Recommended cessation counselling for pregnant women who smoke: a review of the evidence

Objective-To review the evidence base underlying recommended cessation coun selling for pregnant women who smoke, as it applies to the steps identified in the Agency for Healthcare Research and Quality's publication, Treating tobacco use and dependence: a clinical practice guideline. Data sources-Secondary analysis of literature reviews and meta-analyses. Data synthesis-A brief cessation counselling session of 5-15 minutes, when delivered by a trained provider with the provision of pregnancy specific, s elf help materials, significantly increases rates of cessation among pregna nt smokers. This low intensity intervention achieves a modest but clinicall y significant effect on cessation rates, with an average risk ratio of 1.7 (95% confidence interval 1.3 to 2.2). There are five components of the reco mmended method-"ask, advise, assess, assist, and arrange". Conclusions-We recommend these evidence based procedures be adopted by all prenatal care providers. The use of this evidence based intervention is fea sible in most office or clinic settings offering prenatal care and tan be i mplemented without inhibiting other important aspects of prenatal care or d isrupting patient flow. If implemented widely, this approach has the potent ial to achieve an important reduction in a number of adverse maternal, infa nt, and pregnancy outcomes and to reduce associated, excess health care cos ts.