We all know that smoking can kill and is especially harmful to the unborn whether it is being inhaled by mothers, second hand smoke or in a maternal snuff delivery system. A new study takes a look at what is most dangerous, and it has been found that babies born to snuff using mothers were more likely to have breathing problems than those whose mothers smoked while pregnant.

The researchers got their data from records of about 610,000 babies born in Sweden between 1999 and 2006. They compared information gathered from mothers when they were a few months pregnant, including about snuff and cigarette use with babies’ hospital records.

Anna Gunnerbeck, from the Karolinska Institute in Stockholm explains:

“It may have a little bit different effect than smoking, because smoking has the combustion products, but it’s still not safe during pregnancy. I think the best thing for women who smoke during pregnancy is to stop if it’s possible. It’s really difficult if you have a woman who smokes a lot and can’t stop — what do you do then? Always you have to consider the cases where you need (nicotine replacement) — the women who can’t stop.”

One or two in every 1,000 babies born to mothers who didn’t use snuff or cigarettes developed apnea. For babies whose mothers lit up during pregnancy, that risk increased by about half. For those whose mothers used snuff, the rate was more than twice as high as in babies born to mothers who didn’t use any kind of tobacco.

The risks of undiagnosed obstructive sleep apnea in children include learning problems, developmental problems, behavior problems and in some cases, failure to grow, heart problems and high blood pressure. In addition, obstructive sleep apnea causes daytime sleepiness that can result in personality changes, lost productivity in school and interpersonal relationship problems. A child with sleep apnea may lag behind in many areas of development. The child may become frustrated and depressed. The severity of the symptoms may be mild, moderate or severe.

When the researchers took into account how early babies were born, prematurity has been linked to both maternal smoking and breathing problems in newborns, smoking alone didn’t have any extra effect on the risk of apnea. But apnea was still more common when mothers used snuff, regardless of whether babies were born early or not.

Many babies with apnea will get a bit of extra care after birth and be fine, but it’s also possible that they’re more likely to have breathing problems when they’re older, including sleep apnea. Apnea may also put children at higher risk of infection later.

While snuff use is more common in Sweden than elsewhere, pregnant women in other countries may also use nicotine-containing products such as gum and patches, thinking they’re safer than smoking during pregnancy.

Michael Weitzman, who studies smoking in pregnancy at the New York University Medical Center comments:

“They’re raising the concern that Swedish snuff, because it’s largely nicotine, can be a surrogate for nicotine replacement therapy during pregnancy, that it might have untoward effects.”

Snuff is ground tobacco that is high in nicotine but doesn’t generate the same additional chemicals as cigarette smoke because it’s not burned and is generally assumed to be safer than cigarettes.

Written by Sy Kraft