centre of research excellence: indigenous sovereignty ...the contents, selection and presentation of...

Centre of Research Excellence: Indigenous Sovereignty & Smoking

Effect of using noncombustible tobacco & nicotine products during pregnancy: A systematic reviewProfessor Marewa Glover & Dr Anette Kira

6th Global Forum on Nicotine, Warsaw, Poland, 15 June 2019

© 2019 Centre of Research Excellence: Indigenous Sovereignty & Smoking

Background• Harms from smoking while pregnant are well established• e.g. Low birth weight, preterm, cleft lip, childhood respiratory...

• Ideal is abstinence from smoking anything, or using any tobacco or nicotine products during pregnancy• However, over half (55%) daily smokers unable to stop when

pregnant• Estimated rates smoking/pregnant e.g. 12% UK, 20% France,

35% indigenous Māori women in NZ


Recommended quit methods

• Nicotine replacement ‘therapies’ (NRT) ok’d in Australia, UK, USA, NZ & many other countries• But are these free of risk? • What about the risks of using other noncombustible tobacco &

nicotine products?


• Review relative safety or harm of all noncombustible tobacco & nicotine products• All potentially harmful effects included

Aim

@MarewaGlover


Method• PRISMA protocol followed; Risk of Bias assessed using Newcastle-

Ottawa scale • Included studies comparing:

Women who used any noncombustible tobacco/nicotine product

VS

Non-smoking non-nicotine using (NSNNU) women

OR

Women who smoked tobacco


Excluded• Articles not written in English, Swedish, Norwegian or Danish• Animal or petri dish or other cell reaction simulation type studies;

biomarker measurement studies, nicotine withdrawal studies, cost-effectiveness studies,

• Attitude surveys, faciliators/barriers to cessation, studies not about nicotine; studies saying they’re about nicotine but they were about smoking tobacco • Papers with no method stipulated, or no scientific method used,

opinion pieces; grey literature


Results• Almost 500 papers found• 22 studies described in 27

articles remained


Study Design NRT Snus Chewing/oralTobacco

Vaping

Randomised controlled trial 4

Cross-sectional population (13) 6 5 1 x Indian 1 x Sth Africa

Cross-sectional non-population (4) 1 1 1 x Alaskan Iq’mik

1

Prospective study 1Observational 1


Results • Compared to NSNUU, noncombustible tobacco & nicotine product

use during pregnancy may be associated with preterm-birth, but is less harmful than continued smoking.• The evidence was inconclusive regarding birth weight. • There was weak evidence that noncombustible tobacco & nicotine

product use in pregnancy may not be associated with affected Apgar scores. • There was not enough evidence to support claims of risks for

malformations, CVD, respiratory, neurobehavioral changes and colic.


Results limitations• Study designs were limited by the varied comparison groups & the

variance in products used.• Poor study design & insufficient sample sizes


Recommendations • While we identified some potential risks of using noncombustible

tobacco or nicotine products vs NSNNU, the evidence suggests the risks would be reduced compared to continued smoking while pregnant. • Currently available evidence is not strong enough to justify

denying pregnant women use of potential harm reduced alternatives if they are unable to stop smoking.• More rigorous, AND ethical, studies should be prioritized to more

accurately determine potential risks of using the different tobacco & nicotine products while pregnant.

Future work

• Communication 101! Risk literacy needs help. Continuum of risk needs to be accessible to lay people, maternal care providers, academics & researchers.• Ethics review & journal review/editing needs overhaul to:

1) stop studies going ahead if flawed

2) stop publishing them

• Future reviews need to include articles written in otherlanguages e.g. Japanese



Conclusion • Ideal is women shouldn’t smoke anything (incl cannabis) or use any

tobacco or nicotine product prior to becoming pregnant or during pregnancy. • However, for women who are unable to quit:• Science is clear that continued smoking delivers immediate harm

• There is insufficient evidence to deny supporting switching to a risk reduced alternative• switching could deliver prevention of harm in utero, to pregnancy health, the

pregnant woman & their infant/s


Disclosures I have never received research funding from any tobacco or vaping product company. I have, in the distant past (over 10yrs+) received fees from pharmaceutical companies for consultancy re cessation medicines.

The Centre is funded by a grant that was awarded to it by the Foundation for a Smoke-Free World.

The contents, selection and presentation of facts, as well as any opinions expressed in this presentation are the sole responsibility of the authors and under no circumstances shall be regarded as reflecting the position of the Foundation for a Smoke-Free World, Inc.

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