Trends in maternal use of snus and smoking tobacco in pregnancy. A register study in Southern Norway

Abstract

Background The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. Methods Data on smoking tobacco and snus use at three time points before and during pregnancy for 20 844 women were retrieved from the electronic birth record for the years 2012-2017. The results for the three-year period 2015-2017 were compared with a previously studied period 2012-2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. Results There was an increase of snus use before pregnancy from the period 2012-2014 to the period 2015-2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25-34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. Conclusions While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy.

Impact of nicotine and maternal BMI on fetal birth weight

“…Low birth weight, small for gestational age (SGA) status, preterm birth, and a low APGAR score are just a few of the harmful effects of nicotine on pregnancy and the newborn [7,8]. The effects of nicotine are seen in every trimester of pregnancy; these range from increased spontaneous abortions in the first trimester to increased preterm delivery rates and a low birth weight in the final trimester [9]. A recent study from Rogers [10] showed that smoking causes an epigenetic phenomena because of altered DNA methylation.…”

Environmental Exposure during Pregnancy: Influence on Prenatal Development and Early Life: A Comprehensive Review

“…The amount of nicotine consumed by vaping is similar to that of cigarette smokers [40]. This is important because the prevalence of female smokers of childbearing age in Scandinavian countries (where snus is popular) is decreasing but that of snus is increasing [41]. Besides, vaping is increasing worldwide with a misperception that e-cigarettes are not as damaging as regular cigarettes during pregnancy [40].…”

Hvor smart er det å tillate salg av e-sigaretter?

“…Relativt få gravide røyker i svangerskapet, og det er få studier av gravides snusbruk i Norge. En undersøkelse fra Sørlandet viste at én av fire snusbrukere fortsatte å bruke snus gjennom hele svangerskapet (14). I en rapport fra Folkehelseinstituttet er risikoen ved snusbruk i svangerskapet angitt som risikoendring per 100 000 gravide som bruker snus sammenliknet med tobakksfrie kontrollgrupper (12).…”