Recommended cessation counselling for pregnant women who smoke: a review of the evidence

OBJECTIVE—To review the evidence base underlying recommended cessation counselling for pregnant women who smoke, as it applies to the steps identified in the Agency for Healthcare Research and Quality's publication, Treating tobacco use and dependence: a clinical practice guideline. DATA SOURCES—Secondary analysis of literature reviews and meta-analyses. DATA SYNTHESIS—A brief cessation counselling session of 5-15 minutes, when delivered by a trained provider with the provision of pregnancy specific, self help materials, significantly increases rates of cessation among pregnant smokers. This low intensity intervention achieves a modest but clinically significant effect on cessation rates, with an average risk ratio of 1.7 (95% confidence interval 1.3 to 2.2). There are five components of the recommended method—"ask, advise, assess, assist, and arrange". CONCLUSIONS—We recommend these evidence based procedures be adopted by all prenatal care providers. The use of this evidence based intervention is feasible in most office or clinic settings offering prenatal care and can be implemented without inhibiting other important aspects of prenatal care or disrupting patient flow. If implemented widely, this approach has the potential to achieve an important reduction in a number of adverse maternal, infant, and pregnancy outcomes and to reduce associated, excess health care costs. Keywords: smoking cessation; pregnancy