Background <p>ADHD is a neurodevelopmental disorder linked to impulsivity and self-regulation difficulties. While the association between ADHD and nicotine dependence is well-established, less is known about the association with smokeless tobacco use, such as snuff. Given the adverse health effects of nicotine during pregnancy, this study examines whether women diagnosed with ADHD are more likely to use snuff prior to and early in pregnancy, and whether they persist in use between these periods. This study also explores the associations between ADHD and snuff use in the presence of common psychiatric disorders: depression, anxiety and substance use disorders (SUDs).</p> Methods <p>Using Swedish population-based registers, we identified women who gave birth between 2000 and 2020. ADHD was defined based on clinical diagnoses and/or ADHD medication prescriptions. Snuff use was self-reported during a prenatal care visit. Logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (CIs) for snuff use prior to and early in pregnancy among women with ADHD, adjusting for sociodemographic factors. We also stratified the analyses by depression, anxiety, and/or SUDs to assess potential differences in associations.</p> Results <p>Women diagnosed with ADHD were more likely to use snuff prior to pregnancy (adjOR = 1.89, 95% CI: 1.83–1.95), early in pregnancy (adjOR = 2.43, 95% CI: 2.32–2.55), as well as be persistent snuff users (adjOR = 2.39, 95% CI: 2.27–2.52) compared to women without ADHD. Stratification by common psychiatric disorders revealed that the associations between ADHD and snuff use prior to and early in pregnancy were strongest among women diagnosed with ADHD without depression, anxiety, and/or SUDs.</p> Conclusions <p>ADHD is an important risk factor for snuff use prior to and early in pregnancy, underscoring the need for targeted interventions to prevent nicotine use in young women with ADHD as part of integrated care.</p> Trial registration <p>Retrospectively registered.</p>