Bibliographic Info
GuidelineWHO recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy
Year of Publication2013
Issuing InstitutionWorld Health Organization
Recommendation
Status
Updated
Recommended in favor
Strong
Certainty of evidence
Moderate
Health-care providers should routinely offer advice and psychosocial interventions for tobacco cessation to all pregnant women, who are either current tobacco users or recent tobacco quitters.
Notes and Remarks
- 1.Psychosocial interventions involve behavioural support that may include one or more of the following: counselling, health education, incentives and peer or social support.
- 2.Psychosocial interventions should be offered to pregnant women who are current or former tobacco users as early in pregnancy as possible.
- 3.The recommendation for recent tobacco quitters is based on population-based studies in non-pregnant populations. Recent tobacco quitters may include women who used tobacco before the pregnancy, and who have either spontaneously quit or stopped tobacco use in the pre-conception period or in early pregnancy, before their first antenatal visit.
- 4.There is emerging evidence from some countries that the use of financial incentives may be more effective than other interventions. However, it is difficult to generalize the reported effectiveness to the global population as the evidence is limited and is derived from select small populations.
- 5.The Stages of Change approach is not effective in pregnancy. The Stages of Change approach to tobacco cessation suggests that health behaviour change involves progress through six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination (44). As this approach is not effective, all women should be offered support irrespective of their intention to quit.
- 6.More heavily dependent tobacco users may require high intensity interventions. Interventions should address concerns of the pregnant smokers about gaining weight as a result of tobacco cessation.
- 7.Interventions should recognize and address the impact of partner’s smoking status and their attitudes towards tobacco use or cessation.
- 8.Recognizing that there is no safe level of tobacco use, there is evidence of some benefit from reduction in smoking if quitting is not achieved.
- 9.Almost all existing evidence for interventions is for smokers of manufactured cigarettes, but emerging evidence suggests that similar psychosocial strategies could be applied to users of other forms of tobacco (smokeless tobacco, waterpipes, etc.). There is limited evidence that stopping use of smokeless and other forms of tobacco may improve some birth outcomes.
- 10.Given the cost-effectiveness of these interventions, and long-term cost recovery to the health system through tobacco-related disease burden being averted, programme cost should not be a deterrent to immediate implementation