Low screening rates for smokeless tobacco use in pregnant women

1. Nearly half of surveyed obstetrician-gynecologists reported not asking pregnant patients about smokeless tobacco use at the first visit.

2. Most respondents did not feel fully informed and wanted to learn more about the health effects of smokeless tobacco products. 

Evidence Rating Level: 3 (Average)        

Study Rundown: The adverse effects of cigarette smoking during pregnancy are well studied and include increased risk of fetal growth restriction, placenta previa, placental abruption, preterm delivery and sudden infant death syndrome. Smokeless tobacco, including chewing tobacco, snuff, dissolvable tobacco and electronic cigarettes (e-cigarettes), have been purported to confer less risk to mother and child since the user is not exposed to the products of combustion produced in traditional cigarette smoking. However, studies suggest these products may still confer adverse effects on fetal development and increase risk for preterm delivery, stillbirth and infant apnea. This study found that while most practitioners believe smoking cessation is important, screening for use of smokeless tobacco products was not routine for nearly half of surveyed providers. Most providers did not feel adequately informed about the health effects of smokeless tobacco and wanted more information. These findings suggest that pregnant women are not being appropriately screened and counseled.

Limitations of this study include cross-sectional design and self-reported practices, which may not accurately reflect true practice. Small sample size and non-response bias may also limit generalizability to others. Further prospective cohort studies investigating the etiology of low screening rates are needed to inform interventions to improve screening and counseling of pregnant women. Finally, providers may stand to benefit from education regarding different smokeless tobacco products and the risks of each to expecting mothers and their fetuses.

Click to read the study in AJOG

Relevant Reading: Non-cigarette tobacco products: what have we learnt and where are we headed?

In-Depth [cross-sectional study]: This study evaluated the screening practices and attitudes of 252 practicing obstetricians-gynecologists (OB/GYNs) regarding the use of smokeless tobacco products among pregnant women. Outcomes of interest included attitudes toward smoking cessation and reduction, as well as screening practices and attitudes toward smokeless tobacco products.

Only 53.2% of OB/GYNs reported asking about smokeless tobacco products some or all of the time. More than two-thirds of survey respondents reported a need for and interest in additional information about the health effects of these products. Among all respondents, 94% felt it very important or important for pregnant patients to stop smoking, and 86% felt it was very important to at least cut down on the number of cigarettes.

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