Find Established Evidence

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, Telephone Support, Parent Engagement, Patient Reminder/Invitation
Intervention Description: This study aims to test the acceptability and feasibility of SmokefreeMOM, a national smoking cessation text-messaging program for pregnant smokers.
Conclusion: SmokefreeMOM is acceptable for pregnant smokers. It is recommended that SmokefreeMOM be further refined and evaluated.
Study Design: RCT
Setting: Obstetrics-gynecology clinics
Target Audience: Women who are currently pregnant, English proficient, with a mobile phone and unlimited text messaging, that are currently smoking or smoked in the past 2 weeks
Data Source: Surveys and saliva sample
Sample Size: 99 participants (55 in SmokefreeMOM intervention group and 44 in control group)
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Parent Engagement, Telephone Support
Intervention Description: The study tests whether an interactive and intensive text messaging program, Quit4baby, can promote smoking cessation for pregnant women already enrolled in a health text messaging program, Text4baby.
Conclusion: Results provide limited support of the efficacy of the Quit4baby text messaging program in the short term and late in pregnancy, but not in the postpartum period.
Study Design: RCT
Setting: Electronic phone application
Target Audience: Women over 14 years of age who are currently pregnant, English proficient, that are currently smoking or smoked in the past 2 weeks, who were signed up for Text4Baby message
Data Source: Surveys and saliva sample
Sample Size: 497
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Telephone Support, Parent Engagement, Incentives
Intervention Description: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program.
Conclusion: This pilot test provides support for the feasibility and acceptability of Quit4baby. Future studies are needed to assess whether Quit4baby is effective for smoking cessation during pregnancy.
Study Design: Single group pre-post test evaluation pilot
Setting: Electronic phone application
Target Audience: Women over 18 years of age who are currently pregnant, English proficient, that are currently smoking or smoked in the past 2 weeks
Data Source: Telephone surveys, retrospective computer records review of engagement with the technology
Sample Size: 20
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Incentives
Intervention Description: The Centers for Medicare and Medicaid Services' Meaningful Use (MU) of Electronic Health Record (EHR) Incentive Program could increase rates of smoking assessment and cessation assistance among vulnerable populations. This study examined whether smoking status assessment, cessation assistance, and odds of being a current smoker changed after Stage 1 MU implementation.
Conclusion: Findings suggest that incentives for MU of EHRs increase the odds of smoking assessment and cessation assistance, which could lead to decreased smoking rates among vulnerable populations. Continued efforts for provision of cessation assistance among pregnant patients is warranted.
Study Design: Quasi experimental cross-sectional (Non- randomized evaluation of a policy change)
Setting: Community health centers (CHC)
Target Audience: All smokers over 18 years of age with at least one primary care visit to one of the study CHCs in 2010, 2012, or 2014 as well as a subset of pregnant women
Data Source: Electronic health records
Sample Size: Review of health records for 16,802 participants in 2010, 17,631 in 2012 and 18,110 in 2014
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Person-to-Person Education, Peer Counselor, Motivational Interviewing, Telephone Support, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Consultation (Parent/Family)
Intervention Description: The goals were to describe a smoking cessation intervention, the Tennessee Intervention for Pregnant Smokers program, and examine the impact on quit rates compared to usual care. Additionally we sought to examine reduction in smoking levels and number of quit attempts related to the intervention and finally to examine the impact of the intervention on birth outcomes.
Conclusion: Findings point to the potential for appropriately tailored pregnancy smoking interventions to produce substantial improvements in birth outcomes within populations with health disparities.
Study Design: RCT
Setting: Prenatal care clinics
Target Audience: Pregnant women smokers who receive Medicaid and prenatal care
Data Source: Self-report of smoking behavior, exhaled CO, urine cotinine
Sample Size: 1486
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Policy/Guideline (State)
Intervention Description: Objectives We assessed the impact of varying levels of smokefree regulations on birth outcomes and prenatal smoking.
Conclusion: Regulation restrictiveness is a determining factor in the impact of smokefree regulations on birth outcomes, with comprehensive smokefree regulations showing promise in improving birth outcomes. Favorable effects on birth outcomes appear to stem from reduced secondhand smoke exposure rather than reduced prenatal smoking prevalence. This study is limited by an inability to measure secondhand smoke exposure and the paucity of data on policy implementation and enforcement.
Study Design: Quasi experimental cross-sectional -regression analysis
Setting: State and local policies; State Vital Statistics record
Target Audience: Health records of singleton births for West Virginia residents between 1995-2010
Data Source: WV Vital statistics data
Sample Size: 293715
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Assessment (Provider)
Intervention Description: To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking.
Conclusion: The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.
Study Design: Quasi experimental Crosssectional and Cost-benefit analysis
Setting: National Health Service(NHS) antenatal clinics
Target Audience: Health records of singleton births to mothers who smoked and did not smoke
Data Source: Electronic health records
Sample Size: 37726
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Nicotine Patches
Intervention Description: To determine the efficacy of 16 hour nicotine patches among pregnant smokers, with the dose individually adjusted according to saliva cotinine levels (potential range 10-30 mg/day).
Conclusion: The nicotine patch did not increase either smoking cessation rates or birth weights despite adjustment of nicotine dose to match levels attained when smoking, and higher than usual doses.
Study Design: RCT- Randomized, double blind, placebo controlled, parallel group, multicenter trial
Setting: Maternity wards
Target Audience: Pregnant smokers aged more than 18 years and between 12 and 20 weeks’ gestation, who smoked at least five cigarettes a day and scored at least 5 on a motivational scale of quitting smoking (range 0-10)
Data Source: Saliva cotinine, birth records
Sample Size: 402 (203 to nicotine patches, 199 to placebo patches)
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Health Insurance Coverage
Intervention Description: We examined the association between health insurance coverage and both past month alcohol use and past month tobacco use in a nationally representative sample of women age 12-44 years old, by pregnancy status.
Conclusion: Access to health care, via health insurance coverage is a promising method to help reduce alcohol use during pregnancy. However, despite health insurance coverage, tobacco use persists during pregnancy, suggesting missed opportunities for prevention during prenatal visits.
Study Design: Quasi experimental cross sectional
Setting: Participants in the National Survey of Drug Use and Health (NSDUH) 2010-2013
Target Audience: Non-pregnant and pregnant women 12 to 44 years old with and without health insurance from large data set after passage of ACA
Data Source: National Survey of Drug Use and Health (NSDUH) 2010-2013
Sample Size: 97788
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Person-to-Person Education, Motivational Interviewing, Other Education, Intensive Therapy, Peer Counselor
Intervention Description: This report describes tobacco use prevalence among perinatal smokers identified through an "opt-out" inpatient smoking cessation clinical service.
Conclusion: This opt-out service reached a highly nicotine-dependent perinatal population, many of whom were receptive to the service, and it appeared to improve abstinence rates post-discharge. Opt-out tobacco cessation services may have a significant impact on the health outcomes of this population and their children.
Study Design: Quasi experimental cross sectional evaluation
Setting: Academic medical center
Target Audience: Smokers admitted to the perinatal units
Data Source: In-patient records and follow up phone surveys
Sample Size: 5649
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Referrals
Intervention Description: To assess the impact of ‘opt-out’ referrals for pregnant smokers on SSS uptake and effectiveness, we conducted a ‘before–after’ service development evaluation.
Conclusion: In a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled the numbers of pregnant smokers setting quit dates and reporting smoking cessation.
Study Design: Quasi experimental cross sectional
Setting: Antenatal clinics
Target Audience: Data on Pregnant women who smoke receiving National Health Services (NHS) obstetric services
Data Source: UK National Health Service database
Sample Size: 2287 women who received care before initiation of CO breath test intervention, 2293 after
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Motivational Interviewing, Telephone Support, Peer Counselor, Midwife, PROVIDER/PRACTICE, Nurse/Nurse Practitioner
Intervention Description: The aim of this pilot study was to evaluate the implementation of the American College of Obstetricians and Gynecologists' 5 A's smoking cessation intervention among pregnant women being cared for by 5 A's-trained midwives working with a team of nurse researchers in an effort to reduce prenatal smoking exposure. The evidence-based 5 A's smoking cessation program has been recommended for use in prenatal care by health care providers.
Conclusion: Midwives and nurses can be trained in the implementation of the evidence-based 5 A's smoking cessation program for incorporation into regular prenatal care of pregnant women who smoke. By guiding women in techniques aimed at reducing the amount and frequency of cigarette smoking, nurses and midwives facilitate a decrease in prenatal smoking exposure.
Study Design: Single group pre-post test evaluation pilot
Setting: Prenatal care clinics
Target Audience: Pregnant women who smoked and were willing to quit or cut down smoking receiving prenatal care
Data Source: Surveys (self-report questionnaires)
Sample Size: 35
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, Enabling Services, Access to Provider through Hotline
Intervention Description: To pilot-test a Phone-based Postpartum Continuing Care (PPCC) protocol in addition to the usual care for smoking cessation for pregnant women to demonstrate the feasibility of recruitment, randomization, assessment, and implementation of the PPCC intervention.
Conclusion: The PPCC intervention did not differentially reduce tobacco use postpartum compared with a controlled comparison group, though it was found to be acceptable among a subpopulation of low-income pregnant women and feasible with regard to recruitment, randomization, assessment procedures, and implementation. Further research is needed to identify an intervention that significantly improves smoking relapse rates postpartum.
Study Design: RCT pilot
Setting: Obstetrics clinic
Target Audience: Low-income pregnant women attending their first prenatal visit at a single academic obstetrics clinic
Data Source: Urine testing, Surveys
Sample Size: 130
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Telephone Support
Intervention Description: Pregnant smokers are advised to quit; however, many struggle to do so. Behavioral counseling can increase quitting success, but the efficacy of telephone counseling for pregnant smokers has not been established. This study tests the efficacy of pregnancy-specific counseling, embedded in the ongoing operations of a state quitline.
Conclusion: A pregnancy-specific counseling protocol, embedded in a state quitline, was effective in helping pregnant smokers quit and stay quit postpartum. Wide adoption of this intervention could help reduce the rate of maternal smoking and prevent its devastating health consequences.
Study Design: RCT
Setting: Telephone
Target Audience: Pregnant smokers in the first 27 weeks of gestation who are firsttime callers to a state quitline
Data Source: Self- report telephone interviews, saliva samples
Sample Size: 1173
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Midwife, Referrals
Intervention Description: This was a demonstration project designed to assess whether frequency of midwives’ smoking cessation advice within the home environment had an impact on smoking rates for the women and their wider household contacts over a 15 month period.
Conclusion: Although midwifery care is provided within, and acknowledges the woman’s context, the majority of women in this project faced considerable day-to-day challenges to becoming smoke- free, as they lived in households with others who also smoked. Broad strategies are needed to reduce smoking, that reach beyond the realm of midwifery practice and the health care sector, such as wider tobacco control policies, public health campaigns and smoke-free environments.
Study Design: Cohort /Prospective observational study
Setting: Home-based midwife services
Target Audience: Pregnant women who smoked receiving midwife care in New Zealand
Data Source: Standard point of care data form
Sample Size: 6 midwives, 101 women
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): NATIONAL, Campaign
Intervention Description: In 2012, the Centers for Disease Control and Prevention initiated a national anti-smoking campaign, Tips from Former Smokers (Tips). As a result of the campaign, quit attempts among smokers increased in the general population by 3.7 percentage points. In the current study, we assessed the effects of Tips on smoking cessation in pregnant women.
Conclusion: Exposure to a national anti-smoking campaign for a general audience was associated with smoking cessation in pregnant women.
Study Design: Quasi experimental cross sectional
Setting: State live birth databases
Target Audience: Pregnant women who gave birth in Indiana, Kentucky and Ohio
Data Source: State standard certificate of live birth questionnaire
Sample Size: 60,747 study group, 209,053 population/control
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Navigation, Other Person-to-Person Education, Referrals
Intervention Description: We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services.
Conclusion: The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.
Study Design: Quasi experimental cross sectional -pilot
Setting: University obstetric and gynecology clinics
Target Audience: Pregnant women over 18, smoked and expressed interest in quitting
Data Source: Expired air carbon monoxide (EACO), self-report, standardized scales
Sample Size: 50
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Telephone Support
Intervention Description: To evaluate the impact of text messaging on smoking cessation rates among pregnant women in addition to standard of care (SOC) smoking cessation services. Our SOC includes pharmacist-driven education with or without nicotine patch or bupropion.
Conclusion: Text messaging had minimal impact on improving smoking cessation rates in the obstetric population. However, further research is warranted because of the underpowered nature of this trial. Given the detrimental effects of smoking in pregnancy, more comprehensive cessation strategies are warranted.
Study Design: RCT- pilot
Setting: Maternal fetal care center
Target Audience: English-speaking pregnant women at least 18 years old receiving care at the maternal fetal care center and were willing to set a smoking *quit* date prior to 35 weeks gestation.
Data Source: Self-report, exhaled carbon monoxide levels (eCO)
Sample Size: 49
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Other Person-to-Person Education, PROVIDER/PRACTICE, Outreach (Provider)
Intervention Description: This article describes the smoking behavior outcomes of a feasibility project testing a proactive approach, utilizing Māori voluntary community health workers to identify and reach Māori pregnant women who smoke and provide cessation support.
Conclusion: Aunties are well-placed to find pregnant women and provide cessation support and referral in a way consistent with traditional Māori knowledge and practices. This study suggests such an intervention could increase quit attempts and increase use of effective cessation methods. A more robust study is warranted to develop an enhanced Aunties intervention.
Study Design: Prospective intervention trial- evaluation
Setting: Home-based culturally tailored community health smoking cessation support
Target Audience: Pregnant Māori women smokers
Data Source: In person questionnaires, interviews, and hospital birth records
Sample Size: 67
Age Range: Not specified

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Motivational Interviewing, Referrals, Educational Material
Intervention Description: Home visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied.
Conclusion: While a significant impact on smoking cessation was seen, this study finds a less-clear impact on smoking reduction among women in home visiting programs. As home visiting programs continue to expand, it will be important to best identify effective ways to support tobacco-related harm reduction within vulnerable families.
Study Design: Cohort - Mixed methods using a retrospective cohort of propensity score
Setting: Home visiting programs
Target Audience: English or Spanish speaking mothers who smoked during pregnancy who currently participated in a home visiting program and received welfare benefits
Data Source: Enrollment data, in-person or telephone interviews, birth certificate data
Sample Size: 10,296 women: 2595 study participants and 7701 controls
Age Range: Not specified