What did we want to know?
Cigarette smoking in pregnancy is common, particularly where there is low income and social disadvantage. Smoking in pregnancy increases the risk of babies having low birthweight and being born too early. Babies often struggle to cope with life outside the womb and can suffer ill health later in life. Many mothers find it hard to stop, or to reduce, smoking during pregnancy even knowing the benefits this may have, because smoking can help them cope with stress. We wanted to know what are the effects of smoking cessation programmes for pregnant women and how relevant are they to women’s concerns and for guiding the how programmes are conducted.
Who wants to know?
Policy makers, clinicians, pregnant women who smoke.
What did we find?
There are effective strategies to help and support women to stop smoking that lead to fewer premature babies and better birthweights for babies.
Incorporating process indicators into the review revealed: 1) problems with implementation and transplantation of some interventions and 2) studies with more stringent quality criteria and process evaluations demonstrated greater impact (weighted mean difference in smoking). Pregnant smokers were rarely involved in the design or evaluation of the interventions. Prior observational and qualitative studies and small scale consultations influenced the criteria by which the effectiveness of the interventions were judged, and revealed to what extent these criteria are adopted in practice.
What are the implications?
Systematically abstracting data about the development and delivery of interventions revealed gaps that might be filled by the active involvement of practitioners and service users.
- Smoking cessation programs be implemented in all maternity care settings, as a routine part of antenatal care
- Starting with local piloting of programmes shown elsewhere to be effective
- Paying attention to women’s concerns
- Paying attention to the existing evidence on barriers to implementation in antenatal care.
How did we get these results?
A systematic review of the effects of smoking cessation programmes implemented during pregnancy integrated process indicators and the views of maternity service users and health promotion specialists. Additional qualitative data were extracted systematically from included randomised control trials (RCTs) to determine whether the design of interventions and conclusions arising from their evaluation related to the views of service users. On completing the review we reflected on the types of observational and qualitative research it drew on, where this research was incorporated into the review, and its added value.
This study is reported in two publications which should be cited as:
Oliver S, Oakley L, Lumley J, Waters E (2001) Smoking cessation programmes in pregnancy: systematically addressing development, implementation, women’s concerns and effectiveness. Health Education Journal 60 (4) 362–370.
Lumley J, Oliver SS, Chamberlain C, Oakley L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub2.