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Effects of maternal smokeless tobacco use on selected pregnancy outcomes in Alaska Native women: a case-control study.

ABSTRACT: To examine the potential effects of prenatal smokeless tobacco use on selected birth outcomes.A population-based, case-control study using a retrospective medical record review.Singleton deliveries 1997-2005 to Alaska Native women residing in western Alaska.Hospital discharge codes were used to identify potential case deliveries and a random control sample. Data on tobacco use and confirmation of pregnancy outcomes were abstracted from medical records for 1123 deliveries. Logistic regression was used to examine associations between tobacco use and pregnancy outcomes. Adjusted odds ratios (OR), 95% confidence intervals (95% CI), and p-values were calculated.Preterm delivery, pregnancy-associated hypertension, and placental abruption.In unadjusted analysis, smokeless tobacco use was not significantly associated with preterm delivery (OR 1.44, 95% CI 0.97-2.15). After adjustment for parity, pre-pregnancy body mass index, and maternal age, the point estimate was attenuated and remained non-significant. No significant associations were observed between smokeless tobacco use and pregnancy-associated hypertension (adjusted OR 0.92, 95% CI 0.56-1.51) or placental abruption (adjusted OR 1.11, 95% CI 0.53-2.33).Prenatal smokeless tobacco use does not appear to reduce risk of pregnancy-associated hypertension or to substantially increase risk of abruption. An association between smokeless tobacco and preterm delivery could not be ruled out. Components in tobacco other than nicotine likely play a major role in decreased pre-eclampsia risk in smokers. Nicotine adversely affects fetal neurodevelopment and our results should not be construed to mean that smokeless tobacco use is safe during pregnancy.

SUBMITTER: England LJ

PROVIDER: S-EPMC5881106 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Effects of maternal smokeless tobacco use on selected pregnancy outcomes in Alaska Native women: a case-control study.

England Lucinda J LJ Kim Shin Y SY Shapiro-Mendoza Carrie K CK Wilson Hoyt G HG Kendrick Juliette S JS Satten Glen A GA Lewis Claire A CA Tucker Myra J MJ Callaghan William M WM

Acta obstetricia et gynecologica Scandinavica 20130329 6

<h4>Objective</h4>To examine the potential effects of prenatal smokeless tobacco use on selected birth outcomes.<h4>Design</h4>A population-based, case-control study using a retrospective medical record review.<h4>Population</h4>Singleton deliveries 1997-2005 to Alaska Native women residing in western Alaska.<h4>Methods</h4>Hospital discharge codes were used to identify potential case deliveries and a random control sample. Data on tobacco use and confirmation of pregnancy outcomes were abstract ...[more]

PMID: 23551054

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Project description:IntroductionIn general population samples, higher levels of stress and depression have been associated with increased prevalence of smoking in pregnancy. Little is known about the association of prenatal tobacco use, stress, and depression among American Indian or Alaska Native (AI/AN) women.MethodsThe Healthy Pregnancies Project is a cluster-randomized controlled trial, evaluating a community-level intervention compared with usual care, for reducing tobacco use during pregnancy and postpartum among AN women in 16 villages in western Alaska. This cross-sectional study analyzed baseline data from enrolled pregnant women. Baseline measures included the self-reported, 7-day, point-prevalence current use of any tobacco, Perceived Stress Scale (PSS), and the Center for Epidemiological Studies-Depression (CES-D). Generalized estimating equations (GEE) analyses adjusted for village, participant age, and gestational age.ResultsParticipants (N = 352) were on average (SD) 25.8 (5.0) years of age and at 26.8 (9.8) weeks gestation. 66.5% were current tobacco users, of which 77% used Iqmik, a homemade form of smokeless tobacco. Compared with nonusers, tobacco users reported lower PSS score (p = .020) and less clinical levels of depression (CES-D ≥ 16) (18.1% vs. 9.3%, p = .21). Findings were not accounted for by nicotine dependence severity or self-reported tobacco use before pregnancy.ConclusionsIn this sample of pregnant AN women, tobacco users report less stress and clinical levels of depression than nonusers. A potential challenge with tobacco treatment for pregnant AN women is to provide alternative ways of deescalating stress and affect management instead of using tobacco.ImplicationsThis study contributes novel information on the association of tobacco use, perceived stress, and depression among Alaska Native women enrolled in a clinical trial to promote healthy pregnancies. Most prior studies addressing this topic were conducted among general population samples of pregnant women who smoked cigarettes. Little is known about these associations with prenatal smokeless tobacco, or among American Indian or Alaska Native women. The results are contrary to findings reported previously, because current tobacco use was associated with less stress and depression than nonuse. The study findings have implications for cessation treatment for this tobacco-use disparity group.

Dataset Information

Effects of maternal smokeless tobacco use on selected pregnancy outcomes in Alaska Native women: a case-control study.

Publications

Effects of maternal smokeless tobacco use on selected pregnancy outcomes in Alaska Native women: a case-control study.

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