Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial

Tom Magutu, Mercer University College of Pharmacy

Approximately 40% of women who smoke tobacco quit smoking during pregnancy, yet up to 85% relapse after delivery. [1]

Changes in depressive symptoms, perceived stress, and concerns about weight may relate to postpartum smoking relapse. [2]


Title: Preventing Postpartum Smoking Relapse A Randomized Clinical Trial [3]
Design Randomized trial; N =300
Objective To evaluate the relative efficacy of 2 different approaches to prevent postpartum smoking relapse
Study Groups Pregnant women who recently had quit smoking were recruited before the end of the pregnancy and randomly assigned to either the Strategies to Avoid Returning to Smoking (STARTS) group (n =150) or the supportive, time and attention–controlled comparison (SUPPORT) group (n=150).
Methods Intervention sessions were conducted through a combination of telephone calls and in-person visits beginning at delivery and continuing through 24 weeks postpartum.  Participants completed assessments at the prenatal baseline and at 12, 24, and 52 weeks. At each assessment, women were interviewed about smoking relapse and an expired-air carbon monoxide and a salivary cotinine sample was collected.
Duration March 2008 to February 2015
Primary Outcome Measure Biochemically confirmed sustained tobacco abstinence at 52 weeks postpartum
Baseline Characteristics Variable STARTS SUPPORT
Age, mean (SD) y 24.97 (5.74) 25.01 (5.57)
Cigarettes smoked daily, mean (SD) 10 (7) 12 (11)
Years of smoking, mean (SD) 8.49 (5.75) 8.49 (5.56)
Previous quit attempts mean (SD) 4 (4) 3 (3)
Fagerstrom Test for nicotine  dependence score, mean (SD) 3.22 (2.01) 3.19 (2.07)
Week quit at baseline, mean (SD) 16.42 (11.76) 18.21 (11.69)
Black race, No (%) 82 (54.7) 81 (54)
Weight concerns score, mean (SD) 3.79 (2.20) 4.12 (2.21)
Results Biochemically verified relapse and continuous abstinence rates for the STARTS and SUPPORT interventions

n (%)


n (%)


p > 0.28

Abstinent 40 (26.7) 32 (21.3)
Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions Taking into consideration the health consequences of postpartum smoking for women and children, postpartum specific intervention that prevents smoking relapse can improve maternal and child health.

The findings of this study reveal that providing support tailored to the needs of women after childbirth can decrease the likelihood that a woman will resume smoking postpartum.  A limitation of the study is that the interventions tested provided similar postpartum support and the lack of a nonintervention control group prevents direct comparison with outcomes of women who do not receive treatment.



  1. Phillips RM, Merritt TA, Goldstein MR, Deming DD, Slater LE, Angeles DM. Prevention of postpartum smoking relapse in mothers of infants in the neonatal intensive care unit. J Perinatol. 2012;32(5):374-80.
  2. Levine MD, Marcus MD, Kalarchian MA, Houck PR, Cheng Y. Weight concerns, mood, and postpartum smoking relapse. Am J Prev Med. 2010;39(4):345-51.
  3. Levine MD, Cheng Y, Marcus MD, Kalarchian MA, Emery RL. Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial. JAMA Intern Med. 2016;176(4):443-52.




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