DOI: 10.1111/ajo.13745 ISSN:

A systematic review of interventions to increase the use of smoking cessation services for women who smoke during pregnancy

Cheryl Bailey, Poliana de Barros Medeiros, David A. Ellwood, Philippa Middleton, Christine J. Andrews, Vicki J. Flenady
  • Obstetrics and Gynecology
  • General Medicine


Although many pregnant women accept referrals to stop‐smoking support, the uptake of appointments often remains low.


The aim was to review the success of interventions to increase the uptake of external stop‐smoking appointments following health professional referrals in pregnancy.

Materials and Methods

Embase, PubMed, Cochrane Central Register of Controlled Trials, Scopus and CINAHL were searched in February 2023 for studies with interventions to increase the uptake rates of external stop‐smoking appointments among pregnant women who smoke. Eligible studies included randomised, controlled, cluster‐randomised, quasi‐randomised, before‐and‐after, interrupted time series, case–control and cohort studies. Cochrane tools assessing for bias and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed.


Two before‐and‐after studies were included, including a combined total of 1996 women who smoked during pregnancy. Both studies had a serious risk of bias, and meta‐analysis was not possible due to heterogeneity. One study testing carbon monoxide monitors and opt‐out referrals showed increased uptake of external stop‐smoking appointments, health professional referrals and smoking cessation rates compared to self‐identified smoking status and opt‐in referrals. Results were limited in the second study, which used carbon monoxide monitors, urinary cotinine levels and self‐disclosed methods to identify the smoking status with opt‐out referrals. Only post‐intervention data were available on the uptake of appointments to external stop‐smoking services. The number of health professional referrals increased, but change in smoking cessation rates was less clear.


There is insufficient evidence to inform practice regarding strategies to increase the uptake of external stop‐smoking appointments by women during pregnancy.

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