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Bains KES, Kreyberg I, Färdig M, Granum B, Gudmundsdóttir HK, Haugen G, Hedlin G, Hilde K, Jonassen CM, Nordlund B, Rehbinder EM, Rueegg CS, Skjerven HO, Staff AC, Söderhäll C, Vettukattil R, Carlsen KCL. Maternal use of snus as smokeless tobacco in pregnancy and infant lung function. ERJ Open Res 2024; 10:00958-2023. [PMID: 38978555 PMCID: PMC11228604 DOI: 10.1183/23120541.00958-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/09/2024] [Indexed: 07/10/2024] Open
Abstract
Background Smoking in pregnancy has detrimental effects on infant respiratory health, while the effects of other nicotine-containing products on infant lung function are unclear. We aimed to explore if smokeless tobacco such as snus used in pregnancy increased the risk of lower lung function in infancy and if the associations differed by sex. Methods From the Scandinavian population-based Preventing Atopic Dermatitis and ALLergies in Children birth cohort, we included 1163 infants with available tidal flow-volume measurements at 3 months of age and maternal self-reported use of nicotine-containing products in pregnancy. The risk of a ratio of time to peak tidal expiratory flow to total expiratory time <25th percentile by any nicotine exposure, snus exclusively and cigarette smoking with or without other nicotine-containing products was explored by regression analyses adjusting for maternal age, education and asthma. Results Overall 120 out of 1163 (10.3%) infants were exposed to any nicotine in utero, 71 out of 120 by snus exclusively and 49 out of 120 by smoking, with six also exposed to snus. By pregnancy week 6, 85.8% of mothers reported stopping nicotine use. The risk of lower lung function was higher in children exposed in utero to nicotine-containing products with an odds ratio (OR) of 1.63 (95% confidence interval (CI) 1.02-2.59) with a similar tendency for snus exclusively (OR 1.55, 95% CI 0.88-2.71) and smoking (OR 1.79, 0.84-3.84). Effect estimates were similar after adjusting for covariates. No differences of the effect by sex were observed. Conclusion Our study suggests that in utero exposure to not only cigarettes, but also snus, may negatively affect infant lung function.
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Affiliation(s)
- Karen Eline Stensby Bains
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Ina Kreyberg
- Department of Dermatology and Venerology, Oslo University Hospital, Oslo, Norway
- Shared second authorship
| | - Martin Färdig
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Shared second authorship
| | - Berit Granum
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Hrefna K. Gudmundsdóttir
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Guttorm Haugen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Katarina Hilde
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Christine Monceyron Jonassen
- Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
- Center for Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Eva M. Rehbinder
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Department of Dermatology and Venerology, Oslo University Hospital, Oslo, Norway
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Håvard O. Skjerven
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Anne Cathrine Staff
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Riyas Vettukattil
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Karin C. Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
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2
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Padhani ZA, Das JK, Siddiqui FA, Salam RA, Lassi ZS, Khan DSA, Abbasi AMA, Keats EC, Soofi S, Black RE, Bhutta ZA. Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis. Nutr Rev 2023; 81:1501-1524. [PMID: 37016953 DOI: 10.1093/nutrit/nuad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood. OBJECTIVE This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants. DATA SOURCES Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews. DATA EXTRACTION Two investigators independently extracted data from the included studies on a standardized data-extraction form. DATA ANALYSIS Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score. CONCLUSION Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020218517.
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Affiliation(s)
- Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Faareha A Siddiqui
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Ammaar M A Abbasi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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3
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Gudmundsdóttir HK, Carlsen OCL, Bains KES, Färdig M, Haugen G, Jonassen CM, LeBlanc M, Nordlund B, Rehbinder EM, Skjerven HO, Staff AC, Vettukattil R, Lødrup Carlsen KC. Infant lung function and maternal physical activity in the first half of pregnancy. ERJ Open Res 2022; 8:00172-2022. [PMID: 36329799 PMCID: PMC9619250 DOI: 10.1183/23120541.00172-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/14/2022] [Indexed: 11/07/2022] Open
Abstract
Background and aim Physical activity (PA) in pregnancy is important for maternal and possibly offspring health. To study the early origins of lung function we aimed to determine whether PA in the first half of pregnancy is associated with lung function in healthy 3-month-old infants. Methods From the general population-based Preventing Atopic Dermatitis and Allergies in Children birth cohort recruiting infants antenatally in Norway and Sweden, all 812 infants (48.8% girls) with available tidal flow-volume measures in the awake state at 3 months of age and mid-pregnancy data on PA were included. PA was self-reported by the mothers and, based on intensity, we categorised them as active or inactive during pregnancy. Furthermore, we defined active mothers as fairly or highly active. The main outcome was a ratio of time to peak tidal expiratory flow to expiratory time (t PTEF/t E) <0.25. Associations were analysed by logistic regression, adjusting for maternal age, education, parity, pre-pregnancy body mass index, in utero nicotine exposure and parental atopy. Results The mean±sd t PTEF/t E was 0.391±0.08 and did not differ significantly according to maternal PA level in pregnancy. The 290 infants of inactive mothers had higher odds of having t PTEF/t E <0.25 compared to infants of all active mothers (OR 2.07, 95% CI 1.13-3.82; p=0.019) and compared to infants (n=224) of fairly active (OR 2.83, 95% CI 1.26-7.24; p=0.018) but not highly active mothers (n=298). Conclusion Based on self-reported maternal PA in the first half of pregnancy, 3-month-old infants of inactive compared to active mothers had higher odds of a low t PTEF/t E.
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Affiliation(s)
- Hrefna Katrín Gudmundsdóttir
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Oda C L Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Karen Eline Stensby Bains
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Martin Färdig
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Guttorm Haugen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Christine M Jonassen
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway.,Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Marissa LeBlanc
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eva Maria Rehbinder
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology and Venereology, Oslo University Hospital, Oslo, Norway
| | - Håvard O Skjerven
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Riyas Vettukattil
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Karin C Lødrup Carlsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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4
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Gómez-Roig MD, Pascal R, Cahuana MJ, García-Algar O, Sebastiani G, Andreu-Fernández V, Martínez L, Rodríguez G, Iglesia I, Ortiz-Arrabal O, Mesa MD, Cabero MJ, Guerra L, Llurba E, Domínguez C, Zanini MJ, Foraster M, Larqué E, Cabañas F, Lopez-Azorín M, Pérez A, Loureiro B, Pallás-Alonso CR, Escuder-Vieco D, Vento M. Environmental Exposure during Pregnancy: Influence on Prenatal Development and Early Life: A Comprehensive Review. Fetal Diagn Ther 2021; 48:245-257. [PMID: 33735860 DOI: 10.1159/000514884] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022]
Abstract
Preconception and prenatal exposure to environmental contaminants may affect future health. Pregnancy and early life are critical sensitive windows of susceptibility. The aim of this review was to summarize current evidence on the toxic effects of environment exposure during pregnancy, the neonatal period, and childhood. Alcohol use is related to foetal alcohol spectrum disorders, foetal alcohol syndrome being its most extreme form. Smoking is associated with placental abnormalities, preterm birth, stillbirth, or impaired growth and development, as well as with intellectual impairment, obesity, and cardiovascular diseases later in life. Negative birth outcomes have been linked to the use of drugs of abuse. Pregnant and lactating women are exposed to endocrine-disrupting chemicals and heavy metals present in foodstuffs, which may alter hormones in the body. Prenatal exposure to these compounds has been associated with pre-eclampsia and intrauterine growth restriction, preterm birth, and thyroid function. Metals can accumulate in the placenta, causing foetal growth restriction. Evidence on the effects of air pollutants on pregnancy is constantly growing, for example, preterm birth, foetal growth restriction, increased uterine vascular resistance, impaired placental vascularization, increased gestational diabetes, and reduced telomere length. The advantages of breastfeeding outweigh any risks from contaminants. However, it is important to assess health outcomes of toxic exposures via breastfeeding. Initial studies suggest an association between pre-eclampsia and environmental noise, particularly with early-onset pre-eclampsia. There is rising evidence of the negative effects of environmental contaminants following exposure during pregnancy and breastfeeding, which should be considered a major public health issue.
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Affiliation(s)
- M Dolores Gómez-Roig
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu (IR-SJD), Barcelona, Spain
| | - Rosalia Pascal
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, .,Institut de Recerca Sant Joan de Déu (IR-SJD), Barcelona, Spain,
| | - Marc Josep Cahuana
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu (IR-SJD), Barcelona, Spain
| | - Oscar García-Algar
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Neonatology Unit, Hospital Clinic-Maternitat, ICGON, Universitat de Barcelona, Barcelona, Spain
| | - Giorgia Sebastiani
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Neonatology Unit, Hospital Clinic-Maternitat, ICGON, Universitat de Barcelona, Barcelona, Spain
| | - Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Valencian International University (VIU), Valencia, Spain
| | - Leopoldo Martínez
- Servicio de Cirugía Pediátrica, Hospital la Paz, Instituto de Investigación la Paz (IdiPAZ), Madrid, Spain
| | - Gerardo Rodríguez
- Growth, Exercise, Nutrition, and Development (GENUD) Research Group, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain
| | - Iris Iglesia
- Growth, Exercise, Nutrition, and Development (GENUD) Research Group, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain
| | - Olimpia Ortiz-Arrabal
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Granada, Spain
| | - María Dolores Mesa
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Granada, Spain.,Ibs.Granada, Instituto de Investigación Biosanitaria, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | | | - Lorenzo Guerra
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Elisa Llurba
- Obstetrics and Gynaecology Department, High Risk Unit, Sant Pau University Hospital, Barcelona, Spain.,Women and Perinatal Health Research Group, Biomedical Research Institute Sant Pau (IIB-SantPau), Sant Pau University Hospital, Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carla Domínguez
- Obstetrics and Gynaecology Department, High Risk Unit, Sant Pau University Hospital, Barcelona, Spain.,Women and Perinatal Health Research Group, Biomedical Research Institute Sant Pau (IIB-SantPau), Sant Pau University Hospital, Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Julia Zanini
- Obstetrics and Gynaecology Department, High Risk Unit, Sant Pau University Hospital, Barcelona, Spain.,Women and Perinatal Health Research Group, Biomedical Research Institute Sant Pau (IIB-SantPau), Sant Pau University Hospital, Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Foraster
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESO), Madrid, Spain.,Blanquerna School of Health Science, Universitat Ramon Llull, Barcelona, Spain
| | - Elvira Larqué
- Department of Physiology, Biomedical Institute of Research of Murcia Region (IMIB), Murcia University, Murcia, Spain
| | - Fernando Cabañas
- Department of Neonatology, Quironsalud Madrid University Hospital and Quironsalud San Jose Hospital, Madrid, Spain.,Biomedical Research Foundation-IDIPAZ, La Paz University Hospital, Madrid, Spain
| | - Manuela Lopez-Azorín
- Department of Neonatology, Quironsalud Madrid University Hospital and Quironsalud San Jose Hospital, Madrid, Spain
| | - Aitziber Pérez
- Neonatology Unit, University Hospital Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Begoña Loureiro
- Neonatology Unit, University Hospital Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Carmen Rosa Pallás-Alonso
- Donated Milk Bank, Health Research Institute i + 12, University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Diana Escuder-Vieco
- Donated Milk Bank, Health Research Institute i + 12, University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Máximo Vento
- Neonatal Research Group, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
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5
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Nordhagen LS, Kreyberg I, Bains KES, Carlsen K, Glavin K, Skjerven HO, Småstuen MC, Hilde K, Nordlund B, Vettukattil R, Hedlin G, Granum B, Jonassen CM, Gudmundsdóttir HK, Haugen G, Rehbinder EM, Söderhäll C, Staff AC, Lødrup Carlsen KC, Asarnoj A, Lødrup Carlsen OC, Wik Despriée Å, Dyrseth V, Endre KA, Granlund PA, Holmstrøm H, Håland G, Mägi CO, Nygaard UC, Rudi K, Saunders CM, Sjøborg KD, Skrindo I, Tedner SG, Værnesbranden MR, Wiik J. Maternal use of nicotine products and breastfeeding 3 months postpartum. Acta Paediatr 2020; 109:2594-2603. [PMID: 32274823 DOI: 10.1111/apa.15299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 01/19/2023]
Abstract
AIM We aimed to determine the prevalence of and factors associated with maternal use of nicotine products in relation to breastfeeding. METHODS Nicotine use 3 months postpartum was determined in the Scandinavian PreventADALL mother-child birth cohort study recruiting 1837 women from 2014 to 2016. Electronic questionnaires at 18 weeks pregnancy and 3 months postpartum provided information on snus use, smoking or other nicotine use, infant feeding and socio-economic factors. The risk of nicotine use in relation to breastfeeding was analysed with logistic regression. RESULTS Overall, 5.6% of women used snus (2.9%), smoked (2.7%) or both (n = 2) 3 months postpartum, while one used other nicotine products. Among the 1717 breastfeeding women, 95.1% reported no nicotine use, while 2.4% used snus, 2.5% smoked and one dual user. Compared to 3.7% nicotine use in exclusively breastfeeding women (n = 1242), the risk of nicotine use increased by partly (OR 2.26, 95% CI 1.45-3.52) and no breastfeeding (OR 4.58, 95% CI 2.57-8.21). Nicotine use before (14.5% snus, 16.4% smoking) or in pregnancy (0.2% snus, 0.4% smoking) significantly increased the risk of using nicotine during breastfeeding. CONCLUSION Few breastfeeding women used snus or smoked 3 months postpartum, with increased risk by nicotine use before or during pregnancy.
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Affiliation(s)
- Live S. Nordhagen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- VID Specialized University Oslo Norway
| | - Ina Kreyberg
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Karen Eline S. Bains
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Kai‐Håkon Carlsen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | | | - Håvard O. Skjerven
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | | | - Katarina Hilde
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Obstetrics and Gynaecology Oslo University Hospital Oslo Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Riyas Vettukattil
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Berit Granum
- Department of Environmental Health Norwegian Institute of Public Health Oslo Norway
| | - Christine M. Jonassen
- Faculty of Chemistry, Biotechnology and Food Science Norwegian University of Life Sciences Ås Norway
- Genetic Unit Centre for Laboratory Medicine Østfold Hospital Trust Kalnes Norway
| | - Hrefna K. Gudmundsdóttir
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Guttorm Haugen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Obstetrics and Gynaecology Oslo University Hospital Oslo Norway
| | - Eva Maria Rehbinder
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Department of Dermatology Oslo University Hospital Oslo Norway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Anne Cathrine Staff
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Obstetrics and Gynaecology Oslo University Hospital Oslo Norway
| | - Karin C. Lødrup Carlsen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
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6
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Lindberger E, Wikström AK, Bergman E, Eurenius K, Mulic-Lutvica A, Sundström Poromaa I, Ahlsson F. Association of maternal central adiposity measured by ultrasound in early mid pregnancy with infant birth size. Sci Rep 2020; 10:19702. [PMID: 33184361 PMCID: PMC7665175 DOI: 10.1038/s41598-020-76741-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022] Open
Abstract
We sought to investigate whether early mid pregnancy visceral and subcutaneous fat depths measured by ultrasound were associated with infant birth size, independent of early pregnancy BMI. A cohort study was performed at Uppsala University Hospital, Sweden, between 2015–2018. Visceral and subcutaneous fat depths were measured at the early second-trimester anomaly scan in 2498 women, giving birth to singleton, term infants. Primary outcomes were birthweight and LGA (birthweight standard deviation score > 90th percentile in the cohort). Linear and logistic regression models were used, adjusted for BMI, age, smoking, parity, maternal country of birth, gestational age and infant sex. A 5-mm increase in visceral fat depth was associated with an increase in birthweight of 8.3 g [95% confidence interval (CI) 2.5 − 14.1 g], after adjustments, and a 6% increase in the adjusted odds of having an infant born LGA (OR 1.06, CI 1.02–1.11). There was no association between subcutaneous fat depth and birthweight or LGA after covariate adjustments. Hence, visceral fat depth measured by ultrasound in early mid pregnancy was associated with excessive fetal growth, independent of early pregnancy BMI, and may be useful in models for predicting LGA infants.
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Affiliation(s)
- Emelie Lindberger
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden.
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Eva Bergman
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Karin Eurenius
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Ajlana Mulic-Lutvica
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | | | - Fredrik Ahlsson
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
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7
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Saunders CM, Rehbinder EM, Carlsen KCL, Gudbrandsgard M, Carlsen KH, Haugen G, Hedlin G, Jonassen CM, Sjøborg KD, Landrø L, Nordlund B, Rudi K, O Skjerven H, Söderhäll C, Staff AC, Vettukattil R, Carlsen MH. Food and nutrient intake and adherence to dietary recommendations during pregnancy: a Nordic mother-child population-based cohort. Food Nutr Res 2019; 63:3676. [PMID: 31920469 PMCID: PMC6939665 DOI: 10.29219/fnr.v63.3676] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background A woman's food intake during pregnancy has important implications not only for herself but also for the future health and well-being of her child. Suboptimal dietary quality has been consistently reported in many high-income countries, reflecting poor adherence to dietary guidelines. Objective This study aimed to explore the intake of food and nutrients in a cohort of pregnant women in Norway and their adherence to Nordic Nutrition Recommendations (NNR) and Norwegian food-based guidelines (NFG). Design We investigated the dietary intake in 1,674 pregnant women from the mother-child birth cohort, PreventADALL, recruited at approximately 18-week gestational age. Dietary intake was assessed by an electronic validated food frequency questionnaire (PrevFFQ) in the first half of pregnancy. Results Total fat intake was within the recommended intake (RI) range in most women; however, the contribution of saturated fatty acids to the total energy intake was above RI in the majority (85.2%) of women. Carbohydrate intake was below RI in 43.9% of the women, and 69.5% exceeded the RI of salt. Intakes of fiber, vegetables, and fish were high in a large part of the population. Many women had a high probability of inadequate intakes of the following key micronutrients during pregnancy: folate (54.4%), iron (49.6%), calcium (36.2%), vitamin D (28.7%), iodine (24.4%), and selenium (41.3%). A total of 22.8% women reported an alcohol intake of >1 g/day, and 4.4% reported an alcohol intake of >10 g/day. Women with higher educational levels showed a tendency towards healthier eating habits, except for higher intakes of alcohol and coffee, compared to women with lower educational level. Discussion Excessive saturated fat intake and limited intake of many important micronutrients during pregnancy were common, potentially increasing the risk for adverse pregnancy and birth outcomes. Conclusions This study highlights the need for improved nutritional guidance to pregnant women across all educational levels.
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Affiliation(s)
- Carina Madelen Saunders
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Maria Rehbinder
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Karin C Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Malén Gudbrandsgard
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kai-Håkon Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guttorm Haugen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Christine Monceyron Jonassen
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway.,Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | | | - Linn Landrø
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Knut Rudi
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Håvard O Skjerven
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anne Cathrine Staff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Riyas Vettukattil
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Hauger Carlsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Rygh E, Gallefoss F, Grøtvedt L. Trends in maternal use of snus and smoking tobacco in pregnancy. A register study in southern Norway. BMC Pregnancy Childbirth 2019; 19:500. [PMID: 31842873 PMCID: PMC6915947 DOI: 10.1186/s12884-019-2624-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. METHODS Data on smoking tobacco and snus use at three time points before and during pregnancy for 20,844 women were retrieved from the electronic birth record for the years 2012-2017. The results for the three-year period 2015-2017 were compared with a previously studied period 2012-2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. RESULTS There was an increase of snus use before pregnancy from the period 2012-2014 to the period 2015-2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25-34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. CONCLUSIONS While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy.
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Affiliation(s)
- Ellen Rygh
- Research Department, Sørlandet Hospital, Kristiansand, Norway
| | - Frode Gallefoss
- Chief of Clinical Research, Sørlandet Hospital, Kristiansand, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Liv Grøtvedt
- Department Health and Inequality, Norwegian Institute of Public Health, Sandakerveien 24c, Bygg B, 0473, Oslo, Norway.
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9
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Kreyberg I, Hilde K, Bains KES, Carlsen KH, Granum B, Haugen G, Hedlin G, Jonassen CM, Nordhagen LS, Nordlund B, Rueegg CS, Sjøborg KD, Skjerven HO, Staff AC, Vettukattil R, Lødrup Carlsen KC. Snus in pregnancy and infant birth size: a mother-child birth cohort study. ERJ Open Res 2019; 5:00255-2019. [PMID: 31803771 PMCID: PMC6885591 DOI: 10.1183/23120541.00255-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 11/16/2022] Open
Abstract
Rationale While recent studies show that maternal use of snus during pregnancy is increasing, the potential effects on infant birth size is less investigated, with conflicting results. Objectives We aimed to determine if maternal use of snus during pregnancy influences the infant anthropometric and proportional size measures at birth. Methods In 2313 mother–child pairs from the population-based, mother–child birth cohort PreventADALL (Preventing Atopic Dermatitis and ALLergies) in Norway and Sweden, we assessed nicotine exposure by electronic questionnaire(s) at 18 and 34 weeks of pregnancy, and anthropometric measurements at birth. Associations between snus exposure and birth size outcomes were analysed by general linear regression. Results Birthweight was not significantly different in infants exposed to snus in general, and up to 18 weeks of pregnancy in particular, when adjusting for relevant confounders including maternal age, gestational age at birth, pre-pregnancy body mass index, parity, fetal sex and maternal gestational weight gain up to 18 weeks. We found no significant effect of snus use on the other anthropometric or proportional size measures in multivariable linear regression models. Most women stopped snus use in early pregnancy. Conclusion Exposure to snus use in early pregnancy, with most women stopping when knowing about their pregnancy, was not associated with birth size. We were unable to conclude on effects of continued snus use during pregnancy because of lack of exposure in our cohort. Snus use in pregnancy, reported by 7.1% of 2313 women, was not associated with infant birth size. As most women stopped snus use by 6 weeks gestational age, it was not possible to assess potential birth size effects of persistent use during pregnancy.http://bit.ly/2IG8Vnk
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Affiliation(s)
- Ina Kreyberg
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Katarina Hilde
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Karen Eline S Bains
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kai-Håkon Carlsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Berit Granum
- Dept of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Oslo, Norway
| | - Guttorm Haugen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Christine M Jonassen
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.,Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Live S Nordhagen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,VID Specialized University, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Corina S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Katrine D Sjøborg
- Dept of Obstetrics and Gynaecology, Østfold Hospital Trust, Kalnes, Norway
| | - Håvard O Skjerven
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne C Staff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Riyas Vettukattil
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karin C Lødrup Carlsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Ratsch A, Steadman K, Ryu B, Bogossian F. Tobacco and Pituri Use in Pregnancy: A Protocol for Measuring Maternal and Perinatal Exposure and Outcomes in Central Australian Aboriginal Women. Methods Protoc 2019; 2:E47. [PMID: 31181680 PMCID: PMC6632177 DOI: 10.3390/mps2020047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 01/17/2023] Open
Abstract
Maternal tobacco smoking is a recognized risk behavior that has adverse impacts onmaternal and fetal health. However, in some populations, the use of smokeless tobacco exceeds theuse of smoked tobacco. In central Australia, Aboriginal populations utilize wild tobacco plants(Nicotiana spp.) as a smokeless product. These plants are known by a variety of names, one of whichis pituri. The plants are masticated and retained in the oral cavity for extended periods of time andtheir use continues throughout pregnancy, birth, and lactation. In contrast to the evidence related tocombusted tobacco use, there is no evidence as to the effects of pituri use in pregnancy. CentralAustralian Aboriginal women who were at least 28 weeks pregnant were stratified into three tobaccoexposure groups: (a) Pituri chewers, (b) smokers, and (c) non-tobacco users. Routine antenatal andbirth information, pre-existing and pregnancy-related maternal characteristics, fetal characteristics,and biological samples were collected and compared. The biological samples were analysed fortobacco and nicotine metabolite concentrations. Samples from the mother included venous blood,urine, hair and colostrum and/or breast milk. From the neonate, this included Day 1 and Day 3 urineand meconium, and from the placenta, arterial and venous cord blood following delivery. This is thefirst study to correlate the pregnancy outcomes of central Australian Aboriginal women with differenttobacco exposures. The findings will provide the foundation for epidemiological data collection inrelated studies. Note to readers: In this article, the term "Aboriginal" was chosen by central Australianwomen to refer to both themselves and the Aboriginal people in their communities. "Indigenous" waschosen to refer to the wider Australian Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Angela Ratsch
- Research Education, Development and Support, Wide Bay Hospital and Health Service,Hervey Bay 4655, Australia.
| | - Kathryn Steadman
- School of Pharmacy, The University of Queensland, Brisbane 4072, Australia.
| | - BoMi Ryu
- School of Pharmacy, The University of Queensland, Brisbane 4072, Australia.
| | - Fiona Bogossian
- School of Health & Sports Science and School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore 4558, Australia.
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane 4072, Australia.
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