The Prevention of Smoking Relapse in Postpartum Women: A Systematic Review and Network Meta-analysis

Abstract

Objectives: To compare the effects of different interventions for maintaining smoking abstinence in postpartum individuals. Methods: We searched PubMed, EMBASE, CENTRAL, CINAHL, PsycINFO, and ProQuest up to February 2024. Randomized controlled trials (RCTs) that studied the effects of any interventions on maintaining smoking abstinence in postpartum individuals who quit smoking before delivery were included. A frequentist network meta-analysis using a random-effect model was performed to compare the efficacy of interventions cognitive behavioral therapy (CBT) and motivational interviewing (MI). The surface under the cumulative ranking curve was used to rank the intervention effects. The GRADE approach assessed evidence certainty. Results: We included 11 studies from 10 RCTs (3365 participants). Comparisons with standard care revealed that CBT [relative risk (RR) = 1.03; 95% CI: 0.86, 1.19], CBT-MI (RR = 1.41; 95% CI: 0.87, 2.27), and MI (RR = 1.06; 95% CI: 0.90, 1.24) failed to maintain smoking abstinence at 12 months postpartum. The absolute differences were imprecise, with wide CIs encompassing both potential increases and decreases in smoking abstinence: 7 more per 1000 (95% CI: -31, 43) for CBT, 92 more per 1000 (95% CI: -29, 284) for CBT-MI, and 13 more per 1000 (95% CI: -22, 54) for MI, all with moderate certainty evidence. Subgroup analyses for follow-up periods of <12 months indicated that CBT-MI (RR = 1.67; 95% CI: 1.08, 2.60) and MI (RR = 1.16; 95% CI: 1.01, 1.33) may improve the maintenance of smoking abstinence over the short term. Conclusions: CBT-MI and MI appear promising in improving the maintenance of smoking abstinence within 12 months postpartum, though further research is needed to enhance long-term abstinence.