Mahajan Akanksha, Gupta Bhawna, Tong Michael
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Department of Public Health, Torrens University, Melbourne, Victoria, Australia.
PLoS One. 2024 Dec 30;19(12):e0312297. doi: 10.1371/journal.pone.0312297. eCollection 2024.
Smokeless tobacco use is a growing public health concern, with potential adverse implications for foetal outcomes if consumed during pregnancy. Birth weight is an important predictive measure for health outcomes of a child throughout their lifespan. Despite extensive literature, it is unclear whether smokeless tobacco consumption during pregnancy has an adverse effect on birth weight. Hence, this review was conducted to determine whether an association exists between maternal smokeless tobacco consumption during pregnancy and birth weight of infants.
Systematic literature search was performed in Medline (via PubMed), Embase, Scopus, and CINAHL with no restrictions on language or time until May 2024. All observational studies that examined the relationship between maternal smokeless tobacco use and low birth weight of infants were eligible for inclusion. Methodological quality of included studies was assessed using the Newcastle Ottawa Scale.
Thirty-three studies were eligible for the review, including twenty-eight cohort, three case-control and two cross-sectional studies. A statistically significant association between use of smokeless tobacco and low birth weight was reported in thirteen studies. Eleven studies reported a statistically significant reduction in mean birth weight in maternal smokeless tobacco users. Pooled estimates of eighteen studies with 733,061 participants showed that there was a statistically significant association (OR = 2.25 [1.63, 3.11] P<0.001); between maternal smokeless tobacco use during pregnancy and low birth weight. Subgroup analysis found a significant association between mishri consumption during pregnancy and low birth weight (n = 646 participants, OR = 10.98 [2.03, 59.34], P = 0.005), but not betel nut (n = 8007 participants, OR = 1.02 [0.84, 1.25]), betel quid (n = 483 participants, OR = 1.51 [0.47, 4.89]) or khat (n = 475 participants, OR = 1.41 [0.64-3.09]).
This review presents an association between maternal smokeless tobacco use and low birth weight, and reduction in mean birth weight. It is suggested that cessation and reduction of maternal smokeless tobacco use should receive specific attention within routine prenatal care.
The results of this study highlight the need for further preventive public health campaigns to create awareness about detrimental effects of smokeless tobacco on foetal outcomes. Patient education in the primary care setting will aid in promoting smokeless tobacco cessation prior to pregnancy.
无烟烟草的使用日益引起公众对健康的关注，如果在孕期使用，可能会对胎儿结局产生不良影响。出生体重是预测儿童一生健康结局的一项重要指标。尽管已有大量文献，但尚不清楚孕期使用无烟烟草是否会对出生体重产生不利影响。因此，开展本综述以确定孕期母亲使用无烟烟草与婴儿出生体重之间是否存在关联。
在Medline（通过PubMed）、Embase、Scopus和CINAHL中进行系统的文献检索，对语言和时间均无限制，检索截至2024年5月。所有考察母亲使用无烟烟草与婴儿低出生体重之间关系的观察性研究均符合纳入标准。使用纽卡斯尔渥太华量表评估纳入研究的方法学质量。
33项研究符合综述标准，包括28项队列研究、3项病例对照研究和2项横断面研究。13项研究报告了无烟烟草使用与低出生体重之间存在统计学显著关联。11项研究报告称，母亲使用无烟烟草者的平均出生体重有统计学显著降低。对18项研究（共733,061名参与者）的汇总估计显示，孕期母亲使用无烟烟草与低出生体重之间存在统计学显著关联（OR = 2.25 [1.63, 3.11]，P<0.001）。亚组分析发现，孕期食用mishri与低出生体重之间存在显著关联（n = 646名参与者，OR = 10.98 [2.03, 59.34]，P = 0.005），但食用槟榔（n = 8007名参与者，OR = 1.02 [0.84, 1.25]）、槟榔嚼块（n = 483名参与者，OR = 1.51 [0.47, 4.89]）或巧茶（n = 475名参与者，OR = 1.41 [0.64 - 3.09]）与低出生体重之间无显著关联。
本综述表明母亲使用无烟烟草与低出生体重以及平均出生体重降低之间存在关联。建议在常规产前护理中应特别关注母亲无烟烟草使用的戒断和减少。
本研究结果凸显了开展进一步预防性公共卫生运动以提高对无烟烟草对胎儿结局有害影响认识的必要性。在初级保健环境中对患者进行教育将有助于促进孕前无烟烟草的戒断。
