| Sumario: | Question: What is the effectiveness of smoking cessation interventions implemented during pregnancy for reducing maternal smoking during pregnancy and for improving newborn outcomes? Data sources: Medline was searched using the strategies of the Cochrane Pregnancy and Childbirth Group. Medline, PsycLIT, Datastar, Dissertation Abstracts Online, Applied Social Sciences Index and Abstracts, Social Citations Index, and Social Science Citations Index were searched using the strategies of the Cochrane Tobacco Group. Studies were also identified from handsearches of 60 journals, conference proceedings, bulletins, and bibliographies of review articles). Study selection: Randomised and quasi-randomised controlled trials of interventions implemented during pregnancy to increase maternal smoking cessation were selected. Data extraction: Data were extracted on study design, participants, participation and withdrawal rates, interventions, and outcomes. Methodological quality of studies was assessed. Main results: 40 trials (1975-97) of healthy pregnant women were identified. Interventions took place in hospitals or community antenatal clinics and included information on the risks of smoking to the fetus and infant and the benefits of stopping; recommendations to stop; feedback about the fetus; and cognitive behavioural strategies for stopping. Main outcome measure was continued maternal smoking in late pregnancy. Meta-analyses were based on a fixed effects model. Smoking cessation interventions reduced continued maternal smoking during late pregnancy compared with usual care (table). Results were similar when analyses were restricted to 17 trials with biochemically validated smoking cessation, 11 trials of interventions with the highest intensities, and 12 trials with high quality interventions. Mothers who received smoking cessation interventions had fewer low birthweight infants (table) and the infants had a higher mean birth weight (8 trials, increase of 41 g, 95% CI 16.6 to 65.5) compared with mothers who received usual care. There were no group differences in the number of very low birthweight infants (3 trials), preterm births (5 trials), stillbirths (3 trials), or total perinatal deaths (3 trials). Conclusion: Smoking cessation interventions implemented during pregnancy reduce maternal smoking during pregnancy and reduce the number of low birthweight infants.
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