Use of Swedish smokeless tobacco during pregnancy: A systematic review of pregnancy and early life health risk

• Published in: Addiction (Abingdon, England) England), 2023-05, Vol.118 (5), p.789-803
• Main Authors: Brinchmann, Bendik C., Vist, Gunn E., Becher, Rune, Grimsrud, Tom K., Elvsaas, Ida‐Kristin Ørjasæter, Underland, Vigdis, Holme, Jørn A., Carlsen, Karin C. Lødrup, Kreyberg, Ina, Nordhagen, Live S., Bains, Karen Eline Stensby, Carlsen, Kai‐Håkon, Alexander, Jan, Valen, Håkon
• Format: Article
• Language: English
• Subjects: Apnea; Birth weight; Bleeding; Cesarean section; Child; Child health; Childbirth & labor; Childrens health; Cohort analysis; epidemiology; Female; Health risks; Health status; Heart rate; Humans; Infant, Newborn; Maternal & child health; Meta-analysis; Mortality rates; Mothers; Neonates; Nicotine; Nicotine - adverse effects; Pre-eclampsia; Preeclampsia; Pregnancy; Pregnancy complications; Pregnancy Complications - epidemiology; Premature birth; Premature Birth - epidemiology; Prenatal care; Prenatal development; public health; Reviews; Risk assessment; smokeless tobacco; snus; Stillbirth; Sweden - epidemiology; Systematic review; Tobacco; Tobacco products; Tobacco Use - epidemiology; Tobacco, Smokeless
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/add.16114

Background and Aims Smokeless tobacco is a heterogeneous product group with diverse composition and prevalence globally. Tobacco use during pregnancy is concerning due to the risk of adverse pregnancy outcomes and effects on child health. Nicotine may mediate several of these effects. This systematic review measured health outcomes from Swedish smokeless tobacco (snus) use during pregnancy. Method Literature search was conducted by an information specialist in May 2022. We included human studies of snus use during pregnancy compared with no tobacco use, assessed risk of bias, conducted a meta‐analysis and assessed confidence in effect‐estimates using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results We included 18 cohort studies (42 to 1 006 398 participants). Snus use during pregnancy probably (moderate confidence in risk estimates) increase the risk of neonatal apnea, adjusted odds ratio 95% confidence interval [aOR (95% CI)] 1.96 (1.30 to 2.96). Snus use during pregnancy possibly (low confidence in risk estimates) increase the risk of stillbirths aOR 1.43 (1.02 to 1.99), extremely premature births aOR 1.69 (1.17 to 2.45), moderately premature birth aOR 1.26 (1.15 to 1.38), SGA aOR 1.26 (1.09 to 1.46), reduced birth weight mean difference of 72.47 g (110.58 g to 34.35 g reduction) and oral cleft malformations aOR 1.48 (1.00 to 2.21). It is uncertain (low confidence in risk estimates, CI crossing 1) whether snus use during pregnancy affects risk of preeclampsia aOR 1.11 (0.97 to 1.28), antenatal bleeding aOR 1.15 (0.92 to 1.44) and very premature birth aOR 1.26 (0.95 to 1.66). Risk of early neonatal mortality and altered heart rate variability is uncertain, very low confidence. Snus using mothers had increased prevalence of caesarean sections, low confidence. Conclusions This systematic review reveals that use of smokeless tobacco (snus) during pregnancy may adversely impact the developing child.