{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T06:56:04Z","timestamp":1785912964735,"version":"3.56.0"},"reference-count":59,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T00:00:00Z","timestamp":1673827200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Smokeless tobacco is a heterogeneous product group with diverse composition and prevalence globally. Tobacco use during pregnancy is concerning due to the risk of adverse pregnancy outcomes and effects on child health. Nicotine may mediate several of these effects. This systematic review measured health outcomes from Swedish smokeless tobacco (snus) use during pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Literature search was conducted by an information specialist in May 2022. We included human studies of snus use during pregnancy compared with no tobacco use, assessed risk of bias, conducted a meta\u2010analysis and assessed confidence in effect\u2010estimates using Grading\u00a0of Recommendations, Assessment, Development and Evaluations (GRADE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 18 cohort studies (42 to 1 006 398 participants). Snus use during pregnancy probably (moderate confidence in risk estimates) increase the risk of neonatal apnea, adjusted odds ratio 95% confidence interval [aOR (95% CI)] 1.96 (1.30 to 2.96). Snus use during pregnancy possibly (low confidence in risk estimates) increase the risk of stillbirths aOR 1.43 (1.02 to 1.99), extremely premature births aOR 1.69 (1.17 to 2.45), moderately premature birth aOR 1.26 (1.15 to 1.38), SGA aOR 1.26 (1.09 to 1.46), reduced birth weight mean difference of 72.47 g (110.58 g to 34.35 g reduction) and oral cleft malformations aOR 1.48 (1.00 to 2.21). It is uncertain (low confidence in risk estimates, CI crossing 1) whether snus use during pregnancy affects risk of preeclampsia aOR 1.11 (0.97 to 1.28), antenatal bleeding aOR 1.15 (0.92 to 1.44) and very premature birth aOR 1.26 (0.95 to 1.66). Risk of early neonatal mortality and altered heart rate variability is uncertain, very low confidence. Snus using mothers had increased prevalence of caesarean sections, low confidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This systematic review reveals that use of smokeless tobacco (snus) during pregnancy may adversely impact the developing child.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16114","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T14:48:50Z","timestamp":1671202130000},"page":"789-803","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Use of Swedish smokeless tobacco during pregnancy: A systematic review of pregnancy and early life health risk"],"prefix":"10.1111","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8023-1148","authenticated-orcid":false,"given":"Bendik C.","family":"Brinchmann","sequence":"first","affiliation":[{"name":"Division of Climate and Environmental Health Norwegian Institute of Public Health  Oslo Norway"},{"name":"Department of Occupational Medicine and Epidemiology National Institute of Occupational Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunn E.","family":"Vist","sequence":"additional","affiliation":[{"name":"Division for Health Services Norwegian Institute of Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rune","family":"Becher","sequence":"additional","affiliation":[{"name":"Division of Climate and Environmental Health Norwegian Institute of Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom K.","family":"Grimsrud","sequence":"additional","affiliation":[{"name":"Cancer Registry of Norway  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ida\u2010Kristin \u00d8rjas\u00e6ter","family":"Elvsaas","sequence":"additional","affiliation":[{"name":"Division for Health Services Norwegian Institute of Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vigdis","family":"Underland","sequence":"additional","affiliation":[{"name":"Division for Health Services Norwegian Institute of Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f8rn A.","family":"Holme","sequence":"additional","affiliation":[{"name":"Division of Climate and Environmental Health Norwegian Institute of Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin C. L\u00f8drup","family":"Carlsen","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Adolescent Medicine Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ina","family":"Kreyberg","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Adolescent Medicine Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine University of Oslo  Oslo Norway"},{"name":"Department of Dermatology Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Live S.","family":"Nordhagen","sequence":"additional","affiliation":[{"name":"VID Specialized University  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen Eline Stensby","family":"Bains","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Adolescent Medicine Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai\u2010H\u00e5kon","family":"Carlsen","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Adolescent Medicine Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Alexander","sequence":"additional","affiliation":[{"name":"Division of Climate and Environmental Health Norwegian Institute of Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e5kon","family":"Valen","sequence":"additional","affiliation":[{"name":"Division of Climate and Environmental Health Norwegian Institute of Public Health  Oslo Norway"},{"name":"Nordic Institute of Dental Materials  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,16]]},"reference":[{"key":"e_1_2_9_2_1","series-title":"IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, no. 89","volume-title":"Smokeless Tobacco and Some Tobacco\u2010Specific n\u2010Nitrosamines","author":"International Agency for Research on Cancer (IARC) Working Group on the Evaluation of Carcinogenic Risks to Humans","year":"2007"},{"key":"e_1_2_9_3_1","unstructured":"The Public Health Agency of Sweden.Public Health Data. 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