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This is in accordance with an observational study by Bauld, Judge and Platt , whereby despite low overall efficacy, smoking cessation services have had a disproportionate effect in the most disadvantaged groups, possibly reducing the social gradient.
Unfortunately, there is little information available regarding smoking cessation treatment efficacy in pregnancy and the few relevant studies provide conflicting results .
Higher cigarette consumption, lower educational level, higher confidence in ability to quit on one’s own, and multiparity, are some of the risk factors that have predicted treatment non-adherence among pregnant women with low SES .
This overrepresentation of women with lower SES among pregnant smokers warrants the need for approaches that address modifiable risk factors of non-adherence.
Short-term strategies may involve, for example, providing childcare or utilizing telecommunication technologies for intervention delivery, to ensure that women have access to proper prenatal, perinatal and postnatal care .
Healthcare professionals should also be tasked with increasing knowledge of smoking harms and cessation methods, as well as providing culturally competent care to low-SES groups.
Experts agree that the increased nicotine clearance from the body experienced during pregnancy is partly to blame for lack of compliance to an NRT regime and higher doses of nicotine may be required to optimize efficacy .
Unlike persistent smokers, spontaneous quitters tend to be more highly educated, less addicted, and less likely to have partners who smoke .
Yet, interventions tend to focus on individual behaviour change , overlooking important predictors of non-adherence such as the level of education, baseline cotinine levels , psychosocial barriers , culture , and more.
: Women who are generally part of socially disadvantaged and economically marginalized groups are especially susceptible to smoking during pregnancy but smoking rates are underreported in both research and interventions.
While there is evidence to support the short-term efficacy of nicotine replacement therapy (NRT) use in pregnancy, long-term abstinence rates are modest.