Overview

Tobacco use and second-hand smoke (SHS) exposure during pregnancy have adverse health effects on women and infants. Potential increases in tobacco use and SHS exposure among pregnant women threaten to undermine improvements in maternal and child health outcomes achieved in the past 50 years.

There are currently no up-to-date, evidence-based guidelines for identifying and managing tobacco use and exposure to SHS in pregnancy in most of low- and middle- income countries. Furthermore, many existing guidelines do not include all forms of tobacco use or measures to limit maternal SHS exposure. To fill this gap, the WHO has developed the “WHO Recommendations for the Prevention and Management of Tobacco use and Second-hand Smoke Exposure in Pregnancy”. The guidelines were developed by an independent Guidelines Development Group.

The primary objective of these guidelines is to reduce tobacco use and SHS exposure in pregnant women by providing evidence-based recommendations to health-care providers and other related service providers.

These guidelines cover the following issues:

• Elements necessary for effective screening of pregnant women for tobacco use (smoked and smokeless) and SHS exposure.
• Safety and effectiveness of psychosocial and pharmacological interventions for tobacco use in pregnancy.
• Effective interventions for reducing SHS exposure.
  • at work and in public places,
  • at home.

These recommendations are part of a larger project of the WHO Noncommunicable Diseases and Mental Health, which aims to make recommendations regarding the management of substance abuse in pregnancy, covering tobacco, alcohol and other psychoactive substances.

Contents

• Acknowledgements
• Abbreviations and Acronyms
• Preface
• Executive Summary
• Introduction and Scope
  • HARMS OF TOBACCO USE AND SECOND-HAND SMOKE EXPOSURE IN PREGNANCY
  • PREVALENCE OF TOBACCO USE AND SECOND-HAND SMOKE EXPOSURE
  • EXISTING NATIONAL GUIDELINES ON MANAGEMENT OF TOBACCO USE IN PREGNANCY
  • GUIDING GLOBAL TREATIES AND FRAMEWORKS
  • PREGNANCY AS A WINDOW OF OPPORTUNITY
  • OBJECTIVES
  • TARGET AUDIENCE
• Process of Formulating Guidelines
  • INDIVIDUALS AND PARTNERS INVOLVED IN DEVELOPMENT OF THE GUIDELINES
  • WHO STEERING GROUP
  • GUIDELINES DEVELOPMENT GROUP
  • EXTERNAL REVIEW GROUP
  • MANAGEMENT OF CONFLICTS OF INTEREST
  • THE SCOPE
  • EVIDENCE SEARCH AND RETRIEVAL
  • EVIDENCE TO RECOMMENDATIONS
  • GROUP PROCESS AND DECISION-MAKING
• Recommendations
  • IDENTIFICATION OF TOBACCO USE AND SECOND-HAND SMOKE EXPOSURE
  • INTERVENTIONS FOR TOBACCO-USE CESSATION
  • PROTECTION FROM SECOND-HAND SMOKE
• Research Priorities
  • RESEARCH PRIORITIES BASED ON SPECIFIC QUESTIONS
• Plans for disseminating, adapting and implementing the recommendations
  • GUIDELINES DISSEMINATION
  • LOCAL ADAPTATION
  • LOCAL IMPLEMENTATION
  • EVALUATING THE IMPACT OF THE GUIDELINES
• Review and update of the recommendations
• References
• ANNEX 1 Technical Secretariat for the guidelines development
• ANNEX 2 WHO staff (HQ, regions and country office) involved in the guidelines development
• ANNEX 3 Guidelines Development Group
• ANNEX 4 External reviewers who contributed to development and/or peer review of questions and draft recommendations document
• ANNEX 5 Declaration of Interest
• ANNEX 6 GRADE profile summaries
• ANNEX 7 Decision tables summarizing the values, preferences and judgements made about the strength of the recommendations

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