Smokeless nicotine use in pregnancy and perinatal health

The use of smokeless nicotine products (SNP) is increasing fast among young people in high-income countries, especially among women.

While the adverse perinatal effects of smoking in pregnancy are well established, and the marketing and sales of smoked tobacco products thus strictly regulated, less is known about such effects of SNP. Young women’s attitudes towards, and risk perception of, SNP use in pregnancy have never been surveyed in Sweden.

We therefore propose a project to fill these knowledge gaps, taking a multidisciplinary approach.

The work will rest on a recent register-based cohort study, involving all pregnancies in Sweden since 1999 (N=2.4 million) with data from health data registers.

We will use “snus use”, as recorded at various points of gestation in the Medical Birth Register (MBR), as our main exposure and proxy for SNP use.

In addition to perinatal outcomes (e.g., gestational diabetes and preterm birth) assessed from health registers, we will explore associations between snus use and foetal growth and growth velocity identified from ultrasounds measures. We will also validate the MBR data on snus using biomarkers analysed from maternal sera.

Lastly, we will conduct semi-structured interviews with young women to improve the understanding of risk perceptions.

We believe that the expected research findings are important to guide the development of interventions that can mitigate any negative public health consequences of the current surge in SNP use.