Sweden's public health agency has a direct message for young women who use white snus and want to get pregnant: stop. The warning is not about tobacco — it is about the tobacco-free nicotine pouches that have swept through a generation of Swedish women, and the nicotine they deliver to a developing fetus.

Behind the warning sits a striking piece of data. A registry study from Karolinska Institutet, published in BJOG in January 2026, found that the share of Swedish women using nicotine or tobacco pouches in the three months before pregnancy rose 538% between 1999 and 2024. It is, the authors say, the first documented case anywhere in the world where pouch use has overtaken cigarette smoking before pregnancy.

What Sweden's health agency actually said

In May 2026, Ekot — the news desk of Sveriges Radio — ran Nikotinkriget ("The Nicotine War"), a multi-part investigation into how the tobacco industry and lobby-linked organisations have promoted white snus as a positive, even health-positive, product. As part of it, Folkhälsomyndigheten (the Public Health Agency of Sweden) issued a warning aimed squarely at young women.

Josefin Päiviö Jonsson, a department head at the agency, told Ekot that anyone planning a pregnancy should stay away from nicotine entirely:

"As a woman, and if you plan to become a parent, you should absolutely abstain from using nicotine during pregnancy."

The agency's position is that nicotine is known to be harmful to the fetus, and that nothing in the research supports the claim — heavily promoted by industry-linked groups — that snus or white snus is an effective way to quit smoking. The warning matters because the user base has shifted: daily snus use among women aged 16 to 29 rose from 3% in 2018 to nearly 18% in 2024. Roughly one in five young Swedish women now uses snus daily, and white snus (nicotine pouches) accounts for most of that growth.

The 538% number, and where it comes from

The headline figure comes from a research letter in BJOG: An International Journal of Obstetrics & Gynaecology, authored by Alma Larsdotter Zweygberg, Stamatia Tsampa and colleagues at Karolinska Institutet, published 7 January 2026 (open access).

The team combined two national registers — the Swedish Medical Birth Register and the Swedish Pregnancy Register — to build a near-complete national cohort of 3,075,235 pregnancies between 1999 and September 2024. At the first antenatal visit (around 6 to 8 weeks of gestation), women reported their cigarette and pouch use in the three months before becoming pregnant.

Result: preconception pouch use rose from 1.6% (95% CI 1.5–1.8) in 1999 to 10.2% (95% CI 10.0–10.4) in 2024 — a 538% relative increase. Over the same window, cigarette smoking fell. Pouches crossed cigarettes to become the more common preconception nicotine source. The trend bent sharply upward from 2016, the year tobacco-free nicotine pouches were introduced and marketed in Sweden.

A technical caveat the authors are explicit about: the registers record "snus" without separating brown (tobacco) snus from white (tobacco-free) nicotine pouches. So the 538% figure covers both products combined. But because brown snus use was already established and roughly flat, the post-2016 acceleration is driven almost entirely by the arrival of white snus.

Why nicotine — not combustion — is the concern here

With cigarettes, the documented pregnancy harms come largely from combustion byproducts and carbon monoxide. Nicotine pouches contain no tobacco and produce no smoke. That is exactly why they are being marketed as "clean." The Swedish agencies' concern is that this framing hides a different problem: the nicotine dose.

The BJOG letter highlights a pharmacokinetic comparison (Lunell et al., Nicotine & Tobacco Research, 2020): a single cigarette delivers about 1 mg of absorbed nicotine, while a 6 mg-strength nicotine pouch delivers about 3.5 mg — and pouch uptake is higher than from traditional tobacco snus. A regular pouch user can therefore absorb more nicotine per day than a smoker, sustained over many hours, with no combustion at all. Whether that higher, sustained dose is safe for a fetus is the open question.

The evidence that exists is worrying but incomplete. A 2023 systematic review in Addiction (Brinchmann, Vist, Becher et al.) on Swedish smokeless tobacco use during pregnancy linked prenatal nicotine exposure to adverse fetal development. The BJOG authors stress that "the long-term effects of high-dose, sustained nicotine delivery from pouches remain unknown." Established: nicotine reaches the fetus and can affect development. Uncertain: the specific long-term consequences of the high pouch doses now common among young Swedish women.

The pregnancy register: still few users, but a rising tail

The most recent annual report from Graviditetsregistret (the Swedish Pregnancy Register), quoted by Ekot, makes the point carefully: overall, few women still use snus during pregnancy. But in the regions where snus use was already high before pregnancy, use is now creeping up during pregnancy too.

The clearest example is Jämtland. There, close to 5% of women were still snusing when they entered antenatal care, and 2.5% were still snusing at gestational week 32 — well into the second trimester. The agency's worry is simple: a far larger share of young women now enter pregnancy nicotine-dependent, and a meaningful minority do not quit.

What happens next

The Nikotinkriget investigation had political fallout. After Ekot reported that lobby-linked organisations had presented industry arguments about white snus as fact — and that two government ministers were involved in pushing Sweden's protest against EU nicotine rules — the ministers were called before the social affairs committee (socialutskottet).

For users, the practical signal is the one Folkhälsomyndigheten is already giving: the official Swedish public-health position is that nicotine and pregnancy do not mix, regardless of whether the nicotine comes from a cigarette, brown snus, or a tobacco-free pouch. The new registry data shows that the audience for that message is bigger than it has ever been.

SOURCES:

• Zweygberg AL, Tsampa S, Galanti R, Magnusson C, Ahlqvist VH. "Nicotine Use Among Young Women Before Pregnancy: National Register-Based Time Trend Analysis." BJOG, published 7 January 2026. Open access. DOI: 10.1111/1471-0528.70153
• Sveriges Radio Ekot: "Folkhälsomyndigheten varnar för vitt snus bland gravida" (7 May 2026, Nikotinkriget). sverigesradio.se
• Expressen: "Myndigheten varnar gravida kvinnor för vitt snus" (12 May 2026). expressen.se
• Brinchmann BC, Vist GE, Becher R, et al. "Use of Swedish Smokeless Tobacco During Pregnancy: A Systematic Review of Pregnancy and Early Life Health Risk." Addiction 118(5):789-803 (2023). DOI: 10.1111/add.16114
• Lunell E, Fagerström K, Hughes J, Pendrill R. "Pharmacokinetic Comparison of a Novel Non-Tobacco-Based Nicotine Pouch (ZYN) With Conventional, Tobacco-Based Swedish Snus and American Moist Snuff." Nicotine & Tobacco Research 22(10):1757-1763 (2020). DOI: 10.1093/ntr/ntaa068
• Folkhälsomyndigheten: "Hälsorisker med snusning." folkhalsomyndigheten.se

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