Systematic Review of the Literature on Postpartum Care: Effectiveness of Interventions for Smoking Relapse Prevention, Cessation, and Reduction in Postpartum Women

BACKGROUND: Many women stop smoking during pregnancy and relapse again either later in the pregnancy or in the postpartum period. Smoking is harmful to mothers, and environmental tobacco smoke is harmful for children. This systematic review examined the published evidence for the effectiveness of postpartum interventions that prevent relapse (current persons who have stopped but start smoking again), improve cessation rates (current smokers who stop smoking), and reduce smoking (number of cigarettes smoked per day) in postpartum women. METHODS: MEDLINE, CINAHL, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postpartum women. The initial literature search was done in 1999 and enhanced in 2003 and 2005. Randomized controlled trials that examined relapse prevention, smoking cessation, or smoking reduction interventions in the postpartum period were reviewed in this report. Data were extracted in a systematic manner, and the quality of each study was reviewed. RESULTS: Five papers were published based on three trials for which data were extracted and summarized. Our review of these trials showed no statistically significant benefits of advice materials and counseling interventions in hospital (Vancouver), pediatricians' offices (Portland), or child health centers (Stockholm) on relapse prevention, cessation rates, or smoking reduction in the postpartum period. Although the interventions had little effect on the major smoking outcomes, some positive attitudinal and knowledge changes were reported. CONCLUSION: This review found no evidence from the randomized controlled trial literature to date to support implementing postpartum smoking cessation interventions, such as providing advice materials and counseling, insofar as they were delivered in the trials reviewed.