, Outcome 1 Continued smoking in late pregnancy.

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Analysis 6.1

Comparison 6 Trials subgrouped by intervention strategy, Outcome 1 Continued smoking in late pregnancy.

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Analysis 7.1

Comparison 7 Trials to prevent smoking relapse in women who stopped smoking in early pregnancy, Outcome 1 Smoking in late pregnancy.

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Table 1. Randomised cluster trials: summary of effect

Trial ID	Outcome measurement	Adjustment	Effect	95% CI
Kendrick 1995	Biochemically validated smoking cessation at 8 months of pregnancy	Odds ratio adjusted	1.0	0.69‐1.6
Manfredi 1999	Self reported smoking cessation at 5‐8 weeks post birth	Odds ratio Z‐score adjusted	0.67	0.38‐1.15 p = 0.006
Bakker 2000b	Self reported smoking cessation at 6 weeks post birth	Odds ratio adjusted	0.42	0.18‐0.97
Hajek 2001	Biochemically validated smoking cessation at birth	Odds ratio	0.86	0.48‐1.57
Moore 2002	Biochemically validated smoking cessation at 6‐7 months of pregnancy	Odds ratio adjusted	0.89	0.48‐1.57
Lawrence 2003	Biochemically validated smoking cessation at 10 days post birth	Odds ratio adjusted	0.58	0.26‐1.33

Table 1. Randomised cluster trials: summary of effect

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Comparison 1. All trials

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Continued smoking in late pregnancy Show forest plot	47	13882	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.92, 0.96]

2 Mean birthweight Show forest plot	16	13618	Mean Difference (IV, Random, 95% CI)	33.03 [11.32, 54.74]

3 Low birthweight (under 2500 g) Show forest plot	13	8930	Risk Ratio (M‐H, Random, 95% CI)	0.82 [0.70, 0.95]

4 Very low birthweight (under 1500 g) Show forest plot	3	4765	Risk Ratio (M‐H, Random, 95% CI)	1.26 [0.69, 2.32]

5 Preterm birth (under 37 or under 36 weeks) Show forest plot	11	10932	Risk Ratio (M‐H, Random, 95% CI)	0.84 [0.72, 0.98]

7 Stillbirths Show forest plot	5	4525	Risk Ratio (M‐H, Random, 95% CI)	1.16 [0.71, 1.88]

8 Neonatal deaths Show forest plot	3	4143	Risk Ratio (M‐H, Random, 95% CI)	1.17 [0.34, 4.01]

9 Perinatal deaths Show forest plot	3	4335	Risk Ratio (M‐H, Random, 95% CI)	1.13 [0.72, 1.77]

Comparison 1. All trials

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Comparison 2. Trials with biochemically validated smoking cessation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Continued smoking in late pregnancy Show forest plot	35	10362	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.92, 0.97]

Comparison 2. Trials with biochemically validated smoking cessation

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Comparison 3. Interventions with high quality scores

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Continued smoking in late pregnancy Show forest plot	25	7819	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.93, 0.97]

Comparison 3. Interventions with high quality scores

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Comparison 4. Interventions of high intensity with high quality scores and biochemically validated smoking cessation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Continued smoking in late pregnancy Show forest plot	17	5252	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.94, 0.98]

Comparison 4. Interventions of high intensity with high quality scores and biochemically validated smoking cessation

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Comparison 5. Trials subgrouped by intervention intensity

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Continued smoking in late pregnancy Show forest plot	48	13884	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.92, 0.96]

1.1 High intensity	35	10503	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.92, 0.97]
1.2 Medium intensity	10	2246	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.91, 0.97]
1.3 Low intensity	3	1135	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.83, 1.09]

Comparison 5. Trials subgrouped by intervention intensity

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Comparison 6. Trials subgrouped by intervention strategy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Continued smoking in late pregnancy Show forest plot	46	13603	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.92, 0.96]

1.1 Cognitive behaviour strategies	20	6155	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.92, 0.97]
1.2 Stages of Change	7	1465	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.95, 1.02]
1.3 Feedback	3	292	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.77, 1.11]
1.4 Rewards	2	1155	Risk Ratio (M‐H, Random, 95% CI)	0.77 [0.72, 0.82]
1.5 Nicotine Replacement Therapy	3	927	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.92, 0.98]
1.6 Other	11	3609	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.93, 0.98]

Comparison 6. Trials subgrouped by intervention strategy

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Comparison 7. Trials to prevent smoking relapse in women who stopped smoking in early pregnancy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking in late pregnancy Show forest plot	5	843	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.63, 1.04]

Comparison 7. Trials to prevent smoking relapse in women who stopped smoking in early pregnancy

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