Skip to main content

Advertisement

SpringerLink
Log in

The Human Cost of Tobacco Chewing Among Pregnant Women in India: A Systematic Review and Meta-analysis

  • Original Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Background

In India, smokeless tobacco (SLT) use among pregnant women is high and its adverse effects on pregnancy outcomes have not been properly documented in.

Objectives

To collate available evidence on the association between SLT use and three adverse pregnancy outcomes, i.e. low birth weight, preterm birth and stillbirth among women in India.

Search Strategy

A systematic search was conducted in MEDLINE, IndMed, Web of Science, Google Scholar and major journals. Two authors independently reviewed the studies and extracted data.

Selection Criteria

Inclusion criteria were English articles published till December 2014, case control, case cohort or cohort, and exposure and outcome variables meeting predefined criteria. Exclusion criteria were case series, case reports, cross-sectional designs, risk estimate not restricted/adjusted for smoking with or without adjustment for other factors and duplicate data. Qualitative synthesis was followed by meta-analysis. Attributable burden was estimated using the population attributable fraction method.

Main Results

Pooled odds ratio was significant for all three outcomes: low birth weight (1.88, 95 % CI 1.38, 2.54), preterm birth (1.39: 1.01, 1.91) and stillbirth (2.85: 1.62, 5.01). We found that 0.87 million low birth weight babies, 0.19 million preterm births and 0.12 million stillbirths occurring annually in India could be attributed to maternal SLT use.

Conclusion

There was a suggestive evidence of SLT use associated with adverse pregnancy outcomes among women in India. Further studies in this field are required to generate more conclusive evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Boffetta P, Hecht S, Gray N, et al. Smokeless tobacco and cancer. Lancet Oncol. 2008;9:667–75. doi:10.1016/S1470-2045(08)70173-6.

    Article  PubMed  Google Scholar 

  2. Lee PN, Hamling J. Systematic review of the relation between smokeless tobacco and cancer in Europe and North America. BMC Med. 2009;7:36. doi:10.1186/1741-7015-7-36.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sinha DN, Rizwan SA, Gupta PC. Smokeless tobacco-associated cancers: a systematic review and meta-analysis of Indian studies. Int J Cancer. 2015;. doi:10.1002/ijc.29884.

    Google Scholar 

  4. Sinha DN, Agarwal N, Gupta PC. Prevalence of smokeless tobacco use and number of users in 121 countries. Br J Med Med Res. 2015;9:1–20. doi:10.9734/BJMMR/2015/16285.

    Article  Google Scholar 

  5. Shea AK, Steiner M. Cigarette smoking during pregnancy. Nicotine Tob Res. 2008;10:267–78. doi:10.1080/14622200701825908.

    Article  CAS  PubMed  Google Scholar 

  6. England LJ, Kim SY, Tomar SL, et al. Non-cigarette tobacco use among women and adverse pregnancy outcomes. Acta Obstet Gynecol Scand. 2010;89:454–64. doi:10.3109/00016341003605719.

    Article  PubMed  Google Scholar 

  7. Pratinidhi A, Gandham S, Shrotri A, et al. Use of “Mishri” a smokeless form of tobacco during pregnancy and its perinatal outcome. Indian J Commun Med. 2010;35:14–8. doi:10.4103/0970-0218.62547.

    Article  Google Scholar 

  8. Gupta PC, Subramoney S, Sreevidya S. Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India. BMJ. 2004;328:1538. doi:10.1136/bmj.38113.687882.EB.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gupta PC, Subramoney S. Smokeless tobacco use and risk of stillbirth: a cohort study in Mumbai, India. Epidemiology. 2006;17:47–51. doi:10.1097/01.ede.0000190545.19168.c4.

    Article  PubMed  Google Scholar 

  10. Ministry of Health and Family Welfare, Government of India. India newborn action plan. New Delhi; 2014. p. 29. http://nrhm.gov.in/india-newborn-action-plan.html. Accessed 15 Aug 2015.

  11. Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379:2162–72. doi:10.1016/S0140-6736(12)60820-4.

    Article  PubMed  Google Scholar 

  12. Cousens S, Blencowe H, Stanton C, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet. 2011;377:1319–30. doi:10.1016/S0140-6736(10)62310-0.

    Article  PubMed  Google Scholar 

  13. Ministry of Health and Family Welfare, Government of India. Global Adult Tobacco Survey: India Report 2009-10. New Delhi, India; 2010. http://whoindia.org/EN/Section20/Section25_1861.html. Accessed 13 Aug 2015.

  14. Mehta A, Shukla S. Tobacco and pregnancy. J Obstet Gynaecol India. 1990;40:156–60.

    Google Scholar 

  15. Krishna K. Tobacco chewing in pregnancy. Br J Obstet Gynaecol. 1978;85:726–8. doi:10.1111/j.1471-0528.1978.tb15591.x.

    Article  CAS  PubMed  Google Scholar 

  16. Krishnamurthy S, Joshi S. Gender differences and low birth weight with maternal smokeless tobacco use in pregnancy. J Trop Pediatr. 1993;39:253–4. doi:10.1093/tropej/39.4.253.

    Article  CAS  PubMed  Google Scholar 

  17. Verma RC, Chansoriya M, Kaul KK. Effect of tobacco chewing by mothers on fetal outcome. Indian Pediatr. 1983;20:105–11.

    CAS  PubMed  Google Scholar 

  18. Deshmukh JS, Motghare DD, Zodpey SP, et al. Low birth weight and associated maternal factors in an urban area. Indian Pediatr 1998;35:33–6. http://www.indianpediatrics.net/jan1998/33.pdf. Accessed 15 Aug 2015.

  19. England LJ, Kim SY, Shapiro-Mendoza CK, et al. Maternal smokeless tobacco use in Alaska Native women and singleton infant birth size. Acta Obstet Gynecol Scand. 2012;91:93–103. doi:10.1111/j.1600-0412.2011.01273.x.

    Article  PubMed  Google Scholar 

  20. Steyn K, de Wet T, Saloojee Y, et al. The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study. Paediatr Perinat Epidemiol. 2006;20:90–9. doi:10.1111/j.1365-3016.2006.00707.x.

    Article  PubMed  Google Scholar 

  21. Rajaram S, Zottarelli LK, Sunil TS. An assessment of fetal loss among currently married women in India. J Biosoc Sci. 2009;41:309–27. doi:10.1017/S0021932008003222.

    Article  CAS  PubMed  Google Scholar 

  22. Singh PN, Eng C, Yel D, et al. Maternal use of cigarettes, pipes, and smokeless tobacco associated with higher infant mortality rates in Cambodia. Asia Pac J Public Health. 2013;25:64S–74S. doi:10.1177/1010539513493458.

    PubMed  Google Scholar 

  23. Krishnamurthy S. Maternal tobacco use and adverse reproductive outcome. Natl Med J India 1997;10:2–4. http://nmji.in/approval/archive/Volume-10/issue-1/editorials-2.pdf. Accessed 15 Aug 2015.

  24. Kumar S. Tobacco and areca nut chewing–reproductive impairments: an overview. Reprod Toxicol. 2013;36:12–7. doi:10.1016/j.reprotox.2012.11.007.

    Article  CAS  PubMed  Google Scholar 

  25. Ratsch A, Bogossian F. Smokeless tobacco use in pregnancy: an integrative review of the literature. Int J Public Health. 2014;59:599–608. doi:10.1007/s00038-014-0558-6.

    Article  PubMed  Google Scholar 

  26. Inamdar AS, Croucher RE, Chokhandre MK, et al. Maternal smokeless tobacco use in pregnancy and adverse health outcomes in newborns: a systematic review. Nicotine Tob Res. 2015;17:1058–66. doi:10.1093/ntr/ntu255.

    Article  PubMed  Google Scholar 

  27. Jauniaux E, Burton GJ. Morphological and biological effects of maternal exposure to tobacco smoke on the feto-placental unit. Early Hum Dev. 2007;83:699–706. doi:10.1016/j.earlhumdev.2007.07.016.

    Article  CAS  PubMed  Google Scholar 

  28. Reeves S, Bernstein I. Effects of maternal tobacco-smoke exposure on fetal growth and neonatal size. Expert Rev Obstet Gynecol. 2008;3:719–30. doi:10.1586/17474108.3.6.719.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rogers JM. Tobacco and pregnancy. Reprod Toxicol. 2009;28:152–60. doi:10.1016/j.reprotox.2009.03.012.

    Article  CAS  PubMed  Google Scholar 

  30. Yildiz D, Liu YS, Ercal N, et al. Comparison of pure nicotine- and smokeless tobacco extract-induced toxicities and oxidative stress. Arch Environ Contam Toxicol. 1999;37:434–9. doi:10.1007/s002449900537.

    Article  CAS  PubMed  Google Scholar 

  31. Stegmayr B, Johansson I, Huhtasaari F, et al. Use of smokeless tobacco and cigarettes—effects on plasma levels of antioxidant vitamins. Int J Vitam Nutr Res. 1993;63:195–200.

    CAS  PubMed  Google Scholar 

  32. Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384:347–70. doi:10.1016/S0140-6736(14)60792-3.

    Article  PubMed  Google Scholar 

Download references

Author Contribution

RSA and DNS planned the study and performed the data retrieval. RSA performed the analysis and wrote the first draft of the manuscript. All authors read the final manuscript and approved it.

Author information

Authors and Affiliations

  1. Department of Community Medicine, Velammal Medical College Hospital and Research Institute, Madurai, India

    Rizwan A. Suliankatchi

  2. Tobacco Free Initiative Unit, World Health Organization, Regional Office for South-East Asia, I.P. Estate, New Delhi, 110 002, India

    Dhirendra N. Sinha

Authors
  1. Rizwan A. Suliankatchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dhirendra N. Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rizwan A. Suliankatchi.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. Since this was a systematic review article no ethical approval was required.

Additional information

Rizwan A. Suliankatchi is Assistant Professor of Community Medicine at Velammal Medical College Hospital and Research Institute; Dhirendra N. Sinha is Regional Adviser, Surveillance, (Tobacco Control) of Tobacco Free Initiative Unit at World Health Organization, Regional Office for South-East Asia.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suliankatchi, R.A., Sinha, D.N. The Human Cost of Tobacco Chewing Among Pregnant Women in India: A Systematic Review and Meta-analysis. J Obstet Gynecol India 66 (Suppl 1), 161–166 (2016). https://doi.org/10.1007/s13224-015-0821-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-015-0821-7

Keywords

Search

Navigation