Smoking cessation intervention in puerperium: A systematic review and meta-analysis

INTRODUCTION Smoking during pregnancy and the postpartum period poses significant risks to maternal and neonatal health. Despite initial reductions in smoking rates during pregnancy, many women relapse post-delivery, influenced by factors such as socioeconomic status, partner's smoking status, and depressive symptoms. This systematic review explores smoking cessation interventions specifically designed for the postpartum period. METHODS We searched the literature for studies related to tobacco cessation in the postpartum period, utilizing the electronic databases PubMed and Scopus. The search strategy was developed using the following keywords in all combinations: 'tobacco cessation', 'smoking cessation', 'quitting smoking', 'vaping cessation' and 'postnatal', 'postpartum', 'childbearing', and 'puerperium'. Various interventions were examined, including technology-based approaches, motivational interviewing, cognitive-behavioral and pharmacological interventions. RESULTS Factors associated with relapse included the partner's smoking status, depressive symptoms, and a lack of breastfeeding. Motivations for cessation included concerns for infant health, support from partners, and financial incentives. Methods for confirming smoking cessation included exhaled carbon monoxide measurement and salivary cotinine detection. Findings highlight the importance of ongoing support from health professionals, particularly during the postpartum period, to promote smoking cessation and prevent relapse. Additionally, interventions targeting family members' smoking behaviors and emphasizing the health benefits of breastfeeding are crucial. We also explored varenicline, nicotine replacement therapy, and electronic cigarettes as cessation aids, finding mixed attitudes among participants. CONCLUSIONS Overall, this review underscores the need for tailored interventions and continued support to address smoking cessation during the vulnerable postpartum period, ultimately safeguarding the health of both mothers and infants.