title: Effects of maternal smokeless tobacco use on selected pregnancy outcomes in Alaska Native women: a case-control study.
abstract: OBJECTIVE
  To examine the potential effects of prenatal smokeless tobacco use on selected birth outcomes.
  
  
  METHODS
  A population-based, case-control study using a retrospective medical record review.
  
  
  METHODS
  Singleton deliveries 1997-2005 to Alaska Native women residing in western Alaska.
  
  
  METHODS
  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.
  
  
  METHODS
  Preterm delivery, pregnancy-associated hypertension, and placental abruption.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30030, USA. lbe9@cdc.gov
authors.forename: Lucinda J
authors.initials: LJ
authors.lastname: England
authors.forename: Shin Y
authors.initials: SY
authors.lastname: Kim
authors.forename: Carrie K
authors.initials: CK
authors.lastname: Shapiro-Mendoza
authors.forename: Hoyt G
authors.initials: HG
authors.lastname: Wilson
authors.forename: Juliette S
authors.initials: JS
authors.lastname: Kendrick
authors.forename: Glen A
authors.initials: GA
authors.lastname: Satten
authors.forename: Claire A
authors.initials: CA
authors.lastname: Lewis
authors.forename: Myra J
authors.initials: MJ
authors.lastname: Tucker
authors.forename: William M
authors.initials: WM
authors.lastname: Callaghan
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology*; D000328:Adult; D000413:Alaska / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D016015:Logistic Models; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D014030:Tobacco, Smokeless; D055815:Young Adult
references.citation: BMJ. 2004 Jun 26;328(7455):1538
references.pmid: 15198947
references.citation: Am J Health Behav. 2005 Nov-Dec;29(6):588-94
references.pmid: 16336113
references.citation: Hypertension. 2010 May;55(5):1254-9
references.pmid: 20231527
references.citation: BJOG. 2010 Jul;117(8):1005-10
references.pmid: 20465559
references.citation: Harm Reduct J. 2006 Dec 21;3:37
references.pmid: 17184539
references.citation: MMWR Surveill Summ. 2008 Jan 25;57(1):1-28
references.pmid: 18219269
references.citation: Paediatr Perinat Epidemiol. 2006 Mar;20(2):90-9
references.pmid: 16466427
references.citation: Semin Neonatol. 2000 Aug;5(3):231-41
references.pmid: 10956448
references.citation: Front Biosci. 2007 Jan 01;12:2471-83
references.pmid: 17127256
references.citation: Am J Obstet Gynecol. 2000 Feb;182(2):465-72
references.pmid: 10694353
references.citation: Matern Child Health J. 2009 Sep;13(5):652-9
references.pmid: 18712464
references.citation: Hypertension. 2010 May;55(5):1100-1
references.pmid: 20231524
references.citation: J Intern Med. 2001 Dec;250(6):457-61
references.pmid: 11902814
references.citation: Am J Obstet Gynecol. 2003 Oct;189(4):939-43
references.pmid: 14586330
references.citation: Epidemiology. 2006 Jan;17(1):47-51
references.pmid: 16357594