Abstract
Smoking during pregnancy has been linked to a variety of adverse outcomes for both maternal and child health. Decades of studies have sought to increase cessation antepartum and reduce relapse postpartum. A number of effective interventions exist to significantly reduce smoking rates during pregnancy; however, less is known about how to prevent relapse in the postpartum period. This review investigates interventions to prevent relapse in the long-term postpartum period. We focus specifically on nonspontaneous quitters (individuals who quit smoking as a result of an external intervention) to reveal differences in long-term response to interventions for this population compared to spontaneous quitters. A systematic literature search yielded 32 relevant studies of pharmacological, behavioral, and incentives-based interventions. Results were compiled, analyzed, and compared in order to evaluate success factors in maintaining cessation postpartum. Though intervention groups showed consistently higher quit rates during pregnancy than control groups, none of the intervention types were effective at preventing relapse in the longer-term postpartum period. One study maintained significantly higher abstinence in the longer-term period postpartum using a mix of behavioral and incentives strategies. Additional research in this area is needed to identify optimal intervention strategies to reduce long-term postpartum relapse, particularly for nonspontaneous quitters.
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References
Hannöver, W., Thyrian, J. R., Ebner, A., et al. (2008). Smoking during pregnancy and postpartum: Smoking rates and intention to quit smoking or resume after pregnancy. Journal of Women’s Health (Larchmt), 17(4), 631–640.
DiFranza, J. R., Aligne, C. A., & Weitzman, M. (2004). Prenatal and postnatal environmental tobacco smoke exposure and children’s health. Pediatrics, 113(Suppl 4), 1007–1015.
Levitt, C., Shaw, E., Wong, S., Kaczorowski, J., & Group, M. U. P. R. (2007). Systematic review of the literature on postpartum care: Effectiveness of interventions for smoking relapse prevention, cessation, and reduction in postpartum women. Birth, 34(4), 341–347.
Lumley, J., Chamberlain, C., Dowswell, T., Oliver, S., Oakley, L., & Watson, L. (2009). Interventions for promoting smoking cessation during pregnancy. Cochrane Database Systematic Review, 3, CD001055.
Solomon, L., & Quinn, V. (2004). Spontaneous quitting: Self-initiated smoking cessation in early pregnancy. Nicotine & Tobacco Research, 6(Suppl 2), S203–S216.
Higgins, S. T., Heil, S. H., Dumeer, A. M., Thomas, C. S., Solomon, L. J., & Bernstein, I. M. (2006). Smoking status in the initial weeks of quitting as a predictor of smoking-cessation outcomes in pregnant women. Drug and Alcohol Dependence, 85(2), 138–141.
Coleman, T., Chamberlain, C., Davey, M. A., Cooper, S. E., & Leonardi-Bee, J. (2012). Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Systematic Review, 9, CD010078.
Hoedjes, M., Berks, D., Vogel, I., et al. (2010). Effect of postpartum lifestyle interventions on weight loss, smoking cessation, and prevention of smoking relapse: A systematic review. Obstetrical & Gynecological Survey, 65(10), 631–652.
Ratner, P. A., Johnson, J. L., Bottorff, J. L., Dahinten, S., & Hall, W. (2000). Twelve-month follow-up of a smoking relapse prevention intervention for postpartum women. Addictive Behaviors, 25(1), 81–92.
Severson, H. H., Andrews, J. A., Lichtenstein, E., Wall, M., & Akers, L. (1997). Reducing maternal smoking and relapse: Long-term evaluation of a pediatric intervention. Preventive Medicine, 26(1), 120–130.
Van’t Hof, S. M., Wall, M. A., Dowler, D. W., & Stark, M. J. (2000). Randomised controlled trial of a postpartum relapse prevention intervention. Tobacco Control, 9(Suppl 3), III64–III66.
Higgins, S. T., Washio, Y., Heil, S. H., et al. (2012). Financial incentives for smoking cessation among pregnant and newly postpartum women. Preventive Medicine, 55(Suppl), S33–S40.
Agboola, S., McNeill, A., Coleman, T., & Leonardi Bee, J. (2010). A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Addiction, 105(8), 1362–1380.
Cahill, K., & Perera, R. (2011). Competitions and incentives for smoking cessation. Cochrane Database Systematic Review, 4, CD004307.
Brandon, T. H., Simmons, V. N., Meade, C. D., et al. (2012). Self-help booklets for preventing postpartum smoking relapse: A randomized trial. American Journal of Public Health, 102(11), 2109–2115.
Covey, L. S., Glassman, A. H., Jiang, H., et al. (2007). A randomized trial of bupropion and/or nicotine gum as maintenance treatment for preventing smoking relapse. Addiction, 102(8), 1292–1302.
Hays, J. T., Hurt, R. D., Rigotti, N. A., et al. (2001). Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation. a randomized, controlled trial. Annals of Internal Medicine, 135(6), 423–433.
Tonstad, S. (2006). Smoking cessation efficacy and safety of varenicline, an alpha4beta2 nicotinic receptor partial agonist. Journal of Cardiovascular Nursing, 21(6), 433–436.
Thomas, B. H., Ciliska, D., Dobbins, M., & Micucci, S. (2004). A process for systematically reviewing the literature: Providing the research evidence for public health nursing interventions. Worldviews on Evidence-Based Nursing, 1(3), 176–184.
Britton, G. R., Brinthaupt, J., Stehle, J. M., & James, G. D. (2004). Comparison of self-reported smoking and urinary cotinine levels in a rural pregnant population. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 33(3), 306–311.
Russell, T., Crawford, M., & Woodby, L. (2004). Measurements for active cigarette smoke exposure in prevalence and cessation studies: Why simply asking pregnant women isn’t enough. Nicotine & Tobacco Research, 6(Suppl 2), S141–S151.
Higgins, S. T., Heil, S. H., Solomon, L. J., et al. (2004). A pilot study on voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum. Nicotine & Tobacco Research, 6(6), 1015–1020.
Gadomski, A., Adams, L., Tallman, N., Krupa, N., & Jenkins, P. (2011). Effectiveness of a combined prenatal and postpartum smoking cessation program. Maternal and Child Health Journal, 15(2), 188–197.
Peden, A. R., Rayens, M. K., Hall, L. A., et al. (2008). Nicotine addiction in pregnancy: Preliminary efficacy of a mental health intervention. Addictive Disorders and Their Treatment, 7(4), 179–189.
Valanis, B., Lichtenstein, E., Mullooly, J. P., et al. (2001). Maternal smoking cessation and relapse prevention during health care visits. American Journal of Preventive Medicine, 20(1), 1–8.
Pollak, K. I., Oncken, C. A., Lipkus, I. M., et al. (2007). Nicotine replacement and behavioral therapy for smoking cessation in pregnancy. American Journal of Preventive Medicine, 33(4), 297–305.
Wisborg, K., Henriksen, T. B., Jespersen, L. B., & Secher, N. J. (2000). Nicotine patches for pregnant smokers: A randomized controlled study. Obstetrics and Gynecology, 96(6), 967–971.
Clark, S. M., & Nakad, R. (2011). Pharmacotherapeutic management of nicotine dependence in pregnancy. Obstetrics and gynecology clinics of North America, 38(2), 297–311, x.
Albrecht, S. A., Caruthers, D., Patrick, T., et al. (2006). A randomized controlled trial of a smoking cessation intervention for pregnant adolescents. Nursing Research, 55(6), 402–410.
McBride, C. M., Baucom, D. H., Peterson, B. L., et al. (2004). Prenatal and postpartum smoking abstinence a partner-assisted approach. American Journal of Preventive Medicine, 27(3), 232–238.
Hennrikus, D., Pirie, P., Hellerstedt, W., Lando, H. A., Steele, J., & Dunn, C. (2010). Increasing support for smoking cessation during pregnancy and postpartum: Results of a randomized controlled pilot study. Preventive Medicine, 50(3), 134–137.
Zimmer, B. A. (2000). Smoking relapse during postpartum. The Online Journal of Knowledge Synthesis for Nursing, 7, 6.
Hemsing, N., Greaves, L., O’Leary, R., Chan, K., & Okoli, C. (2012). Partner support for smoking cessation during pregnancy: A systematic review. Nicotine & Tobacco Research, 14(7), 767–776.
Lillington, L., Royce, J., Novak, D., Ruvalcaba, M., & Chlebowski, R. (1995). Evaluation of a smoking cessation program for pregnant minority women. Cancer Practice, 3(3), 157–163.
Pbert, L., Ockene, J. K., Zapka, J., et al. (2004). A community health center smoking-cessation intervention for pregnant and postpartum women. American Journal of Preventive Medicine, 26(5), 377–385.
de Vries, H., Bakker, M., Mullen, P. D., & van Breukelen, G. (2006). The effects of smoking cessation counseling by midwives on Dutch pregnant women and their partners. Patient Education and Counseling, 63(1–2), 177–187.
O’Connor, A. M., Davies, B. L., Dulberg, C. S., et al. (1992). Effectiveness of a pregnancy smoking cessation program. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 21(5), 385–392.
Polańska, K., Hanke, W., & Sobala, W. (2005). Smoking relapse one year after delivery among women who quit smoking during pregnancy. International Journal of Occupational Medicine and Environmental Health, 18(2), 159–165.
Secker-Walker, R. H., Solomon, L. J., Flynn, B. S., et al. (1994). Individualized smoking cessation counseling during prenatal and early postnatal care. American Journal of Obstetrics and Gynecology, 171(5), 1347–1355.
Walsh, R. A., Redman, S., Brinsmead, M. W., Byrne, J. M., & Melmeth, A. (1997). A smoking cessation program at a public antenatal clinic. American Journal of Public Health, 87(7), 1201–1204.
Wall, M. A., Severson, H. H., Andrews, J. A., Lichtenstein, E., & Zoref, L. (1995). Pediatric office-based smoking intervention: Impact on maternal smoking and relapse. Pediatrics, 96(4 Pt 1), 622–628.
Lawrence, T., Aveyard, P., Cheng, K. K., Griffin, C., Johnson, C., & Croghan, E. (2005). Does stage-based smoking cessation advice in pregnancy result in long-term quitters? 18-month postpartum follow-up of a randomized controlled trial. Addiction, 100(1), 107–116.
McBride, C. M., Curry, S. J., Lando, H. A., Pirie, P. L., Grothaus, L. C., & Nelson, J. C. (1999). Prevention of relapse in women who quit smoking during pregnancy. American Journal of Public Health, 89(5), 706–711.
Secker-Walker, R. H., Solomon, L. J., Flynn, B. S., Skelly, J. M., & Mead, P. B. (1998). Reducing smoking during pregnancy and postpartum: Physician’s advice supported by individual counseling. Preventive Medicine, 27(3), 422–430.
Bullock, L., Everett, K. D., Mullen, P. D., Geden, E., Longo, D. R., Madsen, R., et al. (2009). A randomized controlled trial of nurses’ individualized social support for poor rural pregnant smokers. Maternal and Child Health Journal, 13(3), 395–406.
Morasco, B. J., Dornelas, E. A., Fischer, E. H., Oncken, C., & Lando, H. A. (2006). Spontaneous smoking cessation during pregnancy among ethnic minority women: A preliminary investigation. Addictive Behaviors, 31(2), 203–210.
Reitzel, L. R., Vidrine, J. I., Businelle, M. S., et al. (2010). Preventing postpartum smoking relapse among diverse low-income women: A randomized clinical trial. Nicotine & Tobacco Research, 12(4), 326–335.
Rigotti, N. A., Park, E. R., Regan, S., et al. (2006). Efficacy of telephone counseling for pregnant smokers: A randomized controlled trial. Obstetrics and Gynecology, 108(1), 83–92.
Mullen, P. D., Quinn, V. P., & Ershoff, D. H. (1990). Maintenance of nonsmoking postpartum by women who stopped smoking during pregnancy. American Journal of Public Health, 80(8), 992–994.
Donatelle, R. J., Prows, S. L., Champeau, D., & Hudson, D. (2000). Randomised controlled trial using social support and financial incentives for high risk pregnant smokers: Significant other supporter (SOS) program. Tobacco Control, 9(Suppl 3), III67–III69.
Heil, S. H., Higgins, S. T., Bernstein, I. M., et al. (2008). Effects of voucher-based incentives on abstinence from cigarette smoking and fetal growth among pregnant women. Addiction, 103(6), 1009–1018.
Albrecht, S. A., Rosella, J. D., & Patrick, T. (1994). Smoking among low-income, pregnant women: Prevalence rates, cessation interventions, and clinical implications. Birth, 21(3), 155–162.
Cinciripini, P. M., Blalock, J. A., Minnix, J. A., et al. (2010). Effects of an intensive depression-focused intervention for smoking cessation in pregnancy. Journal of Consulting and Clinical Psychology, 78(1), 44–54.
Stotts, A. L., Diclemente, C. C., & Dolan-Mullen, P. (2002). One-to-one: A motivational intervention for resistant pregnant smokers. Addictive Behaviors, 27(2), 275–292.
Hymowitz, N., Schwab, M., McNerney, C., Schwab, J., Eckholdt, H., & Haddock, K. (2003). Postpartum relapse to cigarette smoking in inner city women. Journal of the National Medical Association, 95(6), 461–474.
El-Mohandes, A. A., El-Khorazaty, M. N., Kiely, M., & Gantz, M. G. (2011). Smoking cessation and relapse among pregnant African-American smokers in Washington, DC. Maternal and Child Health Journal, 15(Suppl 1), S96–S105.
Petersen, L., Handel, J., Kotch, J., Podedworny, T., & Rosen, A. (1992). Smoking reduction during pregnancy by a program of self-help and clinical support. Obstetrics and Gynecology, 79(6), 924–930.
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The authors thank Dr. Eileen Lake, Eileen Wang, and Kyan T. Chuong for their assistance.
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Su, A., Buttenheim, A.M. Maintenance of Smoking Cessation in the Postpartum Period: Which Interventions Work Best in the Long-Term?. Matern Child Health J 18, 714–728 (2014). https://doi.org/10.1007/s10995-013-1298-6
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DOI: https://doi.org/10.1007/s10995-013-1298-6