Abstract
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.
Similar content being viewed by others
References
Cnattingius S. The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res. 2004;6(Suppl 2):S125–40. doi:10.1080/14622200410001669187.
Shah NR, Bracken MB. A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery. Am J Obstet Gynecol. 2000;182(2):465–72.
England LJ, Levine RJ, Mills JL, Klebanoff MA, Yu KF, Cnattingius S. Adverse pregnancy outcomes in snuff users. Am J Obstet Gynecol. 2003;189(4):939–43.
Wikstrom AK, Cnattingius S, Galanti MR, Kieler H, Stephansson O. Effect of Swedish snuff (snus) on preterm birth. BJOG. 2010;117(8):1005–10.
Foulds J, Ramstrom L, Burke M, Fagerström K. Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tob Control. 2003;12(4):349–59. doi:10.1136/tc.12.4.349.
Gartner CE, Hall WD, Vos T, Bertram MY, Wallace AL, Lim SS. Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study. The Lancet. 2007;369(9578):2010–4.
Curry LE, Pederson LL, Stryker JE. The Changing marketing of smokeless tobacco in magazine advertisements. Nicotine Tob Res. 2011;13(7):540–7. doi:10.1093/ntr/ntr038.
Jaddoe VW, Troe EJ, Hofman A, Mackenbach JP, Moll HA, Steegers EA, et al. Active and passive maternal smoking during pregnancy and the risks of low birthweight and preterm birth: the Generation R Study. Paediatr Perinat Epidemiol. 2008;22(2):162–71.
McCowan LME, Dekker GA, Chan E, Stewart A, Chappell LC, Hunter M, et al. Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: prospective cohort study. BMJ. 2009;338:b1081.
Li CQ, Windsor RA, Perkins L, Goldenberg RL, Lowe JB. The impact on infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy. JAMA. 1993;269(12):1519–24.
Cnattingius S, Ericson A, Gunnarskog J, Kallen B. A quality study of a medical birth registry. Scand J Soc Med. 1990;18(2):143–8.
Center for Epidemiology. The Swedish Medical Birth Register—A summary of content and quality. 2003.
Swedish Council on Technology Assessment in Health Care. Ultrasound screening during pregnancy in Sweden (In Swedish) 1998.
Lindmark G, Cnattingius S. The scientific basis of antenatal care. Report from a state-of-the-art conference. Acta Obstei Gynecol Scand. 1991;70:105–9.
Statistics Sweden. Evaluation of the Swedish register of education (In Swedish). Stockholm 2006.
Meis PJ, Michielutte R, Peters TJ, Wells HB, Sands RE, Coles EC, et al. Factors associated with preterm birth in Cardiff, wales: I. Univariable and multivariable analysis. Am J Obstet Gynecol. 1995;173(2):590–6.
Shiono PH, Klebanoff MA, Rhoads GG. Smoking and drinking during pregnancy. Their effects on preterm birth. JAMA. 1986;255(1):82–4.
Vardavas C, Chatzi L, Patelarou E, Plana E, Sarri K, Kafatos A, et al. Smoking and smoking cessation during early pregnancy and its effect on adverse pregnancy outcomes and fetal growth. Eur J Pediatr. 2010;169(6):741–8. doi:10.1007/s00431-009-1107-9.
Cnattingius S, Granath F, Petersson G, Harlow BL. The influence of gestational age and smoking habits on the risk of subsequent preterm deliveries. N Engl J Med. 1999;341(13):943–8.
Wikstrom AK, Cnattingius S, Stephansson O. Maternal use of Swedish snuff (snus) and risk of stillbirth. Epidemiology. 2010;21(6):772–8. doi:10.1097/EDE.0b013e3181f20d7e.
Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. The Lancet. 2008;371(9606):75–84.
Romero R, Espinoza J, Goncalves LF, Kusanovic JP, Friel L, Hassan S. The role of inflammation and infection in preterm birth. Semin Reprod Med. 2007;25(1):21–39. doi:10.1055/s-2006-956773.
Bermudez EA, Rifai N, Buring JE, Manson JE, Ridker PM. Relation between markers of systemic vascular inflammation and smoking in women. Am J Cardiol. 2002;89(9):1117–9.
Kyrklund-Blomberg NB, Granath F, Cnattingius S. Maternal smoking and causes of very preterm birth. Acta Obstet Gynecol Scand. 2005;84(6):572–7. doi:10.1111/j.0001-6349.2005.00848.x.
Kyrklund-Blomberg NB, Cnattingius S. Preterm birth and maternal smoking: risks related to gestational age and onset of delivery. Am J Obstet Gynecol. 1998;179(4):1051–5.
Arias F, Rodriquez L, Rayne SC, Kraus FT. Maternal placental vasculopathy and infection: two distinct subgroups among patients with preterm labor and preterm ruptured membranes. Am J Obstet Gynecol. 1993;168(2):585–91.
Resnik R, Brink GW, Wilkes M. Catecholamine-mediated reduction in uterine blood flow after nicotine infusion in the pregnant ewe. J Clin Investig. 1979;63(6):1133–6.
Zamudio S. The placenta at high altitude. High Alt Med Biol. 2003;4(2):171–91. doi:10.1089/152702903322022785.
Rosario GX, Konno T, Soares MJ. Maternal hypoxia activates endovascular trophoblast cell invasion. Dev Biol. 2008;314(2):362–75.
Caniggia I, Winter J, Lye SJ, Post M. Oxygen and placental development during the first trimester: implications for the pathophysiology of pre-eclampsia. Placenta. 2000;21(Suppl 1):S25–30.
Solomon LJ, Quinn VP. Spontaneous quitting: self-initiated smoking cessation in early pregnancy. Nicotine Tob Res. 2004;6(Suppl 2):S203–16. doi:10.1080/14622200410001669132.
Gunnerbeck A, Wikström A-K, Bonamy A-KE, Wickström R, Cnattingius S. Relationship of maternal snuff use and cigarette smoking with Neonatal Apnea. Pediatrics. 2011;128(3):503–9. doi:10.1542/peds.2010-3811.
Forinash AB, Pitlick JM, Clark K, Alstat V. Nicotine replacement therapy effect on pregnancy outcomes. Ann Pharmacother. 2010;44(11):1817–21. doi:10.1345/aph.1P279.
Coleman T, Chamberlain C, Cooper S, Leonardi-Bee J. Efficacy and safety of nicotine replacement therapy for smoking cessation in pregnancy: systematic review and meta-analysis. Addiction. 2011;106(1):52–61. doi:10.1111/j.1360-0443.2010.03179.x.
Coleman T, Cooper S, Thornton JG, Grainge MJ, Watts K, Britton J, et al. A randomized trial of Nicotine-replacement therapy patches in pregnancy. N Engl J Med. 2012;366(9):808–18.
George L, Granath F, Johansson ALV, Cnattingius S. Self-reported nicotine exposure and plasma levels of cotinine in early and late pregnancy. Acta Obstet Gynecol Scand. 2006;85(11):1331–7.
Acknowledgments
Sachiko Baba is a recipient of Institutional Program for Young Researcher Overseas Visits granted for Public Health, the Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine by the Japan Society of Promotion of Science. The study was supported by grants from the Swedish Council for Working Life and Social Research (2009–1619) and by grants from Karolinska Institutet.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Baba, S., Wikström, AK., Stephansson, O. et al. Influence of smoking and snuff cessation on risk of preterm birth. Eur J Epidemiol 27, 297–304 (2012). https://doi.org/10.1007/s10654-012-9676-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-012-9676-8