BACKGROUND
Smoking cessation improves pregnancy outcomes, yet there is uncertainty around the
efficacy of models of antenatal intervention for smoking cessation in pregnancy.
OBJECTIVE
This study aimed to test the Smoking cessation Through Optimization of clinical care
in Pregnancy (STOP) clinic as an antenatal care pathway for smoking cessation in pregnancy.
The STOP intervention is a smoking cessation clinic staffed by a dedicated multidisciplinary
team of obstetricians, midwives, and smoking cessation practitioners, who provide
motivational and psychological support and intensive clinical monitoring of pregnancy.
STUDY DESIGN
This was a pragmatic randomized controlled trial of the STOP clinic compared with
routine antenatal care at a tertiary urban maternity hospital delivering >8000 infants
per year. The primary outcome measured was continuous abstinence from smoking before
28+0 weeks’ gestation, sustained throughout the duration of the pregnancy, and validated
using biological measures. The secondary outcomes included maternal and fetal morbidity,
delivery and neonatal outcomes, smoking outcomes, and qualitative measures.
RESULTS
A total of 436 women were randomized, with 430 women included in the primary outcome
analysis. Women attending the STOP antenatal clinic were more likely to quit smoking
compared with those in routine care (odds ratio, 3.62; 95% confidence interval, 1.43–9.17).
In addition, women who continued to smoke in the STOP clinic smoked fewer cigarettes
daily at the time of delivery compared with controls: 5±4 in the STOP clinic and 7±5
in the control group (odds ratio, 0.28; 95% confidence interval, 0.13–0.59). However,
this intervention did not alter postpartum relapse rates (4.3% intervention arm vs
1.5% control arm, not significant) at 4 to 6 months following delivery. The mean birthweight
was similar in the intervention and control arms; however, quitters in both groups
had infants with significantly higher birthweights compared with those of continued
smokers.
CONCLUSION
The STOP antenatal model of care leads to higher smoking cessation rates among pregnant
smokers and lower daily cigarette consumption at time of delivery. Currently, there
is no defined or dedicated antenatal pathway for pregnant smokers, despite the high-risk
nature of their pregnancies. Our findings suggest that improved smoking cessation
rates in pregnancy may be achieved using the holistic approach of the STOP model of
care.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & Gynecology MFMAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes.Nicotine Tob Res. 2004; 6: S125-S140
- Maternal smoking and the risk of still birth: systematic review and meta-analysis.BMC Public Health. 2015; 15: 239
- American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics and the Society for Maternal-Fetal Medicine. ACOG Practice Bulletin No. 204: fetal growth restriction.Obstet Gynecol. 2019; 133: e97-109
- Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.N Engl J Med. 2005; 352: 2477-2486
Chamberlain C, O'Mara-Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001055. https://doi.org/10.1002/14651858.CD001055.pub5.
- Pharmacological interventions for promoting smoking cessation during pregnancy.Cochrane Database Syst Rev. 2020; 3CD010078
- Smoking, attitudes to smoking and provision of smoking cessation advice in two teaching hospitals in Ireland: do smoke-free policies matter?.Heal Psychol Behav Med. 2015; 3: 142-153
- The behaviour change wheel: a new method for characterising and designing behaviour change interventions.Implement Sci. 2011; 6: 42
- Physical activity as an aid to smoking cessation during pregnancy (LEAP) trial: study protocol for a randomized controlled trial.Trials. 2012; 13: 186
- Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort.BMJ Open. 2017; 7e018746
StataCorp. Stata statistical software. Release 16. College Station, TX: StataCorp LLC; 2019.
- Smoking cessation through optimisation of clinical care in pregnancy: the STOP randomised controlled trial.Trials. 2019; 20: 550
NCSCT Training Standard. Third Edition, 2018. Editors: Sophia Papadakis and Andy McEwen. Published by National Centre for Smoking Cessation and Training. Available from: https://www.ncsct.co.uk/usr/pub/NCSCT_training_standard.pdf.
- Outcome criteria in smoking cessation trials: proposal for a common standard.Addiction. 2005; 100: 299-303
- Smoking cessation support and obstetric outcomes in an Irish maternity hospital.Eur J Obstet Gynecol Reprod Biol. 2019; 232: 1-4
- A national audit of smoking cessation services in Irish maternity units.Ir Med J. 2017; 110: 580
- A randomized trial of nicotine-replacement therapy patches in pregnancy.N Engl J Med. 2012; 366: 808-818
- Nicotine patches in pregnant smokers: randomised, placebo controlled, multicentre trial of efficacy.BMJ. 2014; 348: g1622
- Nicotine patches for pregnant smokers: a randomized controlled study.Obstet Gynecol. 2000; 96: 967-971
- Randomized, double-blind, placebo-controlled trial of nicotine replacement therapy in pregnancy.Curr Ther Res Clin Exp. 2001; 62: 274-278
- Nicotine replacement and behavioral therapy for smoking cessation in pregnancy.Am J Prev Med. 2007; 33: 297-305
- A randomized clinical trial of trans-dermal nicotine replacement in pregnant African-American smokers.Matern Child Health J. 2013; 17: 897-906
- A randomised-controlled pilot study using nicotine patches with pregnant women.Addict Behav. 2006; 31: 641-648
- The scientific basis of antenatal care. Report from a state-of-the-art conference.Acta Obstet Gynecol Scand. 1991; 70: 105-109
- Scientific basis for the content of routine antenatal care. II. Power to eliminate or alleviate adverse newborn outcomes; some special conditions and examinations.Acta Obstet Gynecol Scand. 1997; 76: 15-25
- Smoking cessation in pregnancy: a review of postpartum relapse prevention strategies.J Am Board Fam Pract. 2004; 17: 264-275
- Women's longitudinal patterns of smoking during the pre-conception, pregnancy and postnatal period: evidence from the UK infant feeding survey.PLoS One. 2016; 11e0153447
- Predictors of postpartum relapse to smoking.Drug Alcohol Depend. 2007; 90: 224-227
- Factors associated with smoking relapse in the postpartum period: an analysis of the child health surveillance system data in Southeast England.Nicotine Tob Res. 2013; 15: 904-909
- State Medicaid coverage for tobacco cessation treatments and barriers to coverage - United States, 2014-2015.MMWR Morb Mortal Wkly Rep. 2015; 64: 1194-1199
- Smoking cessation in pregnancy: a continuing challenge in the United States.Ther Adv Drug Saf. 2018; 9: 457-474
- Short-term health and economic benefits of smoking cessation: low birth weight.Pediatrics. 1999; 104: 1312-1320
- A dynamic, modifiable model for estimating cost-effectiveness of smoking cessation interventions in pregnancy: application to an RCT of self-help delivered by text message.Addiction. 2019; 114: 353-365
- Smoking and smoking cessation during early pregnancy and its effect on adverse pregnancy outcomes and fetal growth.Eur J Pediatr. 2010; 169: 741-748
- Biochemical verification of tobacco use and cessation.Nicotine Tob Res. 2002; 4: 149-159
- Factors associated with study attrition in a pilot randomised controlled trial to explore the role of exercise-assisted reduction to stop (EARS) smoking in disadvantaged groups.Trials. 2016; 17: 524
- The London exercise and pregnant smokers (LEAP) trial: a randomised controlled trial of physical activity for smoking cessation in pregnancy with an economic evaluation.Health Technol Assess. 2015; 19: 1-135
- Feasibility of recruitment to a behavioural smoking cessation intervention combined with ongoing online support.Eur J Public Health. 2019; 29: 170-172
Article info
Publication history
Published online: October 07, 2022
Accepted:
October 3,
2022
Received in revised form:
October 2,
2022
Received:
July 15,
2022
Footnotes
The authors report no conflict of interest.
This study was funded by the Coombe Women and Infants University Hospital and Friends of the Coombe charity. The funders had no role in any aspect of the study.
Randomized controlled trial registered on January 29, 2018, with first patient recruited on February 12, 2018 (ISRCTN 11214785. https://doi.org/10.1186/ISRCTN112147855).
Data sharing statements:
a. Will individual participant data be available (including data dictionaries)?
No.
b. What data in particular will be shared?
Not available.
c. What other documents will be available (eg, study protocol, statistical analysis plan, etc.)?
Study Protocol, Statistical Analysis Plan, Informed Consent Form, Patient Information Leaflets.
d. When will data be available (start and end dates)?
Not applicable.
e. How will data be shared (including with whom, for what types of analyses, and by what mechanism)?
Not applicable.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
