Smokeless Tobacco Use and Risk of Stillbirth: A Cohort Study in Mumbai, India
Abstract
BACKGROUND: Maternal cigarette smoking has been causally associated with an increased risk for stillbirth. Preliminary reports suggest an increased risk for stillbirth with smokeless tobacco use during pregnancy. METHODS: We conducted a population-based prospective cohort study to investigate this association by using a house-to-house approach to recruit 1,217 women who were between 3 and 7 months' gestation. Of these, 96% were contacted after delivery to determine the pregnancy outcome. Demographic and maternal variables which were apparently associated either with stillbirth or with smokeless tobacco use (OR >or= 1.5) were included as potential confounders. Stillbirth was defined as any delivery of a dead fetus after 20 completed weeks of gestation. We used time-to-event methods to analyze the risk of stillbirth. RESULTS: Overall occurrence of stillbirth among singleton deliveries in this population was 4.1%. Smokeless tobacco use was reported by 17% of women; 8.9% of smokeless tobacco users had a stillbirth compared with 3.1% among nonusers (life-table adjusted hazard ratio = 3.1; 95% confidence interval = 1.7-5.6). After adjustment by the Cox proportional hazards procedure for age, educational and socioeconomic background, working status of mother, parity, prenatal care variables, and place of delivery, the risk for stillbirth in users was 2.6 (95% confidence interval-1.4-4.8). Most women used mishri (a pyrolyzed tobacco product often used as dentifrice), and there was a dose-response relationship between the daily frequency of use and stillbirth risk. The risk of stillbirth associated with smokeless tobacco use was greater in earlier gestational periods. CONCLUSIONS: Smokeless tobacco use during pregnancy increases stillbirth risk, with a risk at least as great as that associated with maternal cigarette smoking.
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Smokeless tobacco use during pregnancy is associated with preterm birth, stillbirth, and orofacial clefts.
“These studies have found associations with preterm birth, stillbirth, and orofacial cleft defects”
From Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products (2017) · cites this paper as [31]
Smokeless tobacco use during pregnancy is associated with a 1.6 to 2.6-fold increase in stillbirth.
“Maternal smokeless tobacco use in pregnancy is associated with a 1.6 to 2.6-fold increase in stillbirth.”
From Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products (2017) · cites this paper as [31]
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- Authors
- Gupta, P. C., & Subramoney, S.
- Affiliations
- Tata Institute of Fundamental Research (IN)
- Corresponding author
- Subramoney, Sreevidya
- Venue
- Epidemiology
- Published
- 2006-01
- Volume
- 17
- Issue
- 1
- Pages
- 47-51
- ISSN
- 1044-3983 (ISSN-L)
- OpenAlex
- W1975378478
- Cited by
- 123
- References
- 13
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 3 · 2018: 9 · 2017: 6 · 2016: 9 · 2015: 9 · 2014: 7 · 2013: 5 · 2012: 12
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- smokeless tobacco, stillbirth, pregnancy, maternal smoking, prenatal exposure, dose-response relationship, gestational age, pregnancy outcomes
- MeSH terms
- Adult, Female, Humans, India, Pregnancy, Socioeconomic Factors, Tobacco, Smokeless, Cohort Studies, Stillbirth
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