Re‐starting smoking in the postpartum period after receiving a smoking cessation intervention: a systematic review

AIMS: In pregnant smoking cessation trial participants, to estimate (1) among women abstinent at the end of pregnancy, the proportion who re‐start smoking at time‐points afterwards (primary analysis) and (2) among all trial participants, the proportion smoking at the end of pregnancy and at selected time‐points during the postpartum period (secondary analysis). METHODS: Trials identified from two Cochrane reviews plus searches of Medline and EMBASE. Twenty‐seven trials were included. The included trials were randomized or quasi‐randomized trials of within‐pregnancy cessation interventions given to smokers who reported abstinence both at end of pregnancy and at one or more defined time‐points after birth. Outcomes were validated biochemically and self‐reported continuous abstinence from smoking and 7‐day point prevalence abstinence. The primary random‐effects meta‐analysis used longitudinal data to estimate mean pooled proportions of re‐starting smoking; a secondary analysis used cross‐sectional data to estimate the mean proportions smoking at different postpartum time‐points. Subgroup analyses were performed on biochemically validated abstinence. RESULTS: The pooled mean proportion re‐starting at 6 months postpartum was 43% [95% confidence interval (CI) = 16–72%, I (2) = 96.7%] (11 trials, 571 abstinent women). The pooled mean proportion smoking at the end of pregnancy was 87% (95% CI = 84–90%, I (2) = 93.2%) and 94% (95% CI = 92–96%, I (2) = 88%) at 6 months postpartum (23 trials, 9262 trial participants). Findings were similar when using biochemically validated abstinence. CONCLUSIONS: In clinical trials of smoking cessation interventions during pregnancy only 13% are abstinent at term. Of these, 43% re‐start by 6 months postpartum.