Pregnancy outcomes
Summary
The association between tobacco use and pregnancy outcomes has been investigated in a recently publish cohort study comprising women who used snus or smoked daily and a control who didn’t use tobacco. Swedish Match recommends that women abstain from snus and other sources of nicotine during pregnancy.
Important research results on Swedish snus:
- Daily use of snus during pregnancy is associated with a modest reduction in average birth weight.
- Daily use of snus during pregnancy is associated with increased risk of preterm delivery, stillbirth and neonatal apnea.
- Daily use of snus during pregnancy is not associated with risk of small-for-gestational-age birth.
England et al. (2003) used data from the Swedish Medical Birth Register to compare the birth outcomes of 789 women who used snus daily, 11240 women who smoked cigarettes daily and 11495 women who used no tobacco products. Four health points were evaluated: birth weight, small-for-gestational-age birth, preterm delivery and preeclampsia.
The results showed that compared to non-users of tobacco, the average birth weight of babies born to snus users was reduced by 39 grams, whereas that of cigarette smokers was reduced by 190 grams. The risk of having a small-for-gestational-age baby among snus users was similar to that of non-users of tobacco, but it was significantly increased among cigarette smokers. The results also showed that the risk of preterm delivery was significantly elevated both in snus users and cigarette smokers compared to non-users of tobacco. In addition snus users are at significantly increased risk of preeclampsia.
Wikström et al (2010) expanded the study population to 610000 women, and included 7600 women who used snus, 58000 women who smoked. The study confirmed that snus use in pregnant women was associated with a reduction in average birth weight, however this larger study did not find an increased risk of preeclapmpsia, on the contrary snus use was associated with a decreased risk of both preeclampsia and gestational hypertension. In addition, the study found an increased risk of stillbirth.
England, L.J., Levine, R.J., Mills, J.L., Klebanoff, M.A., Yu, K.F., and Cnattingius, S. 2003. Adverse pregnancy outcomes in snuff users. Am. J. Obstet. Gynecol. 189: 939-943. Wikstrom AK, Cnattingius S, Galanti MR, Kieleer H and Stephansson O. Effect of Swedish snuff (snus) on preterm birth, BJOG 2010; 117:1005-1010. .Wikstrom AK, Cnattingius S and Stephansson O. Maternal use of Swedish snuff (snus) and risk of stillbirth. Epidemiology 2010; 21:772-778.Wikstrom AK, Stephansson O and Cnattingius S Tobacco use during pregnancy and preeclampsia risk. Effect of cigarette smoking and snuff. Hypertension 2010; 55: 1254. Gunnerbeck PE, Persson M and Hammarstrom. Relationship of maternal snuff use and cigarette smoking with neonatal apnea. Pediatrics 2011; 128:503-509 Gunnerbeck A, Edstedt Bonamy A-K, Wikstro¨m A-K, Granath F, Wickstrom R, et al. (2014) Maternal Snuff Use and Smoking and the Risk of Oral Cleft Malformations - A Population-Based Cohort Study. PLoS ONE 9(1): e84715.
