Smokeless tobacco use in pregnancy: an integrative review of the literature
- 595 Downloads
To systematically critique and summarise the available evidence on the outcomes of smokeless tobacco use in pregnancy to inform the public health response.
In March 2013, a search was conducted of observational studies where the exposure to smokeless tobacco during pregnancy and maternal, placental and/or neonatal outcomes was assessed. Two reviewers extracted data and completed quality assessment of the literature utilizing the Agency for Healthcare Research and Quality criteria (West et al. 2002).
The search resulted in 211 articles, 21 (10 %) of which met the final criteria for integrative review. Ten (10) of the studies are from India, seven (7) from Sweden, two (2) from Alaska and one (1) each from South Africa and Pakistan.
Many studies lacked sufficient power to estimate precise risks. Most reports were hindered by imprecise measures of exposure and lack of confounding variable control. However, there were indications that maternal smokeless tobacco use increases rates of stillbirth, low birth weight and alters the male:female live birth ratio. Maternal smokeless tobacco use may not be safe for mother or foetus.
KeywordsSmokeless tobacco Pregnancy Maternal outcomes Perinatal outcomes
AR is supported by a Queensland Health—Office of Health and Medical Research Fellowship, The University of Queensland—School of Nursing and Midwifery-Elizabeth A. Davies Scholarship, and the Queensland Centaur Memorial Fund for Nurses Scholarship. The University of Queensland has provided a FirstLink Grant to the larger program of research of which this review forms a part.
- Aagaard-Tillery KM, Porter TF, Lane RH, Varner MW, Lacoursiere DY (2008) In utero tobacco exposure is associated with modified effects of maternal factors on fetal growth. Am J Obstet Gynecol 198 (1):66 e61–66. doi: 10.1016/j.ajog.2007.06.078
- Burritt C, Gustafsson K (2013) Sweden’s Snus tobacco invades, but Americans Prefer Snuff. http://www.businessweek.com/articles/2013-07-03/swedens-snus-tobacco-invades-but-americans-prefer-snuff. Accessed 1 Aug 2013
- England LJ, Kim SY, Tomar SL, Ray CS, Gupta PC, Eissenberg T, Cnattingius S, Bernert JT, Tita AT, Winn DM, Djordjevic MV, Lambe M, Stamilio D, Chipato T, Tolosa JE (2010) Non-cigarette tobacco use among women and adverse pregnancy outcomes. Acta Obstet Gynecol Scand 89(4):454–464. doi: 10.3109/00016341003605719 PubMedCrossRefGoogle Scholar
- England LJ, Kim SY, Shapiro-Mendoza CK, Wilson HG, Kendrick JS, Satten GA, Lewis CA, Whittern P, Tucker MJ, Callaghan WM (2012) Maternal smokeless tobacco use in Alaska Native women and singleton infant birth size. Acta Obstet Gynecol Scand 91(1):93–103. doi: 10.1111/j.1600-0412.2011.01273.x PubMedCrossRefGoogle Scholar
- Giovino GA, Mirza SA, Samet JM, Gupta PC, Jarvis MJ, Bhala N, Peto R, Zatonski W, Hsia J, Morton J, Palipudi KM, Asma S (2012) Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet 380(9842):668–679. doi: 10.1016/s0140-6736(12)61085-x PubMedCrossRefGoogle Scholar
- Hurt RD, Renner CC, Patten CA, Ebbert JO, Offord KP, Schroeder DR, Enoch CC, Gill L, Angstman SE, Moyer TP (2005) Iqmik—a form of smokeless tobacco used by pregnant Alaska natives: nicotine exposure in their neonates. J Matern Fetal Neonatal Med 17(4):281–289. doi: 10.1080/14767050500123731 PubMedCrossRefGoogle Scholar
- Benowitz NL, Hukkanen J, Jacob P, III (2009) Nicotine chemistry, metabolism, kinetics and biomarkers. In: Henningfield JE, London ED, Pogun S (eds) Nicotine psychopharmacology, vol 192. Handbook of experimental pharmacology. Springer, Berlin, pp 29–60. doi: 10.1007/978-3-540-69248-5_2
- Khalki H, Khalki L, Aboufatima R, Ouachrif A, Mountassir M, Benharref A, Chait A (2012) Prenatal exposure to tobacco extract containing nicotinic alkaloids produces morphological and behavioral changes in newborn rats. Pharmacol Biochem Behav 101(3):342–347. doi: 10.1016/j.pbb.2012.01.020 PubMedCrossRefGoogle Scholar
- Mehta A, Shukla S (1990) Tobacco and pregnancy. J Obstet Gynaecol India 40(2):156–160Google Scholar
- Sarkar S, Bhide M, Bhide A, Raghavan S, Maru G, Bhide S (1992) Transplacental exposure of human foetuses to nicotine/cotinine in masheri addict mothers and consequent loss of weight in babies at birth. Paper presented at the Nitroso Compounds: Biological Mechanisms, Exposures and Cancer Etiology Conference, Kailua-Kona, Hawaii, USA, November 1–2, 1991Google Scholar
- Shafey O, Eriksen M, Ross H, Mackey J (2009) The tobacco atlas. American Cancer Society. http://www.afro.who.int/en/clusters-a-programmes/hpr/health-risk-factors/tobacco/tobacco-country-profiles.html. Accessed 20 June 2013
- Slotkin T (1997) Expert opinions: Nicotine: interview with professor theodore slotkin. ABC Online—Quantum. Australia Broadcasting Corporation, AustraliaGoogle Scholar
- Slotkin TA, McCook EC, Seidler FJ (1997) Cryptic brain cell injury caused by fetal nicotine exposure is associated with persistent elevations of c-fos protooncogene expression. Brain Res 750(1–2):180–188. doi: 10.1016/S0006-8993(96)01345-5
- Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012. doi: 10.1001/jama.283.15.2008
- von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology 18(6):800–804. doi: 10.1097/EDE.0b013e3181577654 CrossRefGoogle Scholar
- West S, King V, Carey T, Lohr K, McKoy N, Sutton S, Lux L (2002) Systems to rate the strength of scientific evidence. Evidence Report/Technology Assessment No. 472002. (trans: U.S. Department of Health and Human Services), RockvilleGoogle Scholar
- World Health Organization (2011a) WHO Report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. World Health Organisation, GenevaGoogle Scholar
- World Health Organization (2011b) Crude smokeless tobacco prevalence in WHO member states. World Health Organisation, GenevaGoogle Scholar