Abstract
Background: Both smoked and smokeless tobacco use have deleterious effects on most major organ systems including the reproductive system. We conducted a systematic review on smokeless tobacco (SLT) use and reproductive outcomes among women. Methods: We searched Pubmed, ProQuest, Cochrane, Wiley and Emerald databases for studies involving smokeless tobacco use in women with any or a combination of three conditions: infertility, menstrual disorders and pelvic inflammatory disease (PID). Eligibility criteria included English language publications from 1st January 1990 - 31st October 2020. CADIMA software used for filtering the studies and modified SIGN checklist for the quality assessment. The findings are reported as per the PRISMA guidelines. The AXIS and ROBIN E tool were used for assessment of risk of bias. Results: In total, three studies addressed our research question. Two studies addressed infertility (prospective cohort: n=501, cross sectional: n=192) of which, the cross-sectional study compared the mean cotinine levels between those with infertility, menstrual disorders and PID. This study also explored the association between SLT and PID. PID was the most common gynecological complaint. Women with PID had significantly higher urinary cotinine levels = 24.95±12.259) ng/ ml (p=0.0144). Mean urinary cotinine in women with menstrual complaints was 19.32±10.29 ng/ml. The other study used population-based sampling of 501 couples who attempted pregnancy (enrolled in the LIFE Study). Results showed that only 2% (n=28) of men and none of the women used smokeless tobacco. Compared with never users of tobacco, smoking by females was individually associated with longer time-to-pregnancy; smoking among males remained significant when modeling partners together. Conclusions: Available studies exploring associations between SLT and reproductive outcomes are inconclusive due to limitations in the study methodologies. More studies with robust study designs are required from low- and middle-income countries with high prevalence of SLT use.
Highlights
Use of both smoked and smokeless forms of tobacco is a major cause of preventable morbidity and mortality
Search for infertility among women and Smokeless tobacco (SLT) use resulted in 1093 results which were run through CADIMA for removal of the duplicate studies, which gave a final of 1062 results (9 from Pubmed; 44 from Wiley; 6 from Emerald; 11 from Cochrane and 992 from ProQuest). that for Menstrual disorders and SLT gave 1330 results
These results were run through CADIMA for removal of the duplicate studies, which gave a final of 1294 results (44 from Pubmed; 19 from Wiley; 25 from Cochrane and 1206 from ProQuest)
Summary
Use of both smoked and smokeless forms of tobacco is a major cause of preventable morbidity and mortality. It kills half of all its lifetime users (WHO, 2011) and more than 8 million people each year, out of which, 1.2 million die due to second hand smoke (WHO, 2019). 12.8% of women used SLT out of 199.4 million adults (GATS, 2017) Both smoked and smokeless tobacco use have deleterious effects on most major organ systems including the reproductive system. Methods: We searched Pubmed, ProQuest, Cochrane, Wiley and Emerald databases for studies involving smokeless tobacco use in women with any or a combination of three conditions: infertility, menstrual disorders and pelvic inflammatory disease (PID). Mean urinary cotinine in women with menstrual complaints was 19.32±10.29 ng/ml
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