Smoking cessation in pregnancy: a systematic review and meta-analysis of vulnerability approaches and expectant father involvement

Objectives To evaluate behavioral and psychosocial smoking cessation interventions and second-hand smoke reduction strategies in pregnancy, focusing on sociocultural vulnerability approaches and expectant father involvement. Methods Systematic review and meta-analysis (Joanna Briggs Institute methodology; PRISMA 2020). MEDLINE, Scopus, PsycINFO, ASSIA, and CINAHL were searched to October 2023; exclusively pharmacological interventions were excluded. Random-effects meta-analyses examined five vulnerability approaches and two levels of father involvement. Protocol: https://doi.org/10.17605/OSF.IO/DUYF7. Results Fifty-eight studies (41 RCTs) were included. Individual counseling was most effective for maternal cessation (OR = 1.66, 95% CI: 1.39-1.99). Vulnerability-adapted and standard interventions were comparably effective overall (OR = 1.55 vs. 1.51); socioeconomic inclusiveness yielded the largest subgroup effect (OR = 2.51), although subgroup estimates were exploratory (low to very low certainty). Father involvement did not significantly improve maternal cessation (OR = 1.12), but father-directed interventions were highly effective for paternal cessation (OR = 2.18; high-certainty evidence). Conclusion Behavioral interventions, particularly individual counseling, are effective in pregnancy. Father-directed approaches merit consideration in antenatal care, although evidence derives from four trials. Socioeconomically inclusive and mental health-integrated interventions are promising but require confirmation. Systematic review registration https://doi.org/10.17605/OSF.IO/DUYF7, identifier 10.17605/OSF.IO/DUYF7.