Maternal Smokeless Tobacco Consumption and Its Association with Spontaneous Abortion A Study in a Bangladeshi Tertiary Hospital

Abstract

Background: Smokeless tobacco use among women of reproductive age is a significant public health issue, particularly in low- and middle-income countries where it is culturally ingrained and underreported. This study explores the association between prolonged maternal smokeless tobacco use and adverse pregnancy outcomes, focusing on spontaneous abortion, preterm birth, low birth weight (LBW), and intrauterine growth restriction (IUGR). Methods: A retrospective cohort study was conducted at Dhaka Medical College Hospital from January 2009 to December 2010, including 340 mother-newborn pairs: 170 smokeless tobacco users (cases) and 170 non-users (controls), matched for age, BMI, socioeconomic status, paternal smoking, and educational level. Data on maternal characteristics, smokeless tobacco use, and pregnancy outcomes were collected and analyzed using Chi-square, Z-test, and odds ratio calculations, with a p-value <0.05 considered significant. Results: Baseline maternal characteristics, including age, BMI, and hemoglobin levels, were comparable between cases and controls (p > 0.10). Among cases, preterm births (38.24% vs. 16.47%, p < 0.001), LBW (58.82% vs. 27.65%, p < 0.001), and IUGR (26.47% vs. 11.65%, p < 0.001) were significantly more frequent. Spontaneous abortion was more prevalent among cases (34.1% vs. 18.8%, p < 0.01), with a 2.2-fold increased risk for mothers who used smokeless tobacco for >5 years (OR = 2.2, 95% CI: 1.3–3.6). The most common product used was Jorda (61.2%), with a mean usage duration of 7.4 ± 1.8 years. Conclusion: Prolonged maternal smokeless tobacco use is significantly associated with adverse pregnancy outcomes like spontaneous abortion, highlighting the urgent need for public health interventions, routine screening and support in antenatal care.