Efficacy and safety of pharmacotherapy for smoking cessation among pregnant smokers: a meta-analysis.

The efficacy and safety of pharmacotherapy for smoking cessation among pregnant smokers has not yet been established. To investigate the efficacy and safety of pharmacotherapy for smoking cessation among pregnant smokers. A search was made of PubMed, Embase and CENTRAL in June 2011. Randomised controlled trials (RCTs), quasi-RCTs and retrospective or prospective controlled studies were included. The main analyses were designed to examine the efficacy of pharmacotherapy for smoking cessation among pregnant smokers based on the longest follow-up data available and from data obtained at the latest available time-point in pregnancy in each study. Of 74 articles identified from the databases, seven studies (five RCTs, one quasi-RCT and one prospective study) involving a total of 1386 pregnant smokers, 732 in the intervention groups and 654 in the control groups, were included in the final analyses. In a fixed-effects meta-analysis of all seven studies based on the longest follow-up data available, pharmacotherapy had a significant effect on smoking cessation (relative risk [RR] 1.80; 95% confidence interval [CI] 1.32-2.44). Subgroup meta-analysis by type of study design also showed similar findings for RCTs (RR 1.48; 95% CI 1.04-2.09) and other types of studies (RR 3.25; 95% CI 1.65-6.39). The abstinence rate at late pregnancy in the intervention ranged from 7 to 22.6% (mean abstinence rate 13.0%; 95% CI 10.9-15.2%). A few minor adverse effects and serious adverse effects were reported in several studies. This study indicates that there may be clinical evidence to support the use of pharmacotherapy for smoking cessation among pregnant smokers. Further RCTs are needed. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.