Is Smokeless Tobacco Safe?

 Ratsch, A. and F. Bogossian conducted an examination on the effects of smokeless tobacco (ST) uses during pregnancy. They examined studies that compared prenatal and placental development during pregnancy between ST users and nonusers. ST is a term for non-burning tobacco which is orally (or nasally) administered such as the ingestion of tobacco leaves and chewing tobacco pastes on the gums. ST uses during pregnancy contribute to adverse outcomes similar to smoking cigarette (SC). Yet fetuses are exposed at a risk of nicotine. The major impact of nicotine on fetus development is to hinder embryonic and fetal development. Nicotine influences nicotinic-acetylcholine receptors (nAChRs) to abnormally accelerate cell development to tissues and organs, which results to premature maturation. They point out that due to nicotine exposure during pregnancy, ST users have a higher chance of resulting in premature birth, stillbirth, low weight birth, and placenta previa during pregnancy in non-ST users.

 Even though investigations about maternal smoking have been spurred, research on ST uses during pregnancy have not been conducted sufficiently. Global Adult Tobacco Survey (GATS) demonstrated that a large number of women are ST users. According to the March 2010 (GATS), about 88 million women (older than 15 years old) used ST compared to about 56 million women who smoked cigarettes in that same population over 14 low and middle income countries. This calls out the public health responses that women tend to practice ST more than SC. Moreover, public health educates people that STs have undesirable nicotine effects on prenatal development, the same as SC.

 The major complexity in this examination was that broad products are categorized as ST.  This complicates the situation more in terms of varieties of chemicals in different products as well as different administration methods. The examination heavily relied on self-reports from medical records. It is difficult to measure the exact amount or what kind of chemicals pregnant women were exposed to. In addition, the timing of exposure or the dose during the different developmental stages would result in diverse outcomes.

Abstract

Reference

Ratsch, A. and F. Bogossian (2014). "Smokeless tobacco use in pregnancy: an integrative review of the literature." International Journal of Public Health 59 (4): 599-608.