{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:06:53Z","timestamp":1788876413088,"version":"build-2803163510"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,11,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Maternal smoking during pregnancy has been associated with higher blood pressure and autonomic imbalance in the offspring. However, it has been difficult to determine the selective prenatal and postnatal contributions as children frequently have been exposed to smoking both before and after birth. The specific role of nicotine is also unclear. We aimed to determine whether exclusive prenatal exposure to nicotine from maternal use of smokeless tobacco (Swedish snus) in pregnancy was associated with blood pressure and autonomic heart rate control in their children.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We measured oscillometric blood pressures in forty 5\u2010 to 6\u2010year\u2010old children with snus exposure in fetal life (n=21) and in tobacco\u2010free controls (n=19). Taking the child\u2032s age and height into account, snus\u2010exposed children had 4.2 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.2\u20138.1) mm\u00a0Hg higher systolic blood pressure than controls (\n              <jats:italic>P<\/jats:italic>\n              =0.038). The corresponding sex\u2010, age\u2010, and height\u2010standardized systolic blood pressure centiles were 61 and 46 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              of the difference, 2\u201328) (\n              <jats:italic>P<\/jats:italic>\n              =0.029). Heart rate variability was tested in 30 of the children. The spectral heart rate variability variable low\u2010frequency\/high\u2010frequency ratio was higher (median, 0.69; interquartile range, 0.45\u20131.21) in snus\u2010exposed children than in controls (median, 0.21; interquartile range, 0.32\u20130.57;\n              <jats:italic>P<\/jats:italic>\n              =0.034).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Prenatal snus exposure was associated with higher systolic blood pressure and altered heart rate variability at 6\u00a0years of age. These findings may indicate adverse prenatal programming of nicotine, but implications for cardiovascular health in later life remain to be studied. Meanwhile, women should be recommended to abstain from all types of tobacco and nicotine products during pregnancy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.012629","type":"journal-article","created":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T09:00:56Z","timestamp":1571216456000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Blood Pressure and Heart Rate Variability in Preschool Children Exposed to Smokeless Tobacco in Fetal Life"],"prefix":"10.1161","volume":"8","author":[{"given":"Felicia","family":"Nordenstam","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden"},{"name":"Pediatric Cardiology Unit Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Norman","sequence":"additional","affiliation":[{"name":"Department of Neonatal Medicine Karolinska University Hospital Stockholm Sweden"},{"name":"Division of Pediatrics Department of Clinical Science, Intervention and Technology, Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronny","family":"Wickstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden"},{"name":"Neuropediatric Unit Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1042\/CS19980019"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.111.181784"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.c140036"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/582748"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00015.2015"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30223-7"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1159\/000457063"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2014-0299"},{"key":"e_1_3_2_10_2","first-page":"870","article-title":"Sudden infant death syndrome","volume":"79","author":"Adams SM","year":"2009","unstructured":"Adams SM, Good MW, Defranco GM. 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