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Women using smokeless tobacco need proper attention

Dr Abu Sayeed Shimul
Tobacco is currently the second major cause of death in the world and causes significant adverse effects on maternal and child health. Tobacco is a preventable cause of maternal, perinatal and neonatal mortality. Recent findings of the Global Youth Tobacco Survey, shows that young girls are smoking almost as much as young boys and those girls and boys are using non-cigarette tobacco products such as spit tobacco, biddies and water pipes at similar rates.
We all have heard the warnings — cigarettes can cause cancer and increase our risk of heart diseases. But the sad fact is that smokeless tobacco has got little attention that predominantly affects women. Tobacco use in Bangladesh 2009 shows that daily tobacco smokers are 1.3 percent women, and 20.9 percent overall. Most dangerous thing is 27.9 percent women currently use smokeless tobacco and this needs to be focused urgently.
In Bangladesh commonly used smokeless tobaccos are: shada, jorda and gul. These are taken usually with betel quid, areca nut and lime. The use of smokeless tobacco mixed with areca nut is very popular in Bangladesh. Smoke free tobacco (ST) users are exposed to higher level of nicotine than smokers. The systemic absorption of nicotine per dose is greater with use of chewing tobacco (average 4.5 mg from average dose of 7.9g chewed over 30 minutes) or snuff (average 3.6mg from an average 2.5g moist snuff kept in mouth for 30 minutes, compared with that from smoking cigarettes (average Img per cigarette).
Nicotine increases maternal blood pressure and heart rate. Fetal heart rate is also increased. There is concomitant reduction in the blood flow of uterine artery and umbilical artery. Nicotine also impairs placental transfer of amino acids. It has also been suggested that nicotine affects fettil brain development which may cause fetal hypoxia and growth retardation.
One case control study carried out in Sylhet Medical College in 2007 by Prof Ekhlasur Rahman shows that use of smokeless tobacco during antenatal period about five times a day carries a risk of having Inrauterine Growth Retardation infants 6.4 times than that of non-tobacco users.
Another study by Ness RB showed highly significant association of spontaneous abortion with smoking. Krishna K showed that tobacco chewing mothers had a greatly increased stillbirth rate, a major reduction in birth weight which was due in large part to early delivery. Krishonomurthy S showed that maternal smokeless tobacco ingestion causes delivery of low birth weight baby three times more than non ingested mothers.
In Sweden, a study showed that snuff use is associated with increased risk of preterm delivery. Beside this smoking is associated with higher rates of, ectopic pregnancy, placenta previa, abruptio placenta, premature rupture of the membranes, preterm birth, intrauterine growth restriction and sudden infant death syndrome (SIDS).
Smokeless tobacco also causes infertility, menstrual problem, osteoporosis, hormonal problem, early menopause, etc. Maternal smoking habit can hamper her child's physical and mental growth. These child are very much prone to asthma, bronchiolitis, allergic problem, lack of school performance, etc.
So women should avoid smokeless tobacco to become a healthy mother.
The writer is an Assistant Registrar in the Department of Paediatrics at Dhaka Medical College Hospital (DMCH).