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

  • Review
  • Published:
International Journal of Public Health

Abstract

Objectives

To systematically critique and summarise the available evidence on the outcomes of smokeless tobacco use in pregnancy to inform the public health response.

Methods

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).

Results

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.

Conclusions

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Queensland Health and School of Nursing and Midwifery, The University of Queensland, Brisbane, Australia

    Angela Ratsch

  2. School of Nursing and Midwifery, The University of Queensland, Brisbane, Australia

    Fiona Bogossian

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  1. Angela Ratsch
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  2. Fiona Bogossian
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Correspondence to Angela Ratsch.

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

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