International Journal of Public Health

, Volume 59, Issue 4, pp 599–608 | Cite as

Smokeless tobacco use in pregnancy: an integrative review of the literature

  • Angela RatschEmail author
  • Fiona Bogossian



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.


Smokeless 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.

Supplementary material

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Copyright information

© Swiss School of Public Health 2014

Authors and Affiliations

  1. 1.Queensland Health and School of Nursing and MidwiferyThe University of QueenslandBrisbaneAustralia
  2. 2.School of Nursing and MidwiferyThe University of QueenslandBrisbaneAustralia

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