Prevalence of smoking and smokeless tobacco use during breastfeeding: A cross-sectional secondary data analysis based on 0.32 million sample women in 78 low-income and middle-income countries

Singh, Prashant Kumar; Singh, Lucky; Wehrmeister, Fernando C.; Singh, Nishikant; Kumar, Chandan; Singh, Ankur; Sinha, Dhirendra N; Bhutta, Zulfiqar Ahmed; Singh, Shalini

doi:10.1016/j.eclinm.2022.101660

Cited by 7 publications

(2 citation statements)

References 26 publications

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“… 16 , 17 Furthermore, this high prevalence also extends to its use during pregnancy and breastfeeding. 12 , 18 …”

Section: Introductionmentioning

confidence: 99%

The Diversity in Tobacco Use Among Women of Reproductive Age (15–49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016–2018

Sharma,

Kanaan,

Siddiqi

2024

Nicotine and Tobacco Research

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Introduction Tobacco use in women of reproductive age group(15-49 years) may contribute to poor maternal and child health outcomes. We estimated the prevalence of smokeless tobacco (ST), cigarette, and waterpipe use among these women in Pakistan and explored associations with socio-economic differences and birthweights after recent childbirths (past 2 years). Methods We used the Multiple Indicator Cluster Surveys(MICS) datasets from three provinces in Pakistan. Prevalence was generated for current use of tobacco among women with recent childbirth(WWRC) and without recent childbirth(WWoRC). We further compared socio-economic status and birthweights between tobacco users and non-users. Results The prevalence of current ST use was 1·4% and 2·5%, and waterpipe smoking was 1·2% and 1·8%, in WWRC and WWoRC, respectively. ST use varied across Pakistan’s provinces by 13 percentage points in WWRC and WWoRC while waterpipe smoking by 10 and 15 percentage points, respectively. The odds of using any form of tobacco were significantly lower with higher levels of education or wealth index. Compared to children born to mothers who did not use tobacco, the birthweight of children born to mothers who smoked waterpipe was on average 0.83kg (95%CI -1·6 to -0·1) lower whereas it was 0·33kg (95%CI -0·9 to 0·3) higher for ST users. Conclusions Tobacco use among women of reproductive age in Pakistan varied significantly based on province and tobacco type. Waterpipe smoking was associated with a reduction in birth weight. Raising awareness of the harms of tobacco use among women of reproductive age and targeting interventions in high-burden regions of Pakistan should be prioritised. Implications The prevalence of current smokeless tobacco use and waterpipe smoking varied significantly in Pakistan (~13 and ~15 percentage points, respectively) among women of reproductive age, and there seems to be little change in tobacco use behaviour around pregnancy and early motherhood. The study highlights a need to better understand the prevalence of tobacco use in Pakistan, and further contextual research is warranted to understand the reasons for such high tobacco use in certain areas. This information highlights the need for improving current tobacco control interventions and policies, including measures that could help reduce its use and prevent its uptake. Furthermore, compared to children born to mothers who did not use any form of tobacco, we found a statistically significant difference (830 grams) in birthweight for babies born to mothers who at the time of the interview smoked waterpipe and a non-statistically significant difference of about 330 grams for children born to mothers who at the time of the interview used smokeless tobacco. In addition to our findings, some literature suggests the association of waterpipe smoking with low birth weight. A possible explanation could be the exposure to smoke that contains toxicants from the tobacco product itself in addition to the burning of charcoal, which is required when using waterpipe. Waterpipe smoking also results in high exposures of carbon monoxide and polycyclic aromatic hydrocarbons, which are known to be carcinogenic and teratogenic. In terms of smokeless tobacco use, further research is warranted to understand its impact on birth outcomes through longitudinal studies accounting for diverse products, its constituents and the amount of consumption.

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“… 16 , 17 Furthermore, this high prevalence also extends to its use during pregnancy and breastfeeding. 12 , 18 …”

Section: Introductionmentioning

confidence: 99%

The Diversity in Tobacco Use Among Women of Reproductive Age (15–49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016–2018

Sharma,

Kanaan,

Siddiqi

2024

Nicotine and Tobacco Research

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“…19 Globally, 52.9% of smoking women continue to smoke daily during pregnancy and breastfeeding, 20 and the prevalence of tobacco use among breastfeeding women ranges from 3.61% to 5.2%. 21,22 Approximately 51.8% of women who smoked during the perinatal period are light smokers, smoking up to 10 cigarettes per day. However, approximately 13.5% are heavy smokers, smoking ≥ 20 cigarettes per day.…”

Section: Introductionmentioning

confidence: 99%

Neonatal nicotine exposure affects adult rat hepatic pathways involved in endoplasmic reticulum stress and macroautophagy in a sex-dependent manner

Souza,

Rossetti,

Peixoto

et al. 2023

J Dev Orig Health Dis

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Nonalcoholic fatty liver disease (NAFLD) involves changes in hepatic pathways, as lipogenesis, oxidative stress, endoplasmic reticulum (ER) stress, and macroautophagy. Maternal nicotine exposure exclusively during lactation leads to fatty liver (steatosis) only in the adult male offspring, not in females. Therefore, our hypothesis is that neonatal exposure to nicotine sex-dependently affects the signaling pathways involved in hepatic homeostasis of the offspring, explaining the hepatic lipid accumulation phenotype only in males. For this, between postnatal days 2 and 16, Wistar rat dams were implanted with osmotic minipumps, which released nicotine (NIC; 6 mg/Kg/day) or vehicle. The livers of offspring were evaluated at postnatal day 180. Only the male offspring that had been exposed to nicotine neonatally showed increased protein expression of markers of unfolded protein response (UPR), highlighting the presence of ER stress, as well as disruption of the activation of the macroautophagy repair pathway. These animals also had increased expression of diacylglycerol O-acyltransferase 1 and 4-hydroxynonenal, suggesting increased triglyceride esterification and oxidative stress. These parameters were not altered in the female offspring that had been neonatally exposed to nicotine, however they exhibited increased phospho adenosine monophosphate-activated protein kinase pAMPK expression, possibly as a protective mechanism. Thus, the disturbance in the hepatic homeostasis by UPR, macroautophagy, and oxidative stress modifications seem to be the molecular mechanisms underlying the liver steatosis in the adult male offspring of the nicotine-programming model. This highlights the importance of maternal smoking cessation during breastfeeding to decrease the risk of NAFLD development, especially in males.

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Tobacco and alcohol use among lactating women and its association with child nutrition in India: findings from National Family Health Survey 2019–2021

Bhandari,

Das,

Aditi

et al. 2024

Public Health

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Prevalence of smoking and smokeless tobacco use during breastfeeding: A cross-sectional secondary data analysis based on 0.32 million sample women in 78 low-income and middle-income countries

Cited by 7 publications

References 26 publications

The Diversity in Tobacco Use Among Women of Reproductive Age (15–49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016–2018

The Diversity in Tobacco Use Among Women of Reproductive Age (15–49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016–2018

Neonatal nicotine exposure affects adult rat hepatic pathways involved in endoplasmic reticulum stress and macroautophagy in a sex-dependent manner

Tobacco and alcohol use among lactating women and its association with child nutrition in India: findings from National Family Health Survey 2019–2021

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