Efficacy of a nurse-delivered intervention to prevent and delay postpartum return to smoking: The Quit for Two Trial
Mené aux Etats-Unis auprès de 382 femmes enceintes, cet essai multicentrique évalue, du point de vue du taux d'abstinence tabagique 12 mois après l'accouchement, l'efficacité d'un accompagnement infirmier post-partum, personnalisé en fonction du risque de rechute tabagique
Introduction : Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (e.g., had strong intentions to return). Methods : We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum. Results : Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences (Control: 36% (95% CI: 29-43) vs. Intervention: 35% (95% CI: 28-43), p=0.81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%). Conclusions : Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking.