Smoking among pregnant women receiving standard prenatal care compared to an enhanced model with health system navigation

Background: Smoking during pregnancy is a serious and preventable problem that impacts both the mother and her children. Objective: This study compares the effectiveness of standard prenatal care to an intervention that supplemented standard prenatal care with Health System Navigation (HSN). Methods: Pregnant African-American women who received prenatal care at an urban university-affiliated medical center that largely provides services to an under-served population were randomized to receive either standard prenatal care (n=78) or standard prenatal care plus HSN (n=72). Questionnaires were completed at baseline, third trimester, and at two post-partum time points and included self-reported measures of smoking in the past seven days. Results: At baseline, intervention and control study participants were similar. At the third trimester and first post-partum assessment, 41.9% and 58.7% of the intervention group reported smoking compared to 53.8% and 70.0% of the control group, respectively. The prevalence of reported smoking at the second post-partum assessment was 72.3% in the intervention group and 76.9% in the control group. Compared to the control group, women who received navigation were more likely to quit smoking. However, the smoking rate increased postpartum, after completion of the intervention. Conclusion: Although not statistically significant, these findings highlight the need for continued intervention beyond prenatal care to facilitate a reduction of smoking among women.