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Prakash C Gupta and Sreevidya S
Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India
BMJ 2004; 328: 1538 [Abstract] [Full text]
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[Read Rapid Response] Smokeless tobacco use, birth weight, and gestational age Additional Findings
Lucinda J England, Richard J. Levine, James L. Mills, Mark A. Klebanoff, Kai F. Yu   (14 July 2004)

Smokeless tobacco use, birth weight, and gestational age Additional Findings 14 July 2004
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Lucinda J England,
Medical Epidemiolgist
Centers for Disease Control and Prevention 4770 Buford Highway NE, MS K-23,Atlanta Georgia USA 30341,
Richard J. Levine, James L. Mills, Mark A. Klebanoff, Kai F. Yu

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Re: Smokeless tobacco use, birth weight, and gestational age Additional Findings

Editor--We read Gupta’s and Sreevidya’s article on pregnancy outcomes in smokeless tobacco users in India (1) with interest. In a previously published study of 23,524 pregnant women in Sweden (2), we found an increased risk of preterm delivery at < 37 weeks’ gestation in smokeless tobacco (snuff) users (adjusted odds ratio or AOR 2.0 [95% CI 1.5 to 2.7]) that was slightly higher than that described by Gupta and Sreevidya (AOR 1.4 [95% CI 1.0 to 2.1]). In addition, we noted an increased risk of preeclampsia (AOR 1.6 [95% CI 1.1 to 2.3]) which may have contributed in part to the increased risk of preterm delivery.

While Gupta and Sreevidya found an even higher odds ratio for delivery at < 32 weeks (AOR 4.9 [95% CI 2.1 to 11.8]), additional analyses of our data did not reveal the same pattern. We also found an increase in delivery at < 32 weeks in snuff users compared with tobacco nonusers (crude OR 1.7 [95% CI 0.7 to 4.2]), but this odds ratio was not higher than our odds ratio of 2.0 for delivery at < 37 weeks. Our analysis, however, was limited by small numbers (only 5 of 789 smokeless tobacco users delivered at < 32 weeks).

Studies such as these two can provide insight into the potential role of nicotine in adverse pregnancy outcomes. This has relevance for nicotine replacement therapy and tobacco-containing harm reduction products. However, we also need to know more about nicotine exposure levels in pregnant women who use smokeless tobacco, and about what other toxins are contained in smokeless tobacco products. In addition, research is needed to address other potentially relevant outcomes, such as impaired cognitive development and sudden infant death syndrome.

References

1) Gupta PC, Sreevidya S. Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India. BMJ 2004;328:1538. (26 June.)

2) England LJ, Levine RJ, Mills JL, Klebanoff MA, Yu KF, Cnattingius, S. Adverse pregnancy outcomes in snuff users. Am J Obstet Gynecol 2003;189:939-943.

Competing interests: None declared