Dr. Marewa Glover
Centre of Research Excellence: Indigenous Sovereignty and Smoking
A review of studies on the effects of nicotine on pregnancy outcomes concluded that there is no reason to doubt that
switching to smoke-free tobacco and nicotine products is better than continuing to smoke.
The paper, published in the international Harm Reduction Journal found some studies suggest that using non-smoked products containing nicotine during pregnancy is associated with an
increased risk of some negative birth outcomes, but it remains clear the effect is less than that from smoking.
“There is strong evidence linking smoking while pregnant with negative effects on the health of a woman’s pregnancy and
ill-effects on her infant. Despite knowing this, some pregnant women can’t stop smoking. In some countries it is now
accepted practice to prescribe nicotine replacement products, such as nicotine gum, to help pregnant women quit” said
lead author Dr Marewa Glover of the Centre of Research Excellence: Sovereignty & Smoking.
“Alternative nicotine products, such as snus, an oral tobacco product familiar in Scandinavia and the United States, or
vaping nicotine, remains controversial. After doing this review, we understand why there is so much doubt among maternal
care providers about supporting a pregnant woman to use any nicotine product – there are conflicting results.” She said.
The review was conducted by Dr Glover, an expert in smoking cessation and author of several papers on reducing smoking
among Indigenous pregnant women, and Dr Carl Phillips, an epidemiologist with a similarly long career focused on tobacco
harm reduction and epidemiological uncertainty.
Though over two hundred studies appeared to report on the effects of nicotine on pregnancy outcomes, the authors found
only 21 that met their inclusion criteria requiring studies to be methodologically sound, conducted with humans, and
testing the effects of nicotine delivered via non-combustible means.
Of the reviewed studies, 12 reported on the use of nicotine replacement therapies, 7 on Swedish snus, 1 on Alaskan
iq’mik, and one on e-cigarettes.
“It would be so much easier for health professionals if we could quantify the risks for pregnancy of using smoke-free
tobacco or nicotine products versus the risks of smoking, but the studies to date do not enable anyone to make such
definitive statements." Dr Glover said.
“The truest conclusion at this time is that the pregnancy risks from using smoke-free products must be less than those
from smoking, as most of the potentially harmful exposures from smoking are absent or dramatically reduced in the
smoke-free products,” said Dr Glover.
The closing statement of the paper is that “the evidence does not support denying pregnant women use of smoke-free
products if the alternative is that she would continue to smoke.”The paper can be accessed free at: https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00359-2
Background Notes for Editors:Dr. Marewa Glover is one of New Zealand’s leading tobacco control researchers. She has worked on reducing smoking-related harm for almost
30 years and has over 100 scientific papers. She is recognized internationally for her research on reducing smoking
among the Indigenous people of New Zealand, and particularly among Māori pregnant women. In 2019 she was named a
finalist in the BlacklandPR 2018 Communicator of the Year Award and she was one of three finalists in the New Zealander of The Year Awards. Dr Glover is the most prominent public commentator on vaping in NZ. She is regularly called by the media and
has appeared on NZ’s 60 Minutes in addition to participating in live online and conference debates about vaping. In 2018, Dr Glover established her own
independent research centre the Centre of Research Excellence: Indigenous Sovereignty and Smoking.The Centre of Research Excellence: Indigenous Sovereignty and Smoking has an international focus on reducing tobacco related harms among Indigenous peoples globally. www.coreiss.comDr Carl V Phillips is an advocate of tobacco harm reduction and for promoting a better understanding of the uncertainty
inherent in epidemiologic studies. Over the course of his career he has received both research grants and consulting
funding from producers of every one of the products mentioned in the review except iq’mik (most focused on issues
related to tobacco harm reduction), as well as employment as a consumer advocate promoting tobacco harm reduction and
very modest consulting income specifically related to birth outcomes and smoking.This project has been made possible with the help of a researcher-initiated grant from the Foundation for a Smoke-Free World, Inc. The contents, selection and presentation of facts, as well as any opinions expressed herein are the sole
responsibility of the authors and under no circumstances shall be regarded as reflecting the positions of the Foundation
for a Smoke-Free World, Inc.