数字健康、生物标志物反馈以及护士或助产士主导的咨询干预措施对帮助孕妇戒烟的效果：系统评价和荟萃分析。

Effect of digital health, biomarker feedback and nurse or midwife-led counselling interventions to assist pregnant smokers quit: a systematic review and meta-analysis.

机构信息

School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia

School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia.

出版信息

BMJ Open. 2023 Mar 24;13(3):e060549. doi: 10.1136/bmjopen-2021-060549.

OBJECTIVE

To assess the effect of digital health (DH), biomarker feedback (BF) and nurse or midwife-led counselling (NoMC) interventions on abstinence in pregnant smokers during pregnancy and postpartum.

SETTINGS

Any healthcare setting servicing pregnant women, including any country globally.

PARTICIPANTS

Pregnant women of any social, ethnic or geographical background who smoke.

METHODS

We searched Embase, Medline, Web Of Science, Google Scholar, PsychINFO, CINAHL and PubMed between 2007 and November 2021. We included published original intervention studies in English with comparators (usual care or placebo). Two independent assessors screened and abstracted data. We performed a random-effects meta-analysis, assessed risk of bias with the Cochrane Tool and used Grading of Recommendations Assessment, Development and Evaluation to assess the quality of evidence.

RESULTS

We identified 57 studies and included 54 in the meta-analysis. Sixteen studies assessed DH (n=3961), 6 BF (n=1643), 32 NoMC (n=60 251), 1 assessed NoMC with BF (n=1120) and 2 NoMC with DH interventions (n=2107). DH interventions had moderate certainty evidence to achieve continuous abstinence (CA) at late pregnancy (4 studies; 2049 women; RR=1.98, 95% CI 1.08 to 3.64, p=0.03) and low certainty evidence to achieve point prevalence abstinence (PPA) postpartum (5 studies; 2238 women; RR=1.46, 95% CI 1.05 to 2.02, p=0.02). NoMC interventions had moderate certainty evidence to achieve PPA in late pregnancy (15 studies; 16 234 women; RR=1.54, 95% CI 1.16 to 2.06, p<0.01) and low certainty evidence to achieve PPA postpartum (13 studies; 5466 women; RR=1.79, 95% CI 1.14 to 2.83, p=0.01). Both DH and BF interventions did not achieve PPA at late pregnancy, nor NoMC interventions achieve CA postpartum. The certainty was reduced due to risk of bias, heterogeneity, inconsistency and/or imprecision.

CONCLUSION

NoMC interventions can assist pregnant smokers achieve PPA and DH interventions achieve CA in late pregnancy. These interventions may achieve other outcomes.

目的

评估数字健康（DH）、生物标志物反馈（BF）和护士或助产士主导的咨询（NoMC）干预措施对孕妇吸烟的影响，包括在妊娠和产后期间的戒烟效果。

设置

为孕妇提供服务的任何医疗保健环境，包括全球任何国家。

参与者

任何社会、种族或地理背景的孕妇，只要她们吸烟。

方法

我们检索了 Embase、Medline、Web Of Science、Google Scholar、PsychINFO、CINAHL 和 PubMed 数据库，检索时间为 2007 年至 2021 年 11 月。我们纳入了英语发表的原始干预研究，并与对照（常规护理或安慰剂）进行比较。两名独立评估员筛选和提取数据。我们进行了随机效应荟萃分析，使用 Cochrane 工具评估偏倚风险，并使用推荐评估、制定与评价分级来评估证据质量。

结果

我们确定了 57 项研究，并将其中 54 项纳入荟萃分析。16 项研究评估了 DH（n=3961），6 项研究评估了 BF（n=1643），32 项研究评估了 NoMC（n=60251），1 项研究评估了 NoMC 与 BF 联合干预（n=1120），2 项研究评估了 NoMC 与 DH 联合干预（n=2107）。DH 干预措施具有中等确定性证据，可实现晚期妊娠时的连续戒烟（4 项研究；2049 名女性；RR=1.98，95%置信区间 1.08 至 3.64，p=0.03）和产后点患病率戒烟（5 项研究；2238 名女性；RR=1.46，95%置信区间 1.05 至 2.02，p=0.02）。NoMC 干预措施具有中等确定性证据，可实现晚期妊娠时的产后点患病率戒烟（15 项研究；16234 名女性；RR=1.54，95%置信区间 1.16 至 2.06，p<0.01）和产后时的点患病率戒烟（13 项研究；5466 名女性；RR=1.79，95%置信区间 1.14 至 2.83，p=0.01）。DH 和 BF 干预措施均未能在晚期妊娠时实现产后点患病率戒烟，NoMC 干预措施也未能在产后实现持续戒烟。由于偏倚风险、异质性、不一致性和/或不精确性，确定性降低。