Introduction
Pregnant smokers are advised to quit; however, many struggle to do so. Behavioral
counseling can increase quitting success, but the efficacy of telephone counseling
for pregnant smokers has not been established. This study tests the efficacy of pregnancy-specific
counseling, embedded in the ongoing operations of a state quitline.
Design
In this two-group RCT, participants were randomly assigned to the intervention (telephone
counseling plus self-help materials, n=584) or the control group (self-help materials only, n=589).
Setting/participants
Participants were pregnant smokers (N=1,173) in the first 27 weeks of gestation who
called a state quitline between September 2000 and May 2003 for help with quitting.
Intervention
The primary component of the intervention was telephone counseling using a semi-structured
protocol developed specifically for pregnant smokers. It drew its basic structure
and clinical content from a previously tested counseling protocol for adult quitline
callers, while including pregnancy-specific content and additional counseling sessions
(nine rather than the standard five).
Main outcome measures
Subjects were evaluated on prolonged abstinence at the third trimester (about 29 weeks’
gestation) and at 2 and 6 months postpartum. Data were analyzed in 2015.
Results
Abstinence was higher for the intervention than the control group at the end of pregnancy
(30-day abstinence, 29.6% vs 20.1%; p<0.001); 2 months postpartum (90-day abstinence, 22.1% vs 14.8%; p<0.001); and 6 months postpartum (180-day abstinence, 14.4% vs 8.2%; p<0.001). Cotinine-corrected (≤13 ng/mL) 7-day abstinence rates at the end of pregnancy
supported the intervention effect (35.8% vs 22.5%, p<0.001).
Conclusions
A pregnancy-specific counseling protocol, embedded in a state quitline, was effective
in helping pregnant smokers quit and stay quit postpartum. Wide adoption of this intervention
could help reduce the rate of maternal smoking and prevent its devastating health
consequences.
Trial Registration
This study is registered at www.clinicaltrials.gov NCT02144883.
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Article info
Publication history
Published online: April 04, 2016
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© 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
