Page 87 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

Intervention Description
I: face-to-face counseling 40 d pp plus telephone counseling calls 4 and 12 wk later. Motivational interviewing193 194 and relapse prevention176 served as principles for the intervention. Counseling incorporated: information on the health effects of smoking and environmental tobacco smoke, balancing of the pros and cons of smoking, self-efficacy for behavioral change, reflecting previous, observed or imagined behavioral changes, exploring high-risk situations and relapse prevention strategies and the abstinence violation effect.
C: usual care plus self-help material for each parent.
I: home counseling sessions 4-6wk pp and 2 telephone counseling sessions 4 and 12 wk later. The counseling was conducted by 4 trained study co-workers. It was based on the principles of motivational interviewing193 194 and tailored to the motivation stage of change. Both the I and C group received: a self-help manual addressing maternal smoking, smoking cessation and relapse prevention; and a manual addressing the partner of the participating women.
Same intervention as Wall169
Baseline values
Median = 35 d pp
Smokers:
I: n=151 (51%) C: n=187 (54%) Mean number of cigarettes per day (SD):
I: 11.6 (6.9) C: 11.8 (7.5)
Non-smokers: I: n=134 (56.1%)
C: n=145 (53.3%)
Smokers: n=1875 Quitters: n=1026
Weight Loss
With regard to smoking cessation, 4 wk point prevalence abstinence rates were higher in the I group compared to the C group at 6, 12 and 18 mo (7% vs 1%, 7% vs 2% and 9% vs 1% respectively), p<0.05. Sustained abstinence was higher in the I group at 6 mo follow-up (3% vs 0%), p<0.05.
Small effect with regard to smoking cessation. No effect with regard to relapse prevention.
Women in the I group were significantly more likely to be non- smokers 6 mo after the intervention (p<0.05).
Membership in the I group significantly predicted non-smoking at 6 mo, but no 1 yr pp, after controlling for demographic, smoking and pp risk variables.
Smokers: at 12 mo pp 5.5% of the women in the I group reported to have quit smoking, vs. 4.7% of the women in the C group (NS). Continuous quit at both 6 and 12 mo pp was 2.3% in the I group and 1.2% in the C group (p<0.05). However, no effect was found on sustained quitting (OR 1.78, 95% CI 0.84-3.74). Quitters: at 12 mo pp 42.9% in the I group reported to still have quit, vs. 39.1% in the C group. (NS). Continuous quit at both 6 and 12 mo pp was 32.8% in the I group and 26.1% in the C group (p<0.05). No intervention effect was found on sustained quitting (OR 1.25, 95% CI 0.93-1.68). The effect of the intervention at 6 mo pp was reduced at 12 mo pp.
3.1 Effect of Postpartum Lifestyle Interventions| 85
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