Nicotine Use Among Young Women: Describing A Rapidly Growing Reproductive Health Concern

Nicotine Use Among Young Women: Describing A Rapidly Growing Reproductive Health Concern | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL BJOG: An International Journal of Obstetrics and Gynaecology This is a preprint and has not been peer reviewed. Data may be preliminary. 4 September 2025 V1 Latest version Share on Nicotine Use Among Young Women: Describing A Rapidly Growing Reproductive Health Concern Authors : Alma Larsdotter Zweygberg 0009-0005-0418-5801 [email protected] , Stamatia Tsampa , Rosaria Galanti , Cecilia Magnusson , and Viktor Ahlqvist Authors Info & Affiliations https://doi.org/10.22541/au.175696780.02557114/v1 254 views 139 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction: The sharp decline in cigarette smoking is one of the major public health achievements of recent decades [1](#ref-0001). Tobacco companies have, however, responded to the increasingly effective tobacco control policies by marketing alternative nicotine delivery systems, including nicotine or tobacco pouches [1](#ref-0001). Following aggressive youth-targeted and gender-specific promotion, these products have gained popularity among adolescents and young adults, particularly girls and young women [1,2](#ref-0001). Considering this new trend, any prenatal health risks associated with nicotine or tobacco pouches could be of considerable public health concern. Tobacco smoking entails clear and established such risks and pouches, while lacking combustion byproducts, often deliver nicotine at doses exceeding those of cigarettes and contain other bioactive compounds [2](#ref-0002). The health impact of prenatal nicotine or tobacco pouches use, however, remains largely unknown [3](#ref-0003). Methods: Sweden occupies a unique position in this context with its longstanding tradition of tobacco pouch use (“Swedish snus”), and a national exemption from the European Union–wide ban on its sale. Sweden has systematically tracked the use of “snus” during preconception and pregnancy through national health registers. The term “snus” is used for both the internationally marketed white nicotine pouches and the brown moist smokeless tobacco product used mainly in Scandinavia. Since the late 1990s, the Swedish Medical Birth Register [4](#ref-0004) has collected self-reported data on smoking and nicotine or tobacco pouches use in pregnancies carried beyond 22 or 28 gestational weeks. More recently, the Swedish Pregnancy Register [5](#ref-0005) has expanded this surveillance to include earlier gestational ages, including pregnancies ending in termination. These sources thus offer a rare opportunity to monitor trends in prenatal nicotine or tobacco pouches. Based on these registers, we here report an unprecedented rise in the use of nicotine or tobacco pouches during the pre-conception period (Figure [1](#fig-cap-0001)). By combining the two registries we analyzed a near-complete national cohort of 3 075 235 pregnancies. At the first antenatal visit (typically at 7–10 weeks’ gestation), individuals retrospectively reported their use of cigarettes and nicotine or tobacco pouches three months before pregnancy. Results: Between 1999 and September 2024, we observed a relative increase of 538% in nicotine or tobacco pouches use three months before pregnancy (from 1.6% [95% CI, 1.5, 1.8] to 10.2% [95% CI, 10.0, 10.4]). Smoking, instead, declined by 65.2% over the same period (from 22.4% [95% CI, 22.0, 22.8] to 7.8% [95% CI, 7.6, 8.0]). To our knowledge, these trends represent the first documented instance globally in which the use of nicotine or tobacco pouches have surpassed cigarette smoking during the pre-conception period. While we cannot distinguish between tobacco pouches and nicotine pouches in our data, the trend clearly shifted following the introduction of nicotine pouches marketing in 2016. Conclusions: These findings signal a fundamental shift in pre-conception nicotine use that is likely to extend into the prenatal period. Although existing evidence links prenatal nicotine exposure to adverse fetal development[3](#ref-0003), the long-term effects of high-dose, sustained nicotine delivery from pouches remain unknown. Further research is needed to determine how often individuals discontinue use upon pregnancy recognition and whether cessation mitigates potential harm. Clinicians should recognize that pouches now account for a growing share of prenatal nicotine exposure and ensure that screening and counseling explicitly address their use. Targeted surveillance, expanded research, and responsive policy measures are urgently required to guide clinical practice and protect maternal and child health Supplementary Material File (manuscript lte snus use 250827.docx) Download 236.12 KB Information & Authors Information Version history V1 Version 1 04 September 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Collection BJOG: An International Journal of Obstetrics and Gynaecology Keywords epidemiology epidemiology: perinatal substance misuse in pregnancy Authors Affiliations Alma Larsdotter Zweygberg 0009-0005-0418-5801 [email protected] Karolinska Institutet Institutionen for global folkhalsa View all articles by this author Stamatia Tsampa Karolinska Institutet Institutet for miljomedicin View all articles by this author Rosaria Galanti Karolinska Institutet Institutionen for global folkhalsa View all articles by this author Cecilia Magnusson Karolinska Institutet Institutionen for global folkhalsa View all articles by this author Viktor Ahlqvist Karolinska Institutet Institutet for miljomedicin View all articles by this author Metrics & Citations Metrics Article Usage 254 views 139 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Alma Larsdotter Zweygberg, Stamatia Tsampa, Rosaria Galanti, et al. Nicotine Use Among Young Women: Describing A Rapidly Growing Reproductive Health Concern. Authorea . 04 September 2025. DOI: https://doi.org/10.22541/au.175696780.02557114/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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