Maternal use of swedish snuff (snus) and risk of stillbirth
Abstract
BACKGROUND: Swedish snuff has been discussed internationally as a safer alternative to tobacco smoking. International cigarette manufacturers are promoting new snuff products, and the use of Swedish snuff is increasing, especially among women of childbearing age. The effect of Swedish snuff on pregnancy complications is unknown. METHODS: In this population-based cohort study, we estimated the risk of stillbirth in snuff users (n = 7629), light smokers (1-9 cigarettes/day; n = 41,488), and heavy smokers (≥10 cigarettes/day; n = 17,014), using nontobacco users (n = 504,531) as reference. RESULTS: Compared with nontobacco users, snuff users had an increased risk of stillbirth (adjusted odds ratio = 1.6 [95% confidence interval = 1.1-2.3]); the risk was higher for preterm (<37 weeks) stillbirth (2.1 [1.3-3.4]). For light smokers, the adjusted odds ratio of stillbirth was 1.4 (1.2-1.7) and the corresponding risk for heavy smokers was 2.4 (2.0-3.0). When we excluded women with preeclampsia or antenatal bleeding and infants who were small for gestational age, the smoking-related risks of stillbirth was markedly attenuated; the elevated risk for snuff users remained the same level. CONCLUSIONS: Use of Swedish snuff during pregnancy was associated with a higher risk of stillbirth. The mechanism behind this increased risk seems to differ from the underlying mechanism in smokers. Swedish snuff does not appear to be a safe alternative to cigarette smoking during pregnancy.
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Among women who use snus during pregnancy, there is an increased risk of stillbirth (aOR = 1.6; 95% CI: 1.1-2.3), especially preterm (< 37 weeks) stillbirth (aOR = 2.1; 95% CI: 1.3-3.4).
“Increased risk of stillbirth (aOR = 1.6; 95%CI: 1.1-2.3),especially preterm (< 37 weeks) stillbirth (aOR = 2.1; 95% CI:1.3-3.4) among women who use snus during pregnancy (Wikström et al. 2010b)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Wikström et al. 2010b
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 [33]
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 [33]
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- Authors
- Wikström, A.-K., Cnattingius, S., & Stephansson, O.
- Affiliations
- Karolinska Institutet (SE)
- Karolinska University Hospital (SE)
- Corresponding author
- Wikström, Anna-Karin
- Venue
- Epidemiology
- Published
- 2010-11
- Volume
- 21
- Issue
- 6
- Pages
- 772-778
- ISSN
- 1044-3983 (ISSN-L)
- OpenAlex
- W2065451277
- Cited by
- 83
- References
- 30
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 5 · 2021: 5 · 2020: 6 · 2019: 4 · 2018: 6 · 2017: 3 · 2016: 3 · 2015: 8 · 2014: 10 · 2013: 9 · 2012: 10
- FWCI
- 5.63
- 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
- stillbirth, maternal smoking, snuff, smoking during pregnancy, pregnancy complications, preeclampsia, small for gestational age, alternative tobacco products
- MeSH terms
- Adult, Female, Humans, Pregnancy, Registries, Risk, Sweden, Tobacco, Smokeless, Cohort Studies, Odds Ratio, Maternal Exposure, Stillbirth
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