Smoking and smoking cessation in pregnancy. Synthesis of a systematic review - 19/07/20

Doi : 10.1016/j.jogoh.2020.101847

G. Grangé ^a,⁎ , I. Berlin ^b,^c, F. Bretelle ^d, C. Bertholdt ^e,^f, P. Berveiller ^g, J. Blanc ^h,ⁱ, C. DiGuisto ^c,^j,^k,^l, V. Dochez ^m, C. Garabedian ⁿ, P. Guerby ^o, A. Koch ^p, M. Le Lous ^q,^r, E. Perdriolle-Galet ^s, V. Peyronnet ^t,^z, E. Rault ^u, H. Torchin ^v,^w, G. Legendre ^x,^y
^a Maternité Port-Royal, Université de Paris, AP-HP.Centre, FHU Prema, 75014, Paris, France
^b Département de Pharmacologie, AP-HP, 75000, Paris, France
^c Centre Universitaire de Médecine Générale et de Santé Publique, 1011 Lausanne, Switzerland
^d Department of Obstetrics and Gynecology, Conception Hospital, Aix Marseille Université, Prenatal Diagnosis Timone Conception, IHU, IRD, Assistance Publique des Hôpitaux de Marseille (AP-HM), 13005, Marseille, France
^e Pôle de la Femme, Maternité Régionale du CHRU de Nancy, 10, Rue Dr-Heydenreich, 54000, Nancy, France
^f IADI, Inserm U1254, Rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
^g Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain-en-Laye, 78300, Poissy, France
^h Service de Gynécologie Obstétrique, Hôpital Nord, AP-HM, Chemin des Bourrely, 13015, Marseille, France
ⁱ EA3279, CEReSS, Health Service Research and Quality of Life Center, Université Aix-Marseille, 13284, Marseille, France
^j Université de Paris, Epidemiology and Statistics Research center/CRESS, Inserm (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, 75020, Paris, France
^k Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Tours, France
^l Université François-Rabelais, 37000, Tours, France
^m Service de Gynécologie-Obstétrique, CHU de Nantes, 44093, Nantes, France
ⁿ CHU Lille Clinique d'obstetrique Univ. LILLE ULR 2694 Évaluation des technologies de santé. F-59000 Lille, France
^o Service de Gynécologie Obstétrique, Hôpital Paule-de-Viguier, CHU de Toulouse, 330, Avenue de Grande-Bretagne, 31059, Toulouse, France
^p Service de Gynécologie-Obstétrique, CHU de Strasbourg, 67000, Strasbourg, France
^q Département de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Rennes, Rennes, France
^r LTSI-Inserm, Université de Rennes 1, UMR 1099, 35000, Rennes, France
^s Pôle de la Femme, Maternité Régionale du CHRU de Nancy, 10, Rue Dr-Heydenreich, 54000 Nancy, France
^t Service de Gynécologie Obstétrique, Hôpital L.-Mourier, AP-HP, 92700 Colombes, France
^u Hôpital Femme-Mère-Enfant, 69500, Bron, France
^v Service de Médecine et Réanimation Néonatales de Port-Royal, AP-HP, 75014 Paris, France
^w Université de Paris, Epidemiology and Statistics Research center/CRESS, Inserm, INRA, 75004, Paris, France
^x CESP-Inserm, U1018, Team 7, Genre, Sexual and Reproductive Health, Paris-Sud University, Paris-Saclay University, UVSQ, Inserm, 94800, Villejuif, France
^y Department of Obstetrics and Gynecology, Angers University Hospital, 49000, Angers, France
^z Université de Paris, Paris, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 19 July 2020
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Highlights

•	“Counselling”, i.e. all types of non-pharmacological interventions, has a moderate benefit on smoking cessation, birth weight and prematurity.
•	Nicotine replacement therapies (NRT) may be prescribed if failure to stop smoking after trying non-pharmacological therapies.
•	In cases of temporary relapse or resumption of smoking, it should be recommended to continue with NRT.
•	It is not recommended to let the smoking status interfere with the choice of how to feed the new-born infant.

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Abstract

Objectives

To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy and the post-partum period.

Study design

A systematic review of the international literature was undertaken between January 2003 and April 2019. MEDLINE, EMBASE databases and the Cochrane library were searched for a range of predefined key words. All relevant reports in English and French were classified according to their level of evidence ranging from 1(highest) to 4(lowest). The

strength of each recommendation was classified according to the Haute Autorité de Santé (French National Authority for Health) ranging from A (highest) to C (lowest).

Results

“Counselling”, including all types of non-pharmacological interventions, has a moderate benefit on smoking cessation, birth weight and prematurity. The systematic use of measuring expired air CO concentration does not influence smoking abstinence, however, it may be useful in assessing smoked tobacco exposure prior to and after quitting.

The use of self-help therapies and health education are recommended in helping pregnant smokers quit and should be advised by healthcare professionals.

Nicotine replacement therapies (NRT) may be prescribed to pregnant women who have failed to stop smoking after trying non-pharmacological interventions. Different modes of delivery and dosages can be used in optimizing their efficacy.

Smoking in the postpartum period is essential to consider. The same treatment options as during pregnancy can be used.

Conclusion

Smoking during pregnancy concerns more than a hundred thousand women each year in France resulting in a major public health burden. Healthcare professionals should be mobilised to employ a range of methods to reduce or even eradicate it.

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Keywords : Smoking during pregnancy, Pre-and post-natal effects, Smoking cessation during pregnancy