Department of Epidemiology, Columbia University New York, NY, USA.
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Nicotine Tob Res. 2021 Aug 4;23(8):1291-1299. doi: 10.1093/ntr/ntaa215.
Smokeless tobacco (SLT) consumption during pregnancy has adverse consequences for the mother and fetus. We aimed to investigate the effects of maternal pre-pregnancy SLT consumption on maternal and fetal outcomes in the district of Thatta, Pakistan.
We conducted a secondary data analysis of an individual randomized controlled trial of preconception maternal nutrition. Study participants were women of reproductive age (WRA) residing in the district of Thatta, Pakistan. Participants were asked questions regarding the usage of commonly consumed SLT known as gutka (exposure variable). Study outcomes included maternal anemia, miscarriage, preterm births, stillbirths, and low birth weight. We performed a cox-regression analysis by controlling for confounders such as maternal age, education, parity, working status, body mass index, and geographic clusters.
The study revealed that 71.5% of the women reported using gutka, with a higher proportion residing in rural areas as compared with urban areas in the district of Thatta, Pakistan. In the multivariable analysis, we did not find a statistically significant association between gutka usage and anemia [(relative risk, RR: 1.04, 95% confidence interval, CI (0.92 to 1.16)], miscarriage [(RR: 1.08, 95% CI (0.75 to 1.54)], preterm birth [(RR: 1.37, 95% CI (0.64 to 2.93)], stillbirth [(RR: 1.02, 95% CI (0.39 to 2.61)], and low birth weight [(RR: 0.96, 95% CI (0.72 to 1.28)].
The study did not find an association between gutka usage before pregnancy and adverse maternal and fetal outcomes. In the future, robust epidemiological studies are required to detect true differences with a dose-response relationship between gutka usage both before and during pregnancy and adverse fetomaternal outcomes.
While most epidemiological studies conducted in Pakistan have focused on smoking and its adverse outcomes among males, none of the studies have measured the burden of SLT among WRA and its associated adverse outcomes. In addition, previously conducted studies have primarily assessed the effect of SLT usage during pregnancy rather than before pregnancy on adverse fetal and maternal outcomes. The current study is unique because it provides an insight into the usage of SLT among WRA before pregnancy and investigates the association between pre-pregnancy SLT usage and its adverse fetomaternal outcomes in rural Pakistan.
怀孕期间使用无烟烟草（SLT）会对母亲和胎儿造成不良后果。我们旨在调查巴基斯坦萨塔地区母亲孕前 SLT 消费对母婴结局的影响。
我们对一项孕前母亲营养的个体随机对照试验进行了二次数据分析。研究参与者为居住在巴基斯坦萨塔地区的育龄妇女（WRA）。参与者被问及通常食用的被称为 gutka 的 SLT 的使用情况（暴露变量）。研究结果包括母亲贫血、流产、早产、死产和低出生体重。我们通过控制混杂因素（如母亲年龄、教育程度、产次、工作状态、体重指数和地理集群）进行 Cox 回归分析。
研究表明，71.5%的女性报告使用 gutka，与巴基斯坦萨塔地区的城市相比，农村地区的女性比例更高。在多变量分析中，我们没有发现 gutka 使用与贫血[相对风险（RR）：1.04，95%置信区间（CI）（0.92 至 1.16）]、流产[RR：1.08，95%CI（0.75 至 1.54）]、早产[RR：1.37，95%CI（0.64 至 2.93）]、死产[RR：1.02，95%CI（0.39 至 2.61）]和低出生体重[RR：0.96，95%CI（0.72 至 1.28）]之间存在统计学显著关联。
本研究未发现孕前 gutka 使用与母婴不良结局之间存在关联。未来需要进行更强大的流行病学研究，以检测在巴基斯坦，无论是在孕前还是孕期，gutka 使用量与不良母婴结局之间是否存在真正的差异以及剂量反应关系。
虽然巴基斯坦进行的大多数流行病学研究都集中在男性吸烟及其对男性的不良影响上，但没有一项研究测量过 WRA 中 SLT 的负担及其相关不良影响。此外，以前进行的研究主要评估了孕期 SLT 使用对不良胎儿和母亲结局的影响，而不是孕前 SLT 使用对不良胎儿和母亲结局的影响。本研究的独特之处在于，它深入了解了 WRA 孕前 SLT 的使用情况，并调查了巴基斯坦农村地区孕前 SLT 使用及其不良母婴结局之间的关联。
