Action on Smoking and Health (ASH), London, UK.
Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.
Nicotine Tob Res. 2020 Dec 12;22(12):2127-2133. doi: 10.1093/ntr/ntaa089.
Exposure to secondhand smoke (SHS) in pregnancy leads to an increased risk of stillbirths, congenital malformations, and low birth weight. There is a lack of evidence about how best to achieve reductions in SHS exposure among nonsmoking pregnant women. This work systematically reviews individual or household interventions to reduce pregnant women's exposure to SHS.
MEDLINE, EMBASE, and CINAHL databases were searched from their dates of inception to April 17, 2019. Studies were included if: participants were nonsmoking pregnant women; involved an intervention to reduce SHS exposure or encourage partner quitting; and measured SHS exposure of pregnant women and/or recorded quit rates among partners. The UK National Institute for Health & Care Excellence (NICE) Quality Appraisal checklist was used to determine internal and external validity.
Nine studies met the inclusion criteria. Educational interventions were primarily targeted at the pregnant woman to change her or others' behavior, with only two studies involving the partner who smoked. Intervention delivery was mixed, spanning brief discussions through to more involving sessions with role play. The effective interventions involved multiple follow-ups. There was no standardized method of assessing exposure to SHS. Many of the included studies had moderate to high risk of bias.
There is mixed evidence for interventions aimed at reducing pregnant women's exposure to SHS, though multi-component interventions seem to be more effective. The effectiveness of family-centered approaches involving creating smoke-free homes alongside partner smoking cessation, perhaps involving pharmacological support and/or financial incentives, should be explored.
• Measures to protect nonsmoking pregnant women from SHS tend to place the responsibility for "avoidance" on the woman.• There is little work that seeks to involve the smoking partner or other smokers in protecting pregnant women from SHS.• Interventions to create smoke-free homes and/or smoking partner cessation need to be developed: pharmacological and financial support should be explored.
孕妇接触二手烟（SHS）会增加死胎、先天畸形和低出生体重的风险。目前缺乏关于如何最好地减少非吸烟孕妇接触 SHS 的证据。这项工作系统地回顾了减少孕妇接触 SHS 的个体或家庭干预措施。
从建库日期到 2019 年 4 月 17 日，检索了 MEDLINE、EMBASE 和 CINAHL 数据库。如果符合以下标准，则纳入研究：参与者为非吸烟孕妇；涉及减少 SHS 暴露或鼓励伴侣戒烟的干预措施；并测量孕妇的 SHS 暴露情况和/或记录伴侣的戒烟率。英国国家卫生与保健卓越研究所（NICE）质量评估清单用于确定内部和外部有效性。
有 9 项研究符合纳入标准。教育干预主要针对孕妇，以改变她或他人的行为，只有 2 项研究涉及吸烟的伴侣。干预措施的实施方式多种多样，从简短的讨论到更具参与性的角色扮演。有效的干预措施涉及多次随访。没有评估 SHS 暴露的标准化方法。许多纳入的研究存在中度至高度偏倚风险。
针对减少孕妇 SHS 暴露的干预措施的证据参差不齐，但多组分干预措施似乎更有效。应该探索以家庭为中心的方法，包括创建无烟家庭以及戒烟，可能涉及药物治疗支持和/或经济激励。
• 保护非吸烟孕妇免受 SHS 的措施往往将“避免”的责任放在女性身上。• 很少有工作试图让吸烟的伴侣或其他吸烟者参与保护孕妇免受 SHS。• 需要制定创建无烟家庭和/或戒烟的干预措施：应探索药物和财政支持。
