Lumley Judith, Chamberlain Catherine, Dowswell Therese, Oliver Sandy, Oakley Laura, Watson Lyndsey
Mother and Child Health Research, La Trobe University, 324-328 Little Lonsdale Street, Melbourne, Victoria, Australia, 3000.
Cochrane Database Syst Rev. 2009 Jul 8(3):CD001055. doi: 10.1002/14651858.CD001055.pub3.
Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies. Smoking in pregnancy is decreasing in high-income countries and increasing in low- to middle-income countries and is strongly associated with poverty, low educational attainment, poor social support and psychological illness.
To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2008), the Cochrane Tobacco Addiction Group's Trials Register (June 2008), EMBASE, PsycLIT, and CINAHL (all from January 2003 to June 2008). We contacted trial authors to locate additional unpublished data.
Randomised controlled trials where smoking cessation during pregnancy was a primary aim of the intervention.
Trials were identified and data extracted by one person and checked by a second. Subgroup analysis was conducted to assess the effect of risk of trial bias, intensity of the intervention and main intervention strategy used.
Seventy-two trials are included. Fifty-six randomised controlled trials (over 20,000 pregnant women) and nine cluster-randomised trials (over 5000 pregnant women) provided data on smoking cessation outcomes.There was a significant reduction in smoking in late pregnancy following interventions (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.96), an absolute difference of six in 100 women who stopped smoking during pregnancy. However, there is significant heterogeneity in the combined data (I(2) > 60%). In the trials with the lowest risk of bias, the interventions had less effect (RR 0.97, 95% CI 0.94 to 0.99), and lower heterogeneity (I(2) = 36%). Eight trials of smoking relapse prevention (over 1000 women) showed no statistically significant reduction in relapse.Smoking cessation interventions reduced low birthweight (RR 0.83, 95% CI 0.73 to 0.95) and preterm birth (RR 0.86, 95% CI 0.74 to 0.98), and there was a 53.91g (95% CI 10.44 g to 95.38 g) increase in mean birthweight. There were no statistically significant differences in neonatal intensive care unit admissions, very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power.
AUTHORS' CONCLUSIONS: Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and preterm birth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported.
孕期吸烟仍然是少数几个与孕期并发症、低出生体重、早产相关的可预防因素之一，并且对女性和婴儿具有严重的长期健康影响。在高收入国家，孕期吸烟现象正在减少，而在低收入和中等收入国家则呈上升趋势，且与贫困、低教育程度、社会支持不足和心理疾病密切相关。
评估孕期戒烟干预措施对吸烟行为和围产期健康结局的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2008年6月）、Cochrane烟草成瘾组试验注册库（2008年6月）、EMBASE、PsycLIT和CINAHL（均为2003年1月至2008年6月）。我们联系了试验作者以获取更多未发表的数据。
以孕期戒烟为干预主要目标的随机对照试验。
由一人识别试验并提取数据，另一人进行核对。进行亚组分析以评估试验偏倚风险、干预强度和所采用的主要干预策略的影响。
纳入72项试验。56项随机对照试验（超过20,000名孕妇）和9项整群随机试验（超过5000名孕妇）提供了戒烟结局数据。干预后孕晚期吸烟显著减少（风险比（RR）0.94，95%置信区间（CI）0.93至0.96），孕期戒烟的女性中每100人有6人的绝对差异。然而，合并数据存在显著异质性（I(2)>60%）。在偏倚风险最低的试验中，干预效果较小（RR 0.97，95%CI 0.94至0.99），异质性较低（I(2)=36%）。8项预防复吸试验（超过1000名女性）显示复吸率无统计学显著降低。戒烟干预降低了低出生体重（RR 0.83，95%CI 0.73至0.95）和早产（RR 0.86，95%CI 0.74至0.98），平均出生体重增加了53.91克（95%CI 10.44克至95.38克）。新生儿重症监护病房入院率、极低出生体重、死产、围产期或新生儿死亡率无统计学显著差异，但这些分析的效力非常有限。
孕期戒烟干预措施可降低孕晚期继续吸烟的女性比例，并降低低出生体重和早产发生率。所有产科护理机构均应实施孕期戒烟干预措施。鉴于许多孕期吸烟成瘾的孕妇在孕期戒烟困难，应支持基于人群的减少吸烟和社会不平等的措施。
