Clinical interventions to reduce secondhand smoke exposure among pregnant women: a systematic review.
OBJECTIVE
To conduct a systematic review of clinical interventions to reduce secondhand smoke (SHS) exposure among non-smoking pregnant women.


METHODS
We searched 16 databases for publications from 1990 to January 2013, with no language restrictions.


METHODS
Papers were included if they met the following criteria: (1) the study population included non-smoking pregnant women exposed to SHS, (2) the clinical interventions were intended to reduce SHS exposure at home, (3) the study included a control group and (4) outcomes included either reduced SHS exposure of non-smoking pregnant women at home or quit rates among smoking partners during the pregnancy of the woman.


METHODS
Two coders independently reviewed each abstract or full text to identify eligible papers. Two abstractors independently coded papers based on US Preventive Services Task Force criteria for study quality (good, fair, poor), and studies without biochemically-verified outcome measures were considered poor quality.


RESULTS
From 4670 papers, we identified five studies that met our inclusion criteria: four focused on reducing SHS exposure among non-smoking pregnant women, and one focused on providing cessation support for smoking partners of pregnant women. All were randomised controlled trials, and all reported positive findings. Three studies were judged poor quality because outcome measures were not biochemically-verified, and two were considered fair quality.


CONCLUSIONS
Clinical interventions delivered in prenatal care settings appear to reduce SHS exposure, but study weaknesses limit our ability to draw firm conclusions. More rigorous studies, using biochemical validation, are needed to identify strategies for reducing SHS exposure in pregnant women.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Van T
VT
Tong
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Patricia M
PM
Dietz
Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Italia V
IV
Rolle
Research Triangle Institute, International, Atlanta, Georgia, USA.
Sara M
SM
Kennedy
Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
William
W
Thomas
Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Lucinda J
LJ
England
D015415:Biomarkers / Q000378:metabolism; D002248:Carbon Monoxide / Q000378:metabolism*; D005260:Female; D006801:Humans; D018811:Maternal Exposure / Q000517:prevention & control*; D009538:Nicotine / Q000378:metabolism*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*
D015415:Biomarkers; D014028:Tobacco Smoke Pollution; D009538:Nicotine; D002248:Carbon Monoxide
Environmental tobacco smoke; clinical interventions; non-smoking pregnant women; partner cessation; pregnancy; secondhand smoke