CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy—Short Text

Rapport d’Experts et Recommandations CNGOF-SFT sur la prise en charge du tabagisme en cours de grossesse – texte court

Gilles Grangé (1) , Ivan Berlin (2) , Florence Bretelle (3, 4) , Charline Bertholdt (5, 6) , Paul Berveiller (7) , Julie Blanc (8, 9) , Caroline Diguisto (10, 11) , Vincent Dochez (12) , Charles Garabedian (13) , Paul Guerby (14) , Antoine Koch (15) , Maela Le Lous (16, 17) , Estelle Perdriolle-Galet (5) , Violaine Peyronnet (18) , Rault Emmanuel (19) , Héloise Torchin (20) , Guillaume Legendre (21, 22)

1 Maternité Port-Royal [CHU Cochin]
2 CHU Pitié-Salpêtrière [AP-HP]
3 APHM - Assistance Publique - Hôpitaux de Marseille
4 MEPHI - Microbes évolution phylogénie et infections
5 Maternité Régionale Adolphe Pinard [Nancy]
6 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
7 Service de gynécologie et obstétrique [CHI Poissy-Saint Germain]
8 Service de gynécologie-obstétrique [Hôpital Nord - APHM]
9 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
10 EPOPé [CRESS - U1153 / UMR_A 1125] - Obstetrical, Perinatal and Pediatric Epidemiology | Épidémiologie Obstétricale, Périnatale et Pédiatrique
11 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
12 CHU Nantes - Centre Hospitalier Universitaire de Nantes
13 EPS - Environnement périnatal et croissance - EA 4489
14 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
15 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
16 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
17 LTSI - Laboratoire Traitement du Signal et de l'Image
18 Hôpital Louis Mourier - AP-HP [Colombes]
19 HFME - Hôpital Femme Mère Enfant [CHU - HCL]
20 CRESS (U1153 / UMR_A 1125) - Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
21 CHU Angers - Centre Hospitalier Universitaire d'Angers
22 CESP - Centre de recherche en épidémiologie et santé des populations

Objectives - To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy. Methods - Systematic review of the international literature. We identified papers published between January 2003 and April 2019 in Cochrane PubMed, and Embase databases with predefined keywords. All reports published in French and English relevant to the areas of focus were included and classified according the level of evidence ranging from 1 (highest) to 4 (lowest). The strength of the recommendations was classified according to the Haute Autorité de santé, France (ranging from A, highest to C, lowest). Results - "Counseling", involving globally all kind of non-pharmacological interventions, has a modest benefit on smoking cessation, birth weight and prematurity. Moderate physical activity did not show a significant effect on smoking cessation. The systematic use of feedback by measuring the expired air carbon monoxide concentration do not influence smoking abstinence but it may be used in establishing a therapeutic alliance. The use of self-help interventions and health education are recommended in helping pregnant smokers quit. The prescription of nicotine replacement therapies (NRT) may be offered to any pregnant woman who has failed stopping smoking without medication This prescription can be initiated by the health care professional taking care of the pregnant woman in early pregnancy. There is no scientific evidence to propose the electronic cigarette for smoking cessation to pregnant smokers; it is recommended to provide the same advice and to use methods that have already been evaluated. The use of waterpipe (shisha/narghile) during pregnancy is associated with decreased fetal growth. It is recommended not to use waterpipe during pregnancy. Breastfeeding is possible in smokers, but less often initiated by them. Although its benefit for the child's development is not demonstrated to date, breastfeeding allows the mother to reduce or stop smoking. The risk of postpartum relapse is high (up to 82% at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. Conclusions - Smoking during pregnancy concerns more than hundred thousand women and their children per year in France. It is a major public health burden. Health care professionals should be mobilized for reducing or even eradicating it.

Mots clés: Grossesse; Tabagisme; Revue de la littérature; Revue systématique; Essais cliniques; Méta-analyse; Études observationnelles; Déterminants; Comportements; Épidémiologie; Facteurs de risque; Tabagisme passif; Sevrage tabagique; Prédicteurs; Interventions; Nicotine; traitement substitutif nicotinique; Allaitement maternel; Post-partum

Domaines: Bactériologie; Virologie; Parasitologie; Cardiologie et système cardiovasculaire; Maladies émergentes; Maladies infectieuses

Gilles Grangé, Ivan Berlin, Florence Bretelle, Charline Bertholdt, Paul Berveiller, et al.. Rapport d’Experts et Recommandations CNGOF-SFT sur la prise en charge du tabagisme en cours de grossesse – texte court. Gynécologie Obstétrique Fertilité & Sénologie, 2020, 48 (7-8), pp.539-545. ⟨10.1016/j.gofs.2020.04.005⟩. ⟨hal-02547915⟩