Prevalence of smoking during pregnancy and associated social inequalities in developed countries over the 1995–2020 period: A systematic review

Abstract

Background: Smoking during pregnancy (SDP) is an important source of preventable morbidity and mortality for both mother and child. Objectives: The aim of this study was to describe changes in the prevalence of SDP over the last 25 years in developed countries (Human Development Index >0.8 in 2020) and associated social inequalities. Data sources: A systematic review was conducted based on a search in PubMed, Embase and PsycInfo databases and government sources. Study selection and data extraction: Published studies between January 1995 and March 2020, for which the primary outcome was to assess the national prevalence of SDP and the secondary outcome was to describe related socio-economic data were included in the analysis. The selected articles had to be written in English, Spanish, French or Italian. Synthesis: The articles were selected after successive reading of the titles, abstracts and full-length text. An independent double reading with intervention of a third reader in case of disagreement allowed including 35 articles from 14 countries in the analysis. Results: The prevalence of SDP differed across the countries studied despite comparable levels of development. After 2015, the prevalence of SDP ranged between 4.2% in Sweden and 16.6% in France. It was associated with socio-economic factors. The prevalence of SDP slowly decreased over time, but this overall trend masked inequalities within populations. In Canada, France and the United States, the prevalence decreased more rapidly in women of higher socio-economic status, and inequalities in maternal smoking were more marked in these countries. In the other countries, inequalities tended to decrease but remained significant. Conclusions: During pregnancy, that is a period described as a window of opportunity, smoking and social vulnerability factors need to be detected to implement targeted prevention strategies aiming at reducing related social inequalities.