The Prevention of Smoking Relapse in Post-Partum Women: A Systematic Review and Network Meta-Analysis

The Prevention of Smoking Relapse in Post-Partum Women: A Systematic Review and Network Meta-Analysis

Published: January/February 2026
Journal Article

Overview

This one-hour, on-demand, journal article–based activity examines interventions designed to maintain smoking abstinence in postpartum individuals who quit smoking during pregnancy. The systematic review and network meta-analysis compare cognitive behavioral therapy (CBT), motivational interviewing (MI), and combined CBT-MI approaches, assessing their effectiveness at maintaining abstinence at 6 and 12 months postpartum. The article highlights challenges in sustaining long-term abstinence, identifies factors associated with postpartum relapse, and evaluates the current evidence base for psychosocial interventions aimed at reducing postpartum smoking relapse. This review provides insights for clinicians and public health professionals seeking to support ongoing abstinence and improve maternal and child health outcomes during the postpartum period. 

The target audience for this intermediate continuing education activity includes physicians, nurse practitioners, physician assistants, and other clinicians, researchers, students, and policymakers. 

This activity addresses the following ACGME Core Competencies: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, and Systems-Based Practice 

Abstract

Aims 

The objective is to compare the effects of different interventions for maintaining smoking abstinence in postpartum individuals.

Methods

We searched PubMed, EMBASE, CENTRAL, CINAHL, PsycINFO, and ProQuest up to February 2024. Randomized controlled trials (RCTs) that studied the effects of any interventions on maintaining smoking abstinence in postpartum individuals who quit smoking before delivery were included. A frequentist network meta-analysis using a random-effect model was performed to compare the efficacy of interventions, cognitive behavioral therapy (CBT) and motivational interviewing (MI). The surface under the cumulative ranking curve was used to rank the intervention effects. The GRADE approach assessed evidence certainty.

Results

We included 11 studies from 10 RCTs (3365 participants). Comparisons with standard care revealed that CBT [relative risk (RR) = 1.03; 95%  CI: 0.86,1.19], CBT-MI (RR = 1.41; 95% CI: 0.87,2.27), and MI (RR = 1.06; 95% CI: 0.90,1.24) failed to maintain smoking abstinence at 12 months postpartum. The absolute differences were imprecise, with wide CIs encompassing both potential increases and decreases in smoking abstinence: 7 more per 1000 (95% CI: -31, 43) for CBT, 92 more per 1000 (95% CI: -29,284) for CBT-MI, and 13 more per 1000 (95% CI: -22,54) for MI, all with moderate certainty evidence. Subgroup analyses for follow-up periods of <12 months indicated that CBT-MI (RR = 1.67; 95% CI: 1.08, 2.60) and MI (RR=1.16; 95% CI: 1.01, 1.33) may improve the maintenance of smoking abstinence over the short term.

Conclusion

CBT-MI and MI appear promising in improving the maintenance of smoking abstinence within 12 months postpartum, though further research is needed to enhance long-term abstinence.

Learning Objectives

Upon completion of this activity, learners will be able to:

1. Describe the short-term (<12 months) and long-term (12 months) effectiveness of postpartum interventions for maintaining smoking abstinence, including the comparative benefits of CBT, MI, and combined CBT-MI relative to usual care.     
2. Explain the limitations of current evidence on postpartum smoking abstinence interventions.  
3. Recognize gaps in current evidence and identify strategies for designing and implementing postpartum smoking abstinence interventions. 

Registration Rates

*Residents, Fellows-in-training, Interns, and Students must join ASAM to receive a discounted registration rate. Click here to become an ASAM member. National and Chapter membership dues apply. There is no charge for Students to become a Member, but verification of student status is required.

Membership Question?  Call ASAM at 1.301.656.3920, email us, or view the ASAM website for more information.

Refunds & Cancellations

All ASAM eLearning Center refund requests must be made in writing to education@asam.org within 90 days of purchase. Those requesting refunds for courses that are in progress will receive partial refunds or eLearning Center credit. Automatic full refunds will be made for any course with a live-course component that has been canceled.

Open Registration: 02/10/2026 - 02/10/2029

Close Access Date: 02/10/2029

Course Instructions

1. Click on the Contents tab to begin this activity.
2. Click Download Journal Article in the box titled Journal Article and read the journal article in its entirety. 
3. Click Complete Post-Test to answer multiple-choice questions. You will have 10 attempts to pass and must answer 2 out of 3 questions correctly.
4. Click Complete General Evaluation to provide valuable activity feedback. Scroll down on all questions, as there may be answer options that expand past the size of the window.
5. Click the button Claim Medical Credits in the box titled Claim Credits & Certificate. Choose the type of credit and click submit. Click the button View/Print Certificate to save or print your certificate. You can view/print your certificate at any time by visiting the ASAM eLearning Center, clicking Dashboard, and clicking Transcript/Achievements.

Need Assistance?

For assistance logging in, accessing activities, claiming credit, or for other questions or concerns, please check the FAQ page or e-mail Education@ASAM.org

ASAM is proud to offer Essential Accessibility to ensure our website is accessible and functional for all our learners while providing free assistive technology for people with the widest possible range of abilities.

Accreditation & Credits

Joint Accreditation Statement

In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credits Available

• Physicians: 1.00 Credit
• Nurses & NPs: 1.00 Nursing Contact Hour
• PAs: 1.00 Credit
• Interprofessional Continuing Education: 1.00 Credit
• Certified Counselors: NBCC Contact Hours Not Offered

  

  American Society of Addiction Medicine has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7062. Programs that do not qualify for NBCC credit are clearly identified. American Society of Addiction Medicine is solely responsible for all aspects of the programs.

Maintenance of Certification (MOC)/Continuing Certification Program (CCP)

This activity is designed to meet the requirements for MOC/CCP for several primary physician boards and for state licensing CME requirements. MOC Credit is only reported and designated for ABA, ABP, ABIM, and ABS. By completing the online credit application and evaluation, the learner permits ASAM to report credits to the appropriate Board. Learn more.

• ABIM MOC Points: 1.00 Medical Knowledge
• ABP MOC: 1.00 Lifelong Learning & Self-Assessment
• ABS Continuing Certification: 1.00 Accredited CME
• ABA MOCA 2.0®*: 1.00 Lifelong Learning MOCA 2.0® is a trademark of the American Board of Anesthesiology®. This activity contributes to the CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology's (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, https://www.theaba.org/, for a list of all MOCA 2.0 requirements.

Additionally, this activity has been designed to satisfy the requirements of the following primary physician board certification requirements. Please confirm with your individual Board.

• American Board of Addiction Medicine (ABAM)
• American Board of Preventive Medicine (ABPM)
• American Board of Psychiatry and Neurology (ABPN)
• Royal College of Physicians and Surgeons of Canada (RCPSC)

Certificates for other professions

All participants may request a certificate of participation upon completion of the activity and an online evaluation confirming their participation. Learners are strongly advised to contact their professional licensing board or professional association to confirm this certificate will be accepted as evidence supporting continuing education requirements.

California Association for Drug/Alcohol Educators (CAADE)

This educational program is approved by CAADE: #CP40 999 1225.

California Association of DUI Treatment Centers (CADTP)

This educational program is approved by CADTP: #205.

California Consortium of Addiction Programs and Professionals (CCAPP)

This educational program is approved by CCAPP: #OS-20-330-0227.

Disclosure Information

In accordance with the disclosure policies of ASAM and Joint Accreditation, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all accredited continuing education activities. These policies include identifying and mitigating all relevant financial relationships with ineligible companies for those involved in the creation and dissemination of accredited continuing education. 

See the attached article and pdf for a list of disclosures