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Am J Perinatol 2024; 41(S 01): e1901-e1907
DOI: 10.1055/a-2091-5643
Original Article

Effect of a Best-Practice Alert on the Rate of Smoking Cessation among Pregnant Women

Alina Tvina
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Brian Tillis
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Meinuo Chen
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Margaret MacBeth
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Shirng-Wern Tsaih
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Anna Palatnik 
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to determine if a best-practice alert (BPA) implementation increases the rate of smoking cessation during pregnancy and affects pregnancy outcomes associated with smoking.

Study Design This was a pretest–posttest study design where a BPA was added to electronic medical records (EMR) of pregnant persons who reported active smoking. The BPA provided the 5A's method to conduct counseling on smoking cessation. The rates of smoking cessation during pregnancy were compared 1.5 years before and after implementation of the BPA. Secondary outcomes examined whether counseling on smoking cessation was done, the number of the counseling sessions during pregnancy, and obstetric outcomes associated with maternal smoking.

Results After implementation of the BPA, the rate of smoking cessation in pregnancy increased from 17.5% prior to BPA implementation to 54.9% after BPA implementation (p < 0.001). The rate of counseling on smoking cessation increased from 66.6% prior to BPA implementation to 95.6% after BPA implementation, with an increase noted also in the number of smoking cessation counseling sessions. In multivariate analyses, after controlling for maternal demographic and clinical factors, BPA implementation was significantly associated with higher rates of smoking cessation (adjusted odds ratio [aOR]: 3.44, 95% confidence interval [CI]: 2.17–5.51), higher rates of documented smoking cessation counseling in the EMR (aOR: 12.44, 95% CI: 6.06–25.64), and higher odds of conducting the counseling more than once (aOR: 6.90 95% CI: 4.45–10.88).

Conclusion The rate of smoking cessation and number of times pregnant persons were counseled increased after implementation of a BPA. The BPA could be a useful EMR tool to increase smoking cessation rates during pregnancy.

Key Points

  • Smoking during pregnancy is a maternal and fetal concern.

  • Prenatal care offers the chance to address smoking.

  • BPA increases rates of smoking counseling and cessation.

Keywords

best-practice alert - pregnancy - smoking - prenatal care - preventative medicine

Note

This study was presented at the 41st annual meeting of the Society for Maternal-Fetal Medicine, Virtual meeting, January 25 to 30, 2021.


Supplementary Material



Publication History

Received: 25 March 2023

Accepted: 03 May 2023

Accepted Manuscript online:
11 May 2023

Article published online:
06 June 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Dietz PM, England LJ, Shapiro-Mendoza CK, Tong VT, Farr SL, Callaghan WM. Infant morbidity and mortality attributable to prenatal smoking in the U.S. Am J Prev Med 2010; 39 (01) 45-52
    CrossrefPubMedGoogle Scholar
  • 2 Wisborg K, Kesmodel U, Henriksen TB, Olsen SF, Secher NJ. A prospective study of smoking during pregnancy and SIDS. Arch Dis Child 2000; 83 (03) 203-206
    CrossrefPubMedGoogle Scholar
  • 3 Jaakkola JJ, Gissler M. Maternal smoking in pregnancy, fetal development, and childhood asthma. Am J Public Health 2004; 94 (01) 136-140
    CrossrefPubMedGoogle Scholar
  • 4 Bruin JE, Gerstein HC, Holloway AC. Long-term consequences of fetal and neonatal nicotine exposure: a critical review. Toxicol Sci 2010; 116 (02) 364-374
    CrossrefPubMedGoogle Scholar
  • 5 Ino T. Maternal smoking during pregnancy and offspring obesity: meta-analysis. Pediatr Int 2010; 52 (01) 94-99
    CrossrefPubMedGoogle Scholar
  • 6 Fergusson DM, Woodward LJ, Horwood LJ. Maternal smoking during pregnancy and psychiatric adjustment in late adolescence. Arch Gen Psychiatry 1998; 55 (08) 721-727
    CrossrefPubMedGoogle Scholar
  • 7 ACOG Committee on Health Care for Underdeserved Women, ACOG Committee on Obstetric Practice. ACOG committee opinion. Number 316, October 2005. Smoking cessation during pregnancy. Obstet Gynecol 2005; 106 (04) 883-888
    PubMedGoogle Scholar
  • 8 Adams EK, Melvin CL, Raskind-Hood C, Joski PJ, Galactionova E. Infant delivery costs related to maternal smoking: an update. Nicotine Tob Res 2011; 13 (08) 627-637
    CrossrefPubMedGoogle Scholar
  • 9 Drake P, Driscoll AK, Mathews T. Cigarette smoking during pregnancy: United States, 2016. NCHS Data Brief 2018; (305) 1-8
    PubMedGoogle Scholar
  • 10 Sullender RT, Remington PL. Trends in smoking during pregnancy in Wisconsin, 2011-2016. WMJ 2020; 119 (01) 52-55
    PubMedGoogle Scholar
  • 11 Office of the Surgeon General (US), Office on Smoking and Health (US). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2004
    Google Scholar
  • 12 Chamberlain C, O'Mara-Eves A, Porter J. et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2017; 2 (02) CD001055
    PubMedGoogle Scholar
  • 13 Woodby LL, Windsor RA, Snyder SW, Kohler CL, Diclemente CC. Predictors of smoking cessation during pregnancy. Addiction 1999; 94 (02) 283-292
    CrossrefPubMedGoogle Scholar
  • 14 Quinn VP, Mullen PD, Ershoff DH. Women who stop smoking spontaneously prior to prenatal care and predictors of relapse before delivery. Addict Behav 1991; 16 (1-2): 29-40
    CrossrefPubMedGoogle Scholar
  • 15 Claire R, Chamberlain C, Davey MA. et al. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2020; 3 (03) CD010078
    PubMedGoogle Scholar
  • 16 Pollak KI, Oncken CA, Lipkus IM. et al. Nicotine replacement and behavioral therapy for smoking cessation in pregnancy. Am J Prev Med 2007; 33 (04) 297-305
    CrossrefPubMedGoogle Scholar
  • 17 Mejdoubi J, van den Heijkant SC, van Leerdam FJ, Crone M, Crijnen A, HiraSing RA. Effects of nurse home visitation on cigarette smoking, pregnancy outcomes and breastfeeding: a randomized controlled trial. Midwifery 2014; 30 (06) 688-695
    CrossrefPubMedGoogle Scholar
  • 18 Sloan M, Hopewell S, Coleman T, Cooper S, Naughton F. Smoking cessation support by text message during pregnancy: a qualitative study of views and experiences of the MiQuit intervention. Nicotine Tob Res 2017; 19 (05) 572-577
    CrossrefPubMedGoogle Scholar
  • 19 Malchodi CS, Oncken C, Dornelas EA, Caramanica L, Gregonis E, Curry SL. The effects of peer counseling on smoking cessation and reduction. Obstet Gynecol 2003; 101 (03) 504-510
    PubMedGoogle Scholar
  • 20 Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2009; (03) CD001055
    PubMedGoogle Scholar
  • 21 Tobacco TCPGT. Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med 2008; 35 (02) 158-176
    CrossrefPubMedGoogle Scholar
  • 22 Olaiya O, Sharma AJ, Tong VT. et al. Impact of the 5As brief counseling on smoking cessation among pregnant clients of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics in Ohio. Prev Med 2015; 81: 438-443
    CrossrefPubMedGoogle Scholar
  • 23 Tong VT, Dietz PM, Morrow B. et al; Centers for Disease Control and Prevention (CDC). Trends in smoking before, during, and after pregnancy–pregnancy risk assessment monitoring system, United States, 40 sites, 2000-2010. MMWR Surveill Summ 2013; 62 (06) 1-19
    CrossrefPubMedGoogle Scholar
  • 24 Zeev YB, Bonevski B, Twyman L. et al. Opportunities missed: a cross-sectional survey of the provision of smoking cessation care to pregnant women by Australian general practitioners and obstetricians. Nicotine Tob Res 2017; 19 (05) 636-641
    CrossrefPubMedGoogle Scholar
  • 25 Bejjanki H, Mramba LK, Beal SG. et al. The role of a best practice alert in the electronic medical record in reducing repetitive lab tests. Clinicoecon Outcomes Res 2018; 10: 611-618
    CrossrefPubMedGoogle Scholar
  • 26 Ledwich LJ, Harrington TM, Ayoub WT, Sartorius JA, Newman ED. Improved influenza and pneumococcal vaccination in rheumatology patients taking immunosuppressants using an electronic health record best practice alert. Arthritis Rheum 2009; 61 (11) 1505-1510
    CrossrefPubMedGoogle Scholar
  • 27 Silbernagel G, Spirk D, Hager A, Baumgartner I, Kucher N. Electronic alert system for improving stroke prevention among hospitalized oral-anticoagulation-naive patients with atrial fibrillation: a randomized trial. J Am Heart Assoc 2016; 5 (07) e003776
    CrossrefPubMedGoogle Scholar
  • 28 Klatt TE, Hopp E. Effect of a best-practice alert on the rate of influenza vaccination of pregnant women. Obstet Gynecol 2012; 119 (2 Pt 1): 301-305
    CrossrefPubMedGoogle Scholar
  • 29 Lindberg SM, Anderson CK. Improving gestational weight gain counseling through meaningful use of an electronic medical record. Matern Child Health J 2014; 18 (09) 2188-2194
    CrossrefPubMedGoogle Scholar
  • 30 Lindberg SM, DeBoth A, Anderson CK. Effect of a best practice alert on gestational weight gain, health services, and pregnancy outcomes. Matern Child Health J 2016; 20 (10) 2169-2178
    CrossrefPubMedGoogle Scholar
  • 31 Jamal A, Phillips E, Gentzke AS. et al. Current cigarette smoking among adults—United States, 2016. MMWR Morb Mortal Wkly Rep 2018; 67 (02) 53-59
    CrossrefPubMedGoogle Scholar
  • 32 Seth B, Herbst N, Oleinik K. et al. Feasibility, acceptability, and adoption of an inpatient tobacco treatment service at a safety-net hospital: a mixed-methods study. Ann Am Thorac Soc 2020; 17 (01) 63-71
    CrossrefPubMedGoogle Scholar
  • 33 Goodney PP, Spangler EL, Newhall K. et al. Feasibility and pilot efficacy of a brief smoking cessation intervention delivered by vascular surgeons in the Vascular Physician Offer and Report (VAPOR) Trial. J Vasc Surg 2017; 65 (04) 1152-1160.e2
    CrossrefPubMedGoogle Scholar
  • 34 Pollak KI, Lyna P, Gao X. et al. Pilot test of connecting pregnant women who smoke to short message service (SMS) support texts for cessation. Matern Child Health J 2020; 24 (04) 419-422
    CrossrefPubMedGoogle Scholar
  • 35 England MC, Benjamin A, Abenhaim HA. Increased risk of preterm premature rupture of membranes at early gestational ages among maternal cigarette smokers. Am J Perinatol 2013; 30 (10) 821-826
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Tobacco and Nicotine Cessation During Pregnancy. Tobacco and nicotine cessation during pregnancy: ACOG committee opinion, number 807. Obstet Gynecol 2020; 135 (05) e221-e229
    CrossrefPubMedGoogle Scholar