Financial rewards for smoking cessation boost neonatal birth weight

Financial rewards for smoking cessation boost neonatal birth weight | Image Credit: © vchalup - © vchalup - stock.adobe.com.

Neonatal weight may be increased through offering financial rewards for smoking cessation during pregnancy, according to a recent study published in JAMA Network Open.¹

Impact of smoking on neonatal health

Consistent smoking during pregnancy has been linked to significant short- and long-term neonatal health problems, including a 10% decrease in birth weight. Financial incentives have been proven effective for improving the efficacy of stop smoking services for pregnant women. However, the decrease in birth weight from prenatal smoking is greater than the mean improvement linked to financial rewards.

“Only those in the middle, who are not able to quit without the intervention, but are able to do so with additional encouragement, are affected by the intervention,” wrote investigators. “Logically, it is only this group who stand to achieve downstream health benefits, for example in terms of their child’s birth weight.”

Additional benefits have also been reported for smoking cessation during pregnancy, including reduced odds of relapse during the postpartum period.² A study earlier this year reported smoking rates of 14.6%, 7.2%, 7%, and 11.5%, respectively, during the preconception, pregnancy, early postpartum, and late postpartum periods, highlighting an opportunity for preventing smoking relapses.

Study design

The systematic review was conducted to assess birth weights of neonates among women who smoke during pregnancy and the impact of smoking cessation because of financial awards on this association.¹ Low birth weight and small for gestational age (SGA) were reported as additional outcomes.

Articles published through December 5, 2023, were identified through searches of the Embase, Medline, Cochrane, American Psychological Association PsycInfo, and PubMed databases. Study authors were contacted for birth weight data when the information was not included in the report.

Alongside birth weight, investigators collected data about birth weight for gestational age z score. This included sample size, the number of low birthweight neonates, and SGA, defined as being under the tenth percentile.

Study results

There were 12 studies included in the final analysis, reporting a combined relative risk of 2.43 for smoking cessation toward the end of pregnancy. One trial was excluded from complier average causal effects (CACE) analyses because of a negative estimated compliance rate.

In the trials reporting birth weight, a mean 46.30 g increase was reported among neonates born to women in the financial rewards group vs controls. The CACE analysis highlighted an increase of 206 g among neonates of women who stopped smoking because of financial incentives. This evidence was graded as moderate because of potential imprecision in the effect estimate.

No association was reported with low birthweight risk, with risk differences of -0.6% and -3.1% in the intention-to-treat and CACE analyses, respectively. There were also no associations for birth weight for gestational age z scores.

Conclusion

A small decrease in SGA risk was observed when offering financial rewards, with a risk difference of -2.80%. This reduction was significant when assessing risk based on smoking cessation because of financial rewards, at -17.70%. These results highlighted efficacy from financial incentives to quit smoking toward increasing neonatal birth weight.

“Policymakers can be reassured that adding financial rewards to pregnancy smoking cessation support will result in a biochemically measured increase in smoking cessation associated with increased birth weight and an overall reduction in health care costs,” wrote investigators.

References

1. Tappin D, Lee J, McConnachie A, et al. Financial rewards for smoking cessation during pregnancy and birth weight: A meta-analysis. JAMA Netw Open. 2025;8(3):e250214. doi:10.1001/jamanetworkopen.2025.0214
2. Krewson C. Study highlights need for interventions to prevent postpartum smoking relapse. January 21, 2025. Accessed March 10, 2025. https://www.contemporaryobgyn.net/view/study-highlights-need-for-interventions-to-prevent-postpartum-smoking-relapse