Voucher to help women quit smoking during pregnancy

Offering shopping vouchers up to £400 to stop smoking during pregnancy as a supplement to the highly effective conventional smoking cessation aid, a trial published by the BMJ today.

Results show rewards pregnant women In this way, the proportion of people who remained smoke-free at the end of pregnancy was more than doubled, compared with those who received conventional support, and could save costs for the NHS in the long term.

However, they also show that most women stop smoke during pregnancy recurred six months after their child was born.

Smoking during pregnancy has been linked to a range of problems including an increased risk of stillbirth, sudden infant death syndrome, asthma and childhood obesity.

Although the percentage of women who smoke during pregnancy has halved in the last 20 years, a significant number continue to smoke during pregnancy and tend to be harder to reach.

Previous research has shown that financial incentives may increase smoking cessation in pregnant women, but evidence from large UK trials is lacking.

To address this, the researchers drew on data from a successful phase 2 feasibility trial in Glasgow, Scotland to assess whether financial incentives increase smoking cessation in pregnancy when used in conjunction with current UK smoking cessation services.

Their findings were based on 941 pregnant women (mean age 28) recruited from seven smoking cessation services in Scotland, Northern Ireland and the UK between January 2018 and April 2020.

Participants said they smoked (at least one cigarette in the past week) during their first prenatal visit, on average when they were 11 weeks into their pregnancy. Participants were then randomly assigned to an intervention group (471) or a control group (470).

The control group was provided with conventional smoking cessation support, including counseling by specially trained staff and free nicotine replacement therapy.

The intervention group was provided with the usual support plus a voucher for up to £400 ($440; €455) to encourage setting quit and abstinence dates throughout pregnancy.

Participants reported abstinence at weeks 4 and 12 and verified by a carbon monoxide breath test. A final voucher was given to those who reported still not smoking during the late stages of pregnancy (34 to 38 weeks gestation), as verified by a saliva test.

A range of factors are likely to influence including the mother’s age, years of smoking, income, use of nicotine replacement therapy and e-cigarettes, time of birth and birth weight of the baby. has been taken into account.

More women in the incentive group (71%) than in the control group (64%) attended smoking cessation services and set a quit date. Saliva tests confirmed that 126 (27%) of the women in the intervention group had stopped smoking by late pregnancy compared with 58 (12%) controls.

However, the rate of abstinence measured 6 months after delivery was low in both groups (6% in the intervention group versus 4% in the control group), suggesting that most women who stopped smoking relapse not long after. when giving birth.

Overall, the birth weight of 443 children participating in the intervention and 450 control children did not differ significantly between the groups (mean 3.18 kg versus 3.13 kg).

The researchers found a clinically important but insignificant increase in birth weight (10%) in people who quit when encouraged and would not have quit without it. , but they say further analysis is needed to better understand the relevance of this finding.

The severity of preterm birth between the groups was similar, and all serious adverse events, such as miscarriage and stillbirth, were unrelated to the intervention.

It was a well-designed trial, but the researchers conceded that only 23% of women screened with smoking cessation services were enrolled in the trial, which may be overestimated. high rate of quitting smoking in both groups. Furthermore, almost all of the participants were white, so the results may not apply to other groups.

However, they say these results support the implementation advocated in the NICE guidelines by showing that adding financial incentives to existing smoking cessation support for pregnant women is efficient, does not disrupt existing UK smoking cessation services and can save the NHS costs in the long run.

Future research should examine the form and extent of incentives with which frequency of achieving the most effective and cost-effective results, they write. Continued encouragement up to 12 months postpartum to prevent recurrence is also being considered in an ongoing trial.

Financial incentives to maintain smoking cessation during pregnancy are among the most cost-effective interventions in health care and a key opportunity to reduce smoking. health inequalities In early lifeThe researchers said in a linked editorial.

However, they point out that the partners of most pregnant women who smoke are also smokers, and argue that interventions “should also target family members who smoke, to create a a smoke-free home for mother and child.” Smoking cessation support for pregnant women “should also continue after childbirth to improve disappointing long-term abstinence rates,” they added.

“The medical community There is now good evidence supporting effective tools, such as financial incentives, to reduce the health burden associated with smoking during pregnancy. These tools should be implemented wherever possible to protect and improve the health of women, their children and their families,” the researchers concluded.