How can more smoking suspension during pregnancy become lifelong abstinence? Lessons learned about predictors, interventions, and gaps in our accumulated knowledge.

UNLABELLED: Maintenance of abstinence from cigarettes during pregnancy yields important benefits for both women and children, yet only 20%-30% of pregnancy cessation lasts 1 year postpartum. This paper reviews accumulated knowledge about factors that influence restarting smoking and the effectiveness of interventions to decrease it. Evidence from six trials and six multivariate predictor studies is provided, supplemented by qualitative and more focused quantitative studies. Studies were international, with diverse candidate predictors, intensity and timing of interventions, theory, designs, and measures of quitting and of maintenance postpartum. RECOMMENDATIONS: (a). Partner smoking must be addressed in interventions with cessation messages. (b). Intervention studies should include women of lower socioeconomic status and Black women. (c). Program developers and researchers should adopt a consistent standard for cessation. (d). Communication laboratory methods should test ways to increase intrinsic reasons for abstinence and success attributions to stable, internal causes. (e). Staging for postpartum smoking should supplant relapse prevention alone. (f). Among those whose intention it is to maintain nonsmoking postpartum, standard relapse prevention treatment is insufficient to combat environmental cues that also have been suspended for the pregnancy and typical problems of sleeplessness, stress, depression, and weight concern. (g). Interventions ideally should begin in late pregnancy, when postpartum smoking goals can be revised and plans made to manage postpartum issues. (h). Innovative methods for reducing postpartum problems should be tested. (i). Study of incentives for pregnancy cessation should include varying patterns, carryover to early postpartum months, and focus on their impact on long-term change.