# Real-world effectiveness of a community-based multicomponent maternal smoking cessation program in preventing low birthweight deliveries: Findings from the CTTP cohort

## TL;DR

A community-based smoking cessation program for pregnant women significantly reduced low birthweight deliveries in a diverse population.

## Contribution

Demonstrated real-world effectiveness of a multi-component tobacco cessation program in preventing low birthweight.

## Key findings

- Prolonged abstinence during the program reduced low birthweight odds by 33%.
- Self-reported abstinence six months post-program reduced low birthweight odds by 35%.
- Older age and early enrollment correlated with better birth outcomes.

## Abstract

The effect of smoking cessation during pregnancy on preventing adverse birth outcomes has been shown in studies of US birth certificate data, and in other nations. There is a paucity of data to optimize community-based maternal tobacco cessation programs to improve birth outcomes. Our objective is to evaluate the real-world effectiveness of a multi-component, community-based maternal smoking cessation program in preventing adverse infant outcomes using components of known efficacy.

The Comprehensive Tobacco Treatment Program (CTTP) was a state-funded maternal tobacco smoking cessation program serving pregnant women in San Bernardino County, California, the largest county in the contiguous US. CTTP used a six-to-eight-week behavioral intervention with components of known efficacy (i.e. incentives, biomarker testing, feedback, and motivational interviewing). We conducted a retrospective cohort study of the 1402 pregnant women enrolled in CTTP during 2012–2019. We conducted a multivariable logistic regression analysis with adverse infant outcomes [premature birth (PTB), low birthweight (LBW), and NICU admission] as the dependent variables, abstinence achieved during [prolonged abstinence (PA) through weekly urinary cotinine tests] or after the program [self-reported point prevalence abstinence (PPA)] as the main effect exposures, and pertinent confounders.

We found that PA during the program significantly decreased the odds of LBW (OR=0.67; 95% CI: 0.47–0.96, p=0.03), and this association remained for self-report of PPA at 2–4 months after the program (OR=0.70; 95% CI: 0.54–0.90, p=0.006), and six months after the program (OR=0.65; 95% CI: 0.47–0.90, p=0.01). Similar, albeit weaker, trends were found for PTB (OR=0.80). In these models, older age, early trimester at enrollment, and African American/Black ethnicity also trended toward higher rates of LBW and PTB.

Abstinence achieved during a multi-component behavioral smoking cessation intervention program using components of known efficacy, significantly reduced low birthweight deliveries in a multi-ethnic population.