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The Effect of Swedish Snuff (Snus) on Offspring Birthweight: A Sibling Analysis

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  • Sol Pía Juárez
  • Juan Merlo

Abstract

Current observational evidence indicates that maternal smoking during pregnancy is associated with reduced birthweight in offspring. However, less is known about the effect of smokeless tobacco on birthweight and about the possible mechanisms involved in this relationship. This paper studies the effect of Swedish smokeless tobacco (snus) on offspring birthweight comparing the results obtained from a conventional linear regression analysis and from a quasi-experimental sibling design using a multilevel linear regression analysis. From the Swedish Medical Birth Register, we investigated 604,804 singletons born between 2002 and 2010. From them, we isolated 8,861 siblings from 4,104 mothers with discrepant snus-use habits (i.e., women who had at least one pregnancy during which they used snus and at least one other pregnancy in which they did not). The conventional analysis shows that continuous snus use throughout the pregnancy reduces birthweight in 47 g while quitting or relapsing snus has a minor and statistically non-significant effect (−6 g and −4 g, respectively). However, using a sibling analysis the effect observed for mothers who continue to use snus during pregnancy is less intense than that observed with previous conventional analyses (−20 g), and this effect is not statistically significant. Sibling analysis shows that quitting or relapsing snus use after the first trimester slightly reduces birthweight (14 g).However, this small change is not statistically significant. The sibling analysis provides strong causal evidence indicating that exposure to snus during pregnancy has a minor effect on birthweight reduction. Our findings provide a new piece of causal evidence concerning the effect of tobacco on birthweight and support the hypothesis that the harmful effect of smoking on birthweight is not mainly due to nicotine.

Suggested Citation

  • Sol Pía Juárez & Juan Merlo, 2013. "The Effect of Swedish Snuff (Snus) on Offspring Birthweight: A Sibling Analysis," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-6, June.
    • Handle: RePEc:plo:pone00:0065611
    DOI: 10.1371/journal.pone.0065611
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    1. William J. Browne & Fiona Steele & Mousa Golalizadeh & Martin J. Green, 2009. "The use of simple reparameterizations to improve the efficiency of Markov chain Monte Carlo estimation for multilevel models with applications to discrete time survival models," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 172(3), pages 579-598, June.
    2. Merlo, Juan & Ohlsson, Henrik & Chaix, Basile & Lichtenstein, Paul & Kawachi, Ichiro & Subramanian, S.V., 2013. "Revisiting causal neighborhood effects on individual ischemic heart disease risk: A quasi-experimental multilevel analysis among Swedish siblings," Social Science & Medicine, Elsevier, vol. 76(C), pages 39-46.
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    1. Gillian S. Gould & Yael Bar Zeev & Laura Tywman & Christopher Oldmeadow & Simon Chiu & Marilyn Clarke & Billie Bonevski, 2017. "Do Clinicians Ask Pregnant Women about Exposures to Tobacco and Cannabis Smoking, Second-Hand-Smoke and E-Cigarettes? An Australian National Cross-Sectional Survey," IJERPH, MDPI, vol. 14(12), pages 1-11, December.

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