Abstract
ObjectiveTo determine if maternal use of snuff (containing high levels of nicotine, low levels of nitrosamines and no combustion products) is associated with an increased risk of oral cleft malformations in the infant and whether cessation of snuff use or smoking before the antenatal booking influences the risk.MethodA population-based cohort study was conducted on all live born infants, recorded in the Swedish Medical Birth Register from 1999 through 2009 (n = 1 086 213). Risks of oral clefts were evaluated by multivariate logistic regression analyses (using adjusted odds ratios, with 95% confidence intervals [CI]).ResultsAmong 975 866 infants that had information on maternal tobacco use, 1761 cases of oral clefts were diagnosed. More than 50% of the mothers who used snuff or smoked three months prior pregnancy stopped using before the antenatal booking. Almost 8% of the mothers were smoking at the antenatal booking and 1,1% of the mothers used snuff. Compared with infants of non-tobacco users, the adjusted odds ratios (95% CI) of any oral cleft for infants of mothers who continued to use snuff or to smoke were 1.48 [1.00–2.21] and 1.19 [1.01–1.41], respectively. In contrast, in infants of mothers who stopped using snuff or stopped smoking before the antenatal booking, the corresponding risks were not increased (adjusted odds ratios [95% CI] were 0.71 [0.44–1.14] and 0.88 [0.73–1.05], respectively).ConclusionMaternal snuff use or smoking in early pregnancy is associated with an increased risk of oral clefts. Infants of mothers who stopped using snuff or stopped smoking before the antenatal booking had no increased risk of oral cleft malformations. Oral snuff or other sources of nicotine should not be recommended as an alternative for smoke-cessation during pregnancy.
Highlights
Oral cleft malformations are among the most common congenital malformations worldwide, with a birth prevalence of approximately 1.7/1000 live born babies, with ethnic and geographic variations [1]
We identified 1985 infants with an oral cleft malformation
More than 50% of women who were snuff users or smokers three months before pregnancy had stopped using tobacco at the time of the antenatal booking
Summary
Oral cleft malformations are among the most common congenital malformations worldwide, with a birth prevalence of approximately 1.7/1000 live born babies, with ethnic and geographic variations [1]. Oral clefts result from disrupted fusion of the facial prominences during the first trimester. We lack knowledge of whether the effect of smoking is generated by nicotine per se or by combustion products in tobacco smoke. Despite lack of knowledge of possible adverse effects of nicotine on fetal development, nicotine-replacement therapy, NRT, is sometimes recommended as a means of smoking cessation for pregnant women [6,7]. Studies on NRT during pregnancy are few and because of lack of compliance, adverse effects are difficult to study [6]
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