Relationship of Maternal Snuff Use and Cigarette Smoking With Neonatal Apnea

Gunnerbeck, Anna; Wikström, Anna‐Karin; Bonamy, Anna‐Karin Edstedt; Wickström, Ronny; Cnattingius, Sven

doi:10.1542/peds.2010-3811

Cited by 43 publications

(54 citation statements)

References 36 publications

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“…Usually, NRT generates lower nicotine levels than smoking and probably also snuff, but nicotine level remains continuously high during use. 26 To provide NRT to smokers is discussed as one possibility for harm reduction during pregnancy. However, there is still insufficient evidence for the safety of NRT.…”

Section: Discussionmentioning

confidence: 99%

Changes in snuff and smoking habits in Swedish pregnant women and risk for small for gestational age births

Baba

Wikström

Stephansson

et al. 2012

BJOG

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Objective To examine associations between antenatal exposure to Swedish oral moist snuff (which includes essentially only nicotine) and to smoking and risks of small-for-gestational-age (SGA) births and to compare risks among women who stopped or continued using snuff or smoking during pregnancy.Design Population-based cohort study.Setting Sweden.Population All live singleton births in Sweden 1999-2010.Methods Odds ratios (OR) with 95% confidence intervals (CI) were calculated using multiple logistic regression analysis.Main outcome measures SGA birth, also stratified into preterm ( 36 weeks of gestation) and term ( 37 weeks of gestation) SGA births.Results Compared with non-tobacco users in early pregnancy, snuff users and above all smokers in early pregnancy had increased risks of SGA births: adjusted ORs (95% CI) were 1.26 (1.09-1.46) and 2.55 (2.43-2.67), respectively). Snuff use had, if anything, a stronger association with preterm SGA than term SGA, whereas the opposite was true for smoking. Compared with non-tobacco users, women who stopped using snuff before their first visit to antenatal care had no increased risks of preterm or term SGA, and women who stopped using snuff later during pregnancy had no increased risk of term SGA. Smoking cessation early in pregnancy was associated with a larger reduction in risk than smoking cessation later in pregnancy.Conclusions As both smoking and snuff use influence risk of SGA, both nicotine but above all tobacco combustion products are involved in the mechanisms by which maternal smoking increases the risk of SGA.

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Section: Discussionmentioning

confidence: 99%

Changes in snuff and smoking habits in Swedish pregnant women and risk for small for gestational age births

Baba

Wikström

Stephansson

et al. 2012

BJOG

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“…NRT usually generates lower nicotine levels than smoking and probably also snuff, but nicotine level remains continuously high during use [32]. There is insufficient evidence for the NRT's safety during pregnancy [32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Influence of smoking and snuff cessation on risk of preterm birth

et al. 2012

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The mechanisms by which antenatal smoking exposure increases the risk of preterm birth remain unknown. Swedish oral moist snuff contains quantities of nicotine comparable to those typically absorbed from cigarette smoking, but does not result in exposure to the products of combustion, for example carbon monoxide. In a nation-wide study of 776,836 live singleton births in Sweden from 1999 to 2009, the authors used multiple logistic regression models to examine associations between cessation of smoking and Swedish snuff use early in pregnancy and risk of preterm birth (before 37 weeks). Compared with non-tobacco users both before and in early pregnancy, the adjusted odds ratios (OR), 95% confidence interval (CI) were OR=0.92, 95% CI 0.84-1.01, for women who stopped using snuff, and OR=0.90, 95% CI 0.87-0.94, for women who stopped smoking. In contrast, continued snuff use and smoking were associated with increased risks of preterm birth (adjusted OR=1.29, 95% CI 1.17-1.43, adjusted OR=1.30, 95% CI 1.25-1.36, respectively). The snuff and smoking-related risks were, if anything, higher for very (before 32 weeks) than moderately (32-36 weeks) preterm birth, and also higher for spontaneous than induced preterm birth. These findings suggest that antenatal exposure to nicotine is involved in the mechanism by which tobacco use increase the risk of preterm birth.

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“…The mechanism by which maternal smoking increases the risk of SIDS is not completely understood, but infants born of smoking mothers show increased apneic events and decreased rates of arousal in response to the apneic events (86,87). Further supporting the key role of nicotine, in a Swedish study of 600,000 pregnancies, the use of smokeless tobacco in pregnancy was associated with an even higher incidence of neonatal apnea than was conventional cigarette use (88). The key role for nicotine in mediating decreased arousal and increased apnea caused by maternal smoking is further supported by animal studies in both mice (89) and sheep (90), in which prenatal nicotine exposure blunts respiratory responses to hypoxia.…”

Section: Effects Of Prenatal Nicotine Exposure On Offspring Respiratomentioning

confidence: 99%

The Role of Nicotine in the Effects of Maternal Smoking during Pregnancy on Lung Development and Childhood Respiratory Disease. Implications for Dangers of E-Cigarettes

Spindel

McEvoy

2016

Am J Respir Crit Care Med

134

107

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Use of e-cigarettes, especially among the young, is increasing at nearexponential rates. This is coupled with a perception that e-cigarettes are safe and with unlimited advertising geared toward vulnerable populations, the groups most likely to smoke or vape during pregnancy. There is now wide appreciation of the dangers of maternal smoking during pregnancy and the lifelong consequences this has on offspring lung function, including the increased risk of childhood wheezing and subsequent asthma. Recent evidence strongly supports that much of the effect of smoking during pregnancy on offspring lung function is mediated by nicotine, making it highly likely that e-cigarette use during pregnancy will have the same harmful effects on offspring lung function and health as do conventional cigarettes. In fact, the evidence for nicotine being the mediator of harm of conventional cigarettes may be most compelling for its effects on lung development. This raises concerns about both the combined use of e-cigarettes plus conventional cigarettes by smokers during pregnancy as well as the use of e-cigarettes by e-cigarette-only users who think them safe or by those sufficiently addicted to nicotine to not be able to quit e-cigarette usage during pregnancy. Thus, it is important for health professionals to be aware of the risks of e-cigarette usage during pregnancy, particularly as it pertains to offspring respiratory health.

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Relationship of Maternal Snuff Use and Cigarette Smoking With Neonatal Apnea

Cited by 43 publications

References 36 publications

Changes in snuff and smoking habits in Swedish pregnant women and risk for small for gestational age births

Changes in snuff and smoking habits in Swedish pregnant women and risk for small for gestational age births

Influence of smoking and snuff cessation on risk of preterm birth

The Role of Nicotine in the Effects of Maternal Smoking during Pregnancy on Lung Development and Childhood Respiratory Disease. Implications for Dangers of E-Cigarettes

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