Summary of findings for the main comparison. Separate intervention comparisons for supporting women to stop smoking in pregnancy (comparisons 1‐19).
| Separate intervention comparisons for supporting women to stop smoking in pregnancy (comparisons 1‐19) | ||||||
|
Patient or population: Pregnant women who smoke
Setting: Any
Outcome: Smoking abstinence in late pregnancy Comparison: Usual care unless other comparison indicated | ||||||
| Interventions and comparisons | Anticipated absolute effects* (95% CI) |
Relative effect
(95% CI) *these footnotes outline consistent findings |
№ of participants (studies) | Quality of the evidence (GRADE) | Comments (details of variations from main results) | |
| Risk with comparison | Risk with main intervention strategy | |||||
| Counselling vs usual care | Study population | RR 1.44 (1.19 to 1.73) 3 | 12,432 (30 RCTs) 2 | ⊕⊕⊕⊕ HIGH 1 | No clear effect when compared to an alternative counselling intervention (RR 1.15, 95% CI 0.86 to 1.53) or if 1 component of a broader maternal health intervention (RR 0.93, 95% CI 0.69 to 1.25) | |
| 9 per 100 2 | 13 per 100 (11 to 16) | |||||
| Health education vs usual care | Study population | RR 1.59 (0.99 to 2.55) 5 | 629 (5 RCTs) | ⊕⊕⊕⊝ MODERATE 4 | ||
| 8 per 100 | 12 per 100 (8 to 20) | |||||
| Feedback vs usual care | Study population | RR 4.39 (1.89 to 10.21) 6 | 355 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 4 | No clear effect when compared to a less intensive (RR 1.29, 95% CI 0.75 to 2.20) or alternative intervention; or 1 component of broader maternal health intervention (RR 2.11 95% CI 0.98 to 4.57) | |
| 4 per 100 | 17 per 100 (7 to 39) | |||||
| Incentives vs alternative interventions 7 | Study population | RR 2.36 (1.36 to 4.09) 8 | 212 (4 RCTs) | ⊕⊕⊕⊕ HIGH | ||
| 16 per 100 | 37 per 100 (21 to 64) | |||||
| Social support vs less intensive interventions 9 | Study population | RR 1.21 (0.93 to 1.58) 10 | 781 (7 RCTs) | ⊕⊕⊕⊕ HIGH | ||
| 19 per 100 | 23 per 100 (18 to 31) | |||||
| Exercise vs usual care | Study population | RR 1.20 (0.72 to 2.01) | 785 (1 RCT) | ⊕⊕⊕⊝ MODERATE 4 | ||
| 6 per 100 | 8 per 100 (5 to 13) | |||||
| Other (active dissemination vs passive dissemination) | Study population | RR 1.63 (0.62 to 4.32) | 194 (1 RCT) | ⊕⊕⊕⊝ MODERATE 4 | ||
| 6 per 100 | 10 per 100 (4 to 27) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Not downgraded for moderate heterogeneity (49%) as while there was some inconsistency in the magnitude, most RRs favoured counselling.
2 All control group risks are mean values of control group among included studies.
3 While there was no clear difference from this primary result, effect sizes varied if results restricted to biochemically validated smoking cessation (RR 1.23, 95% CI 1.04 to 1.45) or compared to less intensive interventions (RR 1.25, 95% CI 1.07 to 1.47).
4 Downgraded as relatively small numbers and wide confidence intervals.
5 Also no clear effect when compared to a less intensive or alternative intervention, restricted to biochemically validated cessation, single/multiple subgroups, provided as 1 component of a broader maternal health intervention, or are provided as a technological intervention only.
6 Remains clear effect when restricted to single study with biochemically validated cessation
7 Effect not calculable in usual care comparison due to zero cell counts, and not pooled in less intensive comparison due to substantial heterogeneity (I2 = 84%)
8 Clear effect also seen in subset of 3 counselling interventions which included lottery tickets (RR 1.72, 95% CI 1.04 to 2.85).
9 No usual care comparisons for this intervention
10 Remains unclear when restricted to biochemically validated cessation, all subgroups, when partner intervention removed and when provided as part of a broader maternal health intervention.