Central Australian Aboriginal women's placental and neonatal outcomes following maternal smokeless tobacco, cigarette or no tobacco use

Ratsch, Angela; Bogossian, Fiona; Burmeister, Elizabeth; Steadman, Kathryn J.

doi:10.1111/1753-6405.13186

Cited by 4 publications

(3 citation statements)

References 106 publications

(204 reference statements)

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“…The concentration of nicotine, cotinine, 3'-hydroxycotinine, nornicotine, nicotine-N-oxide and nicotine glucuronide in each sample was summed and reported as a per sample total for data analysis [68]. NM concentrations were compared with maternal, birthing and neonatal variables of clinical interest; elevated maternal glucose, hypertension, anaemia, placenta characteristics, and neonatal gender, birthweight, gestational age, APGAR score and admission to SCN [54,55].…”

Section: Discussionmentioning

confidence: 99%

“…This paper reports the concentration of NM in a range of biological samples from prospectively and conveniently enrolled central Australian Aboriginal pregnant women at hospital for the birth of their baby; mothers self-reported their tobacco use as being chewers, smokers, or no-tobacco use. We also considered NM concentrations in relation to the maternal, birthing, placental and neonatal characteristics and outcomes previously described for these families within the overarching research [54,55].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical ndings from the cohort of 73 Central Australian Aboriginal mother-neonate pairs enrolled in this research [54,55] indicate that the most clinically and statistically signi cant maternal outcomes were differences in hypertension and anaemia across the groups, and a higher rate of elevated maternal glucose in pituri chewing mothers (48%) compared with smoking mothers (22%) and no-tobacco using mothers (16%). The presence of elevated maternal glucose was associated with the birthweights of neonates, although the cohort neonate birthweight mean (3348 g) showed no difference between the nicotine user (or not) groups.…”

Section: Introductionmentioning

confidence: 87%

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Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for central Australian Aboriginal pregnancies

Ratsch

Bogossian

Burmeister

et al. 2022

Preprint

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Background: In central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships to maternal self-reported tobacco use, maternal and neonatal outcomes.Methods: Central Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites.Results: A sample of 73 women were enrolled who self-reported: no-tobacco use (n=31), tobacco chewing (n=19), or smoking (n=23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group.Conclusions: This research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in both the mother and neonate and that exposure may be associated with adverse maternal and neonatal outcomes similar to those from smoked tobacco use in pregnancy. Screening for the use of a broader range of tobacco and nicotine products during pregnancy would provide a more inclusive assessment and contribute to a more accurate determination of tobacco exposure. This knowledge will better inform maternal and foetal care, and direct attention to targeted cessation strategies that are appropriate to the tobacco and nicotine use profile of the population.Note to readers: In this research, the central Australian Aboriginal women chose the term ‘Aboriginal’ to refer to themselves, and ‘Indigenous’ to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

See 1 more Smart Citation

Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for central Australian Aboriginal pregnancies

Ratsch

Bogossian

Burmeister

et al. 2022

Preprint

Self Cite

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The impact of rate of nicotine metabolism, as measured by the nicotine metabolite ratio (NMR), on smoking behaviours during pregnancy: A scoping review

Weng,

Ratsch,

Miles

et al. 2024

Health Sciences Review

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Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for Central Australian Aboriginal pregnancies

Ratsch¹,

Bogossian

Burmeister³

et al. 2022

BMC Public Health

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Background In central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships between maternal self-reported tobacco use and maternal and neonatal outcomes. Methods Central Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites. Results A sample of 73 women were enrolled who self-reported: no-tobacco use (n = 31), tobacco chewing (n = 19), or smoking (n = 23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group. Conclusions This research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in a wide range of maternal and neonatal biological samples and that exposure may be associated with adverse maternal and neonatal outcomes. Screening for the use of all tobacco and nicotine products during pregnancy rather than focusing solely on smoking would provide a more comprehensive assessment and contribute to a more accurate determination of tobacco and nicotine exposure. This knowledge will better inform maternal and foetal care, direct attention to targeted cessation strategies and ultimately improve long-term clinical outcomes, not only in this vulnerable population, but also for the wider population. Note to readers In this research, the central Australian Aboriginal women chose the term ‘Aboriginal’ to refer to themselves, and ‘Indigenous’ to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.

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Central Australian Aboriginal women's placental and neonatal outcomes following maternal smokeless tobacco, cigarette or no tobacco use

Cited by 4 publications

References 106 publications

Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for central Australian Aboriginal pregnancies

Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for central Australian Aboriginal pregnancies

The impact of rate of nicotine metabolism, as measured by the nicotine metabolite ratio (NMR), on smoking behaviours during pregnancy: A scoping review

Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for Central Australian Aboriginal pregnancies

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