G Grangé1, I Berlin2, F Bretelle3, C Bertholdt4, P Berveiller5, J Blanc6, C DiGuisto7, V Dochez8, C Garabedian9, P Guerby10, A Koch11, M Le Lous12, E Perdriolle-Galet13, V Peyronnet14, E Rault15, H Torchin16, G Legendre17. 1. Maternité Port-Royal, université de Paris, AP-HP, 75014 Paris, France. Electronic address: gilles.grange@aphp.fr. 2. Département de pharmacologie, AP-HP, 75000 Paris, France; Centre universitaire de médecine générale et de santé publique, 1000 Lausanne, Suisse. 3. 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. 4. Pôle de la femme, maternité régionale du CHRU de Nancy, 10, rue Dr-Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France. 5. Service de gynécologie-obstétrique, CHI Poissy-St-Germain-en-Laye, 78300 Poissy, France. 6. Service de gynécologie obstétrique, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; EA3279, CEReSS, health service research and quality of life center, université Aix-Marseille, 13284 Marseille, France. 7. 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; Maternité Olympe de Gouges, centre hospitalier régional universitaire Tours, Tours, France; Université François-Rabelais, 37000 Tours, France. 8. Service de gynécologie-obstétrique, CHU de Nantes, 44093 Nantes, France. 9. EA 4489 - Perinatal Environment and Health, université de Lille, hôpital Jeanne-de-Flandre, clinique d'obstétrique, CHU de Lille, 59000 Lille, France. 10. Service de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France. 11. Service de gynécologie-obstétrique, CHU de Strasbourg, 67000 Strasbourg, France. 12. Département de gynécologie obstétrique et médecine de la reproduction, CHU de Rennes, Rennes, France; LTSI-Inserm, université de Rennes 1, UMR 1099, 35000 Rennes, France. 13. Pôle de la femme, maternité régionale du CHRU de Nancy, 10, rue Dr-Heydenreich, 54000 Nancy, France. 14. Service de gynécologie obstétrique, hôpital L.-Mourier, AP-HP, 92700 Colombes, France. 15. Hôpital Femme-Mère-Enfant, 69500 Bron, France. 16. Service de médecine et réanimation néonatales de Port-Royal, AP-HP, 75014 Paris, France; Université de Paris, epidemiology and statistics research center/CRESS, Inserm, INRA, 75004 Paris, France. 17. CESP-Inserm, U1018, Team 7, Genre, Sexual and Reproductive Health, Paris-Sud University, Paris-Saclay University, UVSQ, Inserm, 94800 Villejuif, France; Department of obstetrics and gynecology, Angers university hospital, 49000 Angers, France.
Abstract
OBJECTIVES: To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy. METHODS: Systematic review of the international literature. We identified papers published between January 2003 and April 2019 in Cochrane PubMed, and Embase databases with predefined keywords. All reports published in French and English relevant to the areas of focus were included and classified according the level of evidence ranging from 1 (highest) to 4 (lowest). The strength of the recommendations was classified according to the Haute Autorité de santé, France (ranging from A, highest to C, lowest). RESULTS: "Counseling", involving globally all kind of non-pharmacological interventions, has a modest benefit on smoking cessation, birth weight and prematurity. Moderate physical activity did not show a significant effect on smoking cessation. The systematic use of feedback by measuring the expired air carbon monoxide concentration do not influence smoking abstinence but it may be used in establishing a therapeutic alliance. The use of self-help interventions and health education are recommended in helping pregnant smokers quit. The prescription of nicotine replacement therapies (NRT) may be offered to any pregnant woman who has failed stopping smoking without medication This prescription can be initiated by the health care professional taking care of the pregnant woman in early pregnancy. There is no scientific evidence to propose the electronic cigarette for smoking cessation to pregnant smokers; it is recommended to provide the same advice and to use methods that have already been evaluated. The use of waterpipe (shisha/narghile) during pregnancy is associated with decreased fetal growth. It is recommended not to use waterpipe during pregnancy. Breastfeeding is possible in smokers, but less often initiated by them. Although its benefit for the child's development is not demonstrated to date, breastfeeding allows the mother to reduce or stop smoking. The risk of postpartum relapse is high (up to 82% at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. CONCLUSIONS: Smoking during pregnancy concerns more than hundred thousand women and their children per year in France. It is a major public health burden. Health care professionals should be mobilized for reducing or even eradicating it.
OBJECTIVES: To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy. METHODS: Systematic review of the international literature. We identified papers published between January 2003 and April 2019 in Cochrane PubMed, and Embase databases with predefined keywords. All reports published in French and English relevant to the areas of focus were included and classified according the level of evidence ranging from 1 (highest) to 4 (lowest). The strength of the recommendations was classified according to the Haute Autorité de santé, France (ranging from A, highest to C, lowest). RESULTS: "Counseling", involving globally all kind of non-pharmacological interventions, has a modest benefit on smoking cessation, birth weight and prematurity. Moderate physical activity did not show a significant effect on smoking cessation. The systematic use of feedback by measuring the expired air carbon monoxide concentration do not influence smoking abstinence but it may be used in establishing a therapeutic alliance. The use of self-help interventions and health education are recommended in helping pregnant smokers quit. The prescription of nicotine replacement therapies (NRT) may be offered to any pregnant woman who has failed stopping smoking without medication This prescription can be initiated by the health care professional taking care of the pregnant woman in early pregnancy. There is no scientific evidence to propose the electronic cigarette for smoking cessation to pregnant smokers; it is recommended to provide the same advice and to use methods that have already been evaluated. The use of waterpipe (shisha/narghile) during pregnancy is associated with decreased fetal growth. It is recommended not to use waterpipe during pregnancy. Breastfeeding is possible in smokers, but less often initiated by them. Although its benefit for the child's development is not demonstrated to date, breastfeeding allows the mother to reduce or stop smoking. The risk of postpartum relapse is high (up to 82% at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. CONCLUSIONS: Smoking during pregnancy concerns more than hundred thousand women and their children per year in France. It is a major public health burden. Health care professionals should be mobilized for reducing or even eradicating it.
Authors: Julie Blanc; Barthélémy Tosello; Mikael O Ekblad; Ivan Berlin; Antoine Netter Journal: Int J Environ Res Public Health Date: 2021-04-11 Impact factor: 3.390