OBJECTIVES: This aim of this study is to assess the clinical effectiveness of smoking cessation interventions available to women during pregnancy, both pharmacological and non-pharmacological (psychosocial).

METHODS: Searches were carried out for recent systematic reviews of eligible smoking cessation interventions in women during pregnancy. Two systematic reviews relevant to this HTA were identified, both Cochrane Reviews. These reviews were subsequently updated with additional studies that have emerged since the original review was published. Electronic searches were conducted in Medline, Embase and the Cochrane Register of Clinical Trials to identify RCTs comparing any eligible smoking cessation intervention in women during pregnancy to another eligible intervention or to no treatment.

RESULTS: A total of 73 relevant studies were identified, published between 1976 and 2016. The studies broadly support the view that smoking cessation interventions are effective in pregnancy. NRT is the only pharmacotherapy licensed for use in pregnant smokers who wish to quit, and its efficacy appears to be lower in pregnant smokers than in non-pregnant smokers. Eight trials investigated NRT use as a smoking cessation aid in pregnancy, and they were deemed of high quality. Some evidence of a beneficial effect was found for NRT in this group with a 41% increase in cessation rates, but this did not reach statistical significance.

The review identified 64 studies evaluating psychosocial interventions for smoking cessation in pregnancy. However, these were rated as being of low quality. There was some evidence to suggest that counselling, health education and financial incentives increase cessation rates in pregnant smokers.

CONCLUSIONS: Pregnant smokers should be offered a psychosocial intervention in the first instance. However, due to the limited effectiveness of interventions in pregnancy, smokers should be encouraged to quit prior to conception when more treatment options are available and therapy is more likely to succeed.