1. State of Evidence | 2. Better Practices Approaches

A 2003 report prepared by researchers associated with the BC Centre of Excellence for Women’s Health reviewed 58 smoking cessation interventions for pregnant and postpartum girls and women, and provided seven promising better practice approaches for smoking cessation during pregnancy. The report, Expecting to Quit: A Best Practices review of smoking cessation interventions for pregnant and postpartum women and girls was prepared by Lorraine Greaves, Renee Cormier, Karen Devries, Joan Bottorff, Joy Johnson, Susan Kirkland and David Aboussafy.

Here is an overview of evidence regarding interventions for pregnant and postpartum women from that report:

Interventions for Heavy Smokers, Spontaneous Quitters and Teenaged Girls

• Heavy smokers and spontaneous quitters require tailored cessation interventions.
• Heavy smokers include women who smoke 10 or more cigarettes a day.
• Nicotine replacement therapies (NRTs), such as nicotine patch and nicotine gum, have been tested primarily among heavy smoking women, and findings are inconclusive.
• There is a lack of research examining cessation interventions for pregnant teens who smoke.

Pharmacological Interventions for Pregnant Smokers

• There is a lack of research, and no current evidence, that pharmacological interventions (NRT or buproprion) improve smoking cessation among pregnant women who smoke.
• Behavioural therapy should be promoted prior to pharmacological interventions.
• Nicotine replacement therapies may be helpful for women who are unable to quit during pregnancy.
• There is no definite evidence linking nicotine replacement to increased risk of still birth or low birth-weight and pre-term birth. However, careful safety monitoring should always be implemented with NRT trials and it is critical to control double-dosing (smoking while using NRT).

Interventions for Key Sub-Groups of Pregnant Smokers

• Research is required examining interventions that reach low income and ethnic minority groups of pregnant women who smoke.
• More research is required examining the use of financial incentives for marginalized groups of women who smoke during pregnancy.
• There is some evidence that brief interventions are less effective for women of lower socio-economic status.
• Further research is required examining the effectiveness of interventions that are intensive, tailored and include multiple components with marginalized groups of women.

Interventions/ Programs in Substance Abuse Treatment Settings

• There is a lack of research examining smoking cessation interventions for women in substance use treatment programs.
• The available research suggests that interventions tailored for women in these settings are acceptable to both women and staff.

Interventions for Postpartum Smokers

• There is a lack of interventions aimed at maintaining smoking cessation among postpartum women and girls.
• The evidence is insufficient to recommend any particular intervention or specific components, but some important considerations include:
  1. Extending the support time beyond the immediate postpartum period in order to have a greater long-term effect.
  2. Addressing other factors such as having a partner who smokes and the mental health of the smoking mother to improve her odds of quitting long term.