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12 Furthermore, the use of smokeless tobacco by women has been associated with premature birth and low birth-weight babies, ectopic pregnancies, orofacial clefts, and stillbirths

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This is possibly a historical reference to Carthage, a city-state that did trade with sub-Saharan Africa, as it is speculated it was in an alliance with the Persian empire against Greece at the time (the Persians were fighting the Greeks in the latter's homeland while the Carthaginians were facing them in their colonies in Sicily)

Claire Knight, a senior health information manager stated that it was still unclear what was causing the increase and advised caution

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