What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis

Gillian Sandra Gould, Laura Twyman, Leah Stevenson, Gabrielle R. Gribbin, Billie Bonevski, Kerrin Palazzi, Yael Bar Zeev

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)

Abstract

Background Pregnancy is an opportunity for health providers to support women to stop smoking. Objectives Identify the pooled prevalence for health providers in providing components of smoking cessation care to women who smoke during pregnancy. Design A systematic review synthesising original articles that reported on (1) prevalence of health providers' performing the 5As ('Ask', ' Advise', ' Assess', ' Assist', ' Arrange'), prescribing nicotine replacement therapy (NRT) and (2) factors associated with smoking cessation care. Data sources MEDLINE, EMBASE, CINAHL and PsycINFO databases searched using ' smoking', ' pregnancy' and ' health provider practices'. Eligibility criteria for selecting studies Studies included any design except interventions (self-report, audit, observed consultations and women's reports), in English, with no date restriction, up to June 2017. Participants Health providers of any profession. Data extraction, appraisal and analysis Data were extracted, then appraised with the Hawker tool. Meta-analyses pooled percentages for performing each of the 5As and prescribing NRT, using, for example, ' often/always' and ' always/all'. Meta-regressions were performed of 5As for ' often/always'. Results Of 3933 papers, 54 were included (n=29 225 participants): 33 for meta-analysis. Health providers included general practitioners, obstetricians, midwives and others from 10 countries. Pooled percentages of studies reporting practices ' often/always' were: ' Ask' (n=9) 91.6% (95% CI 88.2% to 95%); 'Advise' (n=7) 90% (95% CI 72.5% to 99.3%), ' Assess' (n=3) 79.2% (95% CI 76.5% to 81.8%), ' Assist (cessation support)' (n=5) 59.1% (95% CI 56% to 62.2%), ' Arrange (referral)' (n=6) 33.3% (95% CI 20.4% to 46.2%) and ' prescribing NRT' (n=6) 25.4% (95% CI 12.8% to 38%). Heterogeneity (I 2) was 95.9%-99.1%. Meta-regressions for ' Arrange' were significant for year (p=0.013) and country (p=0.037). Conclusions Health providers ' Ask', ' Advise' and ' Assess' most pregnant women about smoking. 'Assist', ' Arrange' and ' prescribing NRT' are reported at lower rates: Strategies to improve these should be considered.

Original languageEnglish
Article numbere026037
Number of pages13
JournalBMJ Open
Volume9
Issue number8
DOIs
Publication statusPublished - Aug 2019
Externally publishedYes

Keywords

  • healthcare providers
  • maternal health
  • pregnancy
  • smoking
  • smoking cessation

Fingerprint

Dive into the research topics of 'What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this