Abstract
Although cigarette smoking remains the most prevalent form of tobacco use in girls and in women of reproductive age globally, use of non-cigarette forms of tobacco is prevalent or gaining in popularity in many parts of the world, especially in low- and middle-income countries. Sparse but growing evidence suggests that the use of some non-cigarette tobacco products during pregnancy increases the risk of adverse pregnancy outcomes. In this paper we review the literature on the prevalence of non-cigarette tobacco product use in pregnant women and in women of reproductive age in high-, middle-, and low-income countries and the evidence that maternal use of these products during pregnancy has adverse health effects. In addition, we communicate findings from an international group of perinatal and tobacco experts that was convened to establish research priorities concerning the use of non-cigarette tobacco products during pregnancy. The working group concluded that attempts to develop a public health response to non-cigarette tobacco use in women are hindered by a lack of data on the epidemiology of use in many parts of the world and by our limited understanding of the type and magnitude of the health effects of these products. We highlight research gaps and provide recommendations for a global research agenda.
Acknowledgements
The authors would like to acknowledge the members of the Epidemiology of non-cigarette products used during pregnancy working group: Scott Tomar DrPH, DMD, MPH, University of Florida College of Dentistry (group leader), Prakash Gupta, PhD, Healis-Sekhsaria Institute for Public Health, Mumbai, India (group leader); Thomas J. Bernert, PhD, Centers for Disease Control and Prevention; Tsungai Chipato, Sven Cnattingius, Karolinska Institute; M. V. Djordjevic, PhD, National Cancer Institute; Thomas Eissenberg, PhD, Virginia Commonwealth University; Mats Lambe, MD, PhD, MPH, Karolinska Institute; David Stamilio, MD, MSCE, Washington University School of Medicine; Alan Thevenet N. Tita, MD, PhD, University of Alabama at Birmingham and Deborah M. Winn, PhD, National Cancer Institute; members of the steering committee: Jorge E Tolosa, MD, MSCE, Oregon Health and Science University, USA; Michele H. Bloch, MD, PhD, National Cancer Institute, USA; Patricia M. Dietz, DrPH, MPH, Lucinda J. England, MD, MSPH, Shin Y. Kim, MPH, Van T. Tong, MPH, Centers for Disease Control and Prevention; and Terry Njoroge, MPH, Centers for Disease Control and Prevention for her contribution to the literature reviews.
Participants of the expert meeting entitled ‘Tobacco exposure during pregnancy in low- and middle-income countries: Establishing research priorities’ held September 8–10, 2008: Bernardo Agudelo-Jaramillo, Erik Augustson, Cathy Backinger, Dilyara Barzani, José Belizán, Vincenzo Berghella, John Bernert, Michele Bloch, Neal Brandes, F. Carol Bruce, Tsungai Chipato, Sven Cnattingius, Patricia Dietz, M. V. Djordjevic, Thomas Eissenberg, Lucinda England, Ellen Feighery, Mario Festin, Christine Galavotti, Lorrie Gavin, Robert Goldenberg, Lorraine Greaves, Prakash Gupta, Paul Holmes, Carys Horgan, Ann Jensby, Annette Kaufman, Shin Kim, Priyadarshini Koduri, Michael S. Kramer, Mats Lambe, Harry Lando, Xingzhu Liu, Ann Malarcher, Elizabeth McClure, Mario Merialdi, Suneeta Mittal, Patricia Dolan Mullen, Katherine Murphy, Mimi Nichter, Thomas Novotny, Cheryl Oncken, Michael Paglia, Karen Parker, Alexandra Parks, Zhaoxia Ren, Jonathan Samet, Susan Sanders, Isabel Scarinci, David Stamilio, Mary Ellen Stanton, Alan Tita, Jorge Tolosa, Scott Tomar, Van Tong, Sheela Shenoy Trivikram, Deborah Winn, and Linda Wright.
Disclosure of interest: Ms. Kim, Ms. Ray, and Drs. England, Gupta, Eissenberg, Cnattingius, Bernert, Tita, Winn, Djordjevic, Lambe, Stamilio, Chipato, and Tolosa report no conflicts of interest. Dr. Tomar has served as an expert witness for plaintiffs in lawsuits brought against manufacturers of smokeless tobacco products and cigarettes. The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.