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Stopping when knowing: use of snus and nicotine during pregnancy in Scandinavia

Ina Kreyberg, Karen E.S. Bains, Kai-H. Carlsen, Berit Granum, Hrefna K. Gudmundsdóttir, Guttorm Haugen, Gunilla Hedlin, Katarina Hilde, Christine M. Jonassen, Live S. Nordhagen, Björn Nordlund, Katrine D. Sjøborg, Håvard O. Skjerven, Anne C. Staff, Cilla Söderhäll, Riyas M. Vettukatil, Karin C. Lødrup Carlsen on behalf of the PreventADALL study group
ERJ Open Research 2019 5: 00197-2018; DOI: 10.1183/23120541.00197-2018
Ina Kreyberg
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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  • For correspondence: inakreyberg@hotmail.com
Karen E.S. Bains
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Kai-H. Carlsen
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Berit Granum
3Dept of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Oslo, Norway
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Hrefna K. Gudmundsdóttir
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Guttorm Haugen
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
4Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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Gunilla Hedlin
5Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
6Dept of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Katarina Hilde
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
4Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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Christine M. Jonassen
7Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
8Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
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Live S. Nordhagen
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
9VID Specialized University, Oslo, Norway
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Björn Nordlund
5Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
6Dept of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Katrine D. Sjøborg
10Dept of Obstetrics and Gynaecology, Østfold Hospital Trust, Kalnes, Norway
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Håvard O. Skjerven
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Anne C. Staff
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
4Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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Cilla Söderhäll
6Dept of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Riyas M. Vettukatil
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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  • ORCID record for Riyas M. Vettukatil
Karin C. Lødrup Carlsen
1Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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  • FIGURE 1
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    FIGURE 1

    Percentage of women using snus and/or cigarette smoke during pregnancy based on self-reported time for stopping from those who completed both 18-week and 34-week questionnaires (n=2187). Time for stopping categories were from 1–2 weeks to >16 weeks and from <17 weeks to 30–34 weeks, respectively. Among the women who reported the use of snus, cigarette smoke or dual use at some time during pregnancy, most stopped when they recognised their pregnancy (mean pregnancy week three to four). Week 0 reflects the total percentage of women who reported any use during pregnancy. E-cigarettes and nicotine replacement therapies were not included since the rates were low.

  • FIGURE 2
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    FIGURE 2

    Factors associated with snus use during pregnancy. In multivariate analysis, the following factors were identified as associated with the use of snus at some time during pregnancy (reference categories are presented in italic for each factor): living area (countryside (village) versus city (densely populated), city (less densely populated), suburb, countryside (outside village)); grand maternal cigarette smoking (no versus yes, do not know); country of origin (rest of the world and other nordic countries combined versus Norway or Sweden); previous and/or current smoking (no versus yes); marital status (married versus cohabitant, single, divorced/separated, other). Age was used as a continuous variable. OR: odds ratio. #: in utero smoking exposure of the index woman; *: p<0.05; **: p<0.01.

Tables

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  • TABLE 1

    Background characteristics of the study population, comparing those women who were included in the present analysis versus those who were not

    CharacteristicsInclusion in the present analysis
    Yes# (n=2528)No# (n=173)
    Maternal age years32.4 (20–48)¶31.1 (18–44)¶
    Maternal data
     BMI before pregnancy (n=2460)23.2 (13.8–45.7)23.6 (17.1–44.1)
     Height cm (n=2491)168.0 (147.0–187.0)167.4 (147.0–186.0)
     Weight before pregnancy kg (n=2471)65.4 (42.5–126.0)64.2 (42.0–116.0)
     Weight at inclusion kg (n=2498)70.2 (44.8–132.7)68.0 (45.8–117.0)
     Previous pregnancy1292 (51.1)
    Previous pregnancies+ (n=2528)
     01236 (48.9)
     1652 (25.8)
     2377 (14.9)
     3143 (5.7)
     >3120 (4.8)
    Education (n=2350)
     Preliminary school only (9–10 years)18 (0.8)
     High school only239 (10.2)
     Higher education <4 years758 (32.2)
     Higher education ≥4 years1324 (56.3)
     Other2 (0.1)
     Unknown9 (0.4)
    Country of origin (n=2350)
     Norway1562 (66.5)
     Sweden523 (22.3)
     Other nordic31 (1.3)
     Rest of the world234 (10.0)
    Marital status (n=2350)
     Married968 (41.2)
     Cohabitant1313 (55.9)
     Single44 (1.9)
     Divorced/separated1 (0.04)
     Other24 (1.0)
    Living environment (n=2350)
     City (densely populated)916 (39.0)
     City (less densely populated)882 (37.5)
     Suburb373 (15.9)
     Countryside (in village)127 (5.4)
     Countryside (outside village)52 (2.2)

    Data is presented as mean (min–max) or n (%). BMI: body mass index. #: subjects were included in the present analysis if one or more questionnaires (from 18 weeks and 34 weeks) was completed. Subjects were excluded if questionnaires were not completed. Total pregnancies at 18 weeks available for inclusion was 2701. Total questionnaires completed at 18 weeks was 2350. ¶: p<0.001; +: number of reported pregnancies excluding the current pregnancy.

    • TABLE 2

      Reported use of snus, cigarette smoke and nicotine-replacement therapies (NRTs)/e-cigarettes in Norway and Sweden

      ParameterTotalNorwaySwedenp-value#
      Questionnaire adherence
       Completed at 18 weeks2350 (100.0)1818 (77.4)532 (22.6)
       Completed 34 weeks2365 (100.0)1853 (78.4)512 (21.7)
       Completed one or more2528 (100.0)1985 (78.5)543 (21.5)
       Completed both2187 (100.0)1686 (77.1)501 (22.9)
      Tobacco habits
       Ever use in life (n=2350)
        All nicotine-containing products840 (35.7)680 (37.4)160 (30.1)0.002
        Snus529 (22.5)434 (23.9)95 (17.9)0.003
        Cigarette smoke531 (22.6)423 (23.3)108 (20.3)0.15
       Use before pregnancy (n=2350)
        Stopped years before pregnancy
         Snus213 (9.6)165 (9.1)48 (9.0)0.97
         Cigarette smoke338 (14.4)276 (15.2)62 (11.7)0.04
        Stopped in the time before pregnancy
         Snus138 (5.9)120 (6.6)18 (3.4)0.005
         Cigarette smoke77 (3.3)65 (3.6)12 (2.3)0.13
       Snus in pregnancy (including dual users)
        At some time up to 18 weeks (n=2350)178 (7.6)149 (8.2)29 (5.5)0.035
         Current use at 18 weeks13 (0.6)11 (0.6)2 (0.4)0.81
         Stopped when recognising pregnancy165 (7.0)138 (7.6)27 (5.1)
        At some time from 18–34 weeks (n=2365)18 (0.8)14 (0.8)4 (0.8)0.95
         Current use at 34 weeks6 (0.3)4 (0.2)2 (0.4)
         Stopped between 18 and 34 weeks12 (0.5)10 (0.5)2 (0.4)
       Cigarette smoke in pregnancy (including dual users)
        At some time up to 18 weeks (n=2350)116 (4.9)82 (4.5)34 (6.4)0.08
         Current use at 18 weeks18 (0.8)14 (0.8)4 (0.8)0.84
         Stopped when recognising pregnancy98 (4.2)68 (3.7)30 (5.6)
        At some time from 18–34 weeks (n=2365)14 (0.6)10 (0.5)4 (0.8)0.53
         Current use at 34 weeks8 (0.3)6 (0.3)2 (0.4)
         Stopped between 18 and 34 weeks6 (0.3)4 (0.2)2 (0.4)
       Dual snus and cigarette smoke in pregnancy
        At some time up to 18 weeks (n=2350)15 (0.6)7 (0.4)8 (1.5)0.004
         Current use at 18 weeks000
         Stopped when recognising pregnancy15 (0.6)7 (0.4)8 (1.5)
        At some time from 18–34 weeks (n=2365)1 (0.04)01 (0.2)
         Current use at 34 weeks000
         Stopped between 18 and 34 weeks1 (0.04)01 (0.2)
       NRTs/e-cigarettes in pregnancy
        At some time up to 18 weeks (n=2350)5 (0.2)3 (0.2)2 (0.4)
         Current use at 18 weeks2 (0.1)1 (0.1)1 (0.2)
         Stopped when recognising pregnancy3 (0.1)2 (0.1)1 (0.2)
        At some time from 18–34 weeks (n=2365)1 (0.1)01 (0.2)
         Current use at 34 weeks1 (0.1)01 (0.2)
         Stopped between 18 and 34 weeks000

      #: p-values in bold (p<0.05) are significant.

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        Supplementary material 00197-2018_supp

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      Stopping when knowing: use of snus and nicotine during pregnancy in Scandinavia
      Ina Kreyberg, Karen E.S. Bains, Kai-H. Carlsen, Berit Granum, Hrefna K. Gudmundsdóttir, Guttorm Haugen, Gunilla Hedlin, Katarina Hilde, Christine M. Jonassen, Live S. Nordhagen, Björn Nordlund, Katrine D. Sjøborg, Håvard O. Skjerven, Anne C. Staff, Cilla Söderhäll, Riyas M. Vettukatil, Karin C. Lødrup Carlsen
      ERJ Open Research Apr 2019, 5 (2) 00197-2018; DOI: 10.1183/23120541.00197-2018

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      Stopping when knowing: use of snus and nicotine during pregnancy in Scandinavia
      Ina Kreyberg, Karen E.S. Bains, Kai-H. Carlsen, Berit Granum, Hrefna K. Gudmundsdóttir, Guttorm Haugen, Gunilla Hedlin, Katarina Hilde, Christine M. Jonassen, Live S. Nordhagen, Björn Nordlund, Katrine D. Sjøborg, Håvard O. Skjerven, Anne C. Staff, Cilla Söderhäll, Riyas M. Vettukatil, Karin C. Lødrup Carlsen
      ERJ Open Research Apr 2019, 5 (2) 00197-2018; DOI: 10.1183/23120541.00197-2018
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