SMOKING RELAPSE PREVENTION DURING PREGNANCY - A TRIAL OF COORDINATED ADVICE FROM PHYSICIANS AND INDIVIDUAL COUNSELING

Introduction: Our objective was to examine the efficacy of physicians' advice and referral to individual counseling in preventing relapse to smoking among women who were smokers early in pregnancy, but quit pri or to their first prenatal visit. Design: A randomized controlled tria l of prompted physician's advice and individual relapse prevention cou nseling during pregnancy compared to usual physician advice. Smoking s tatus was assessed by self-report, exhaled carbon monoxide, and urinar y cotinine during pregnancy and by self-report 1 year postpartum. Resu lts: There were no significant differences in relapse rates between th e intervention and usual-care groups during pregnancy, nor at 1 year p ostpartum. Relapse rates were 23% in both groups at the 36-week visit, and 32% and 22%, respectively, 1 year postpartum. Younger age, higher motivation to resume smoking, and higher levels of exhaled carbon mon oxide at the first prenatal visit were predictive of relapse to smokin g during pregnancy. With the conservative assumption that all those lo st to followup relapsed, the combined l-year postpartum relapse rate, 51%, was 17 percentage points lower than we observed in an earlier rel apse prevention trial, and 15 percentage points lower than that observ ed nationally a decade earlier. Conclusion: Prompting physicians to pr ovide supportive advice combined with referral to individual relapse p revention counseling did not reduce smoking relapse rates during pregn ancy, or postpartum However, the level of attention paid to smoking by physicians in both intervention and usual-care groups during pregnanc y may have contributed to the relatively low relapse rates seen 1-year postpartum.