Longitudinal Examination of Prenatal Tobacco Switching Behaviors and Birth Outcomes, Including Electronic Nicotine Delivery System (ENDS) and Dual Use
Open accessAbstract
Introduction In the US, approximately 8% of pregnant women smoke, and 5-11.9% currently use ENDS products. The health effects of ENDS use are debated; however, most contain nicotine which is known to cause adverse perinatal outcomes. Studies have shown adult ENDS users significantly alter use behaviors over time (switch to conventional cigarettes-only or dual use) thus complicating efforts to examine health effects of ENDS use. The purpose of this study was to describe switching behaviors and associated birth outcomes among infants of women using conventional cigarettes only, ENDS-only, or both. Methods This was a multisite, longitudinal study of biologically confirmed perinatal tobacco users, with nicotine product use assessed each trimester. For the purpose of analysis, participants were defined as switchers, no-switchers, or quitters. Birth outcomes were abstracted from electronic medical records. Analysis included descriptive statistics, linear and multivariate logistic regression adjusted for age, preterm birth, smoking behavior in the first trimester, and an interaction between smoking switching behavior and smoking behavior in the first trimester. Analysis was conducted using SAS v9.4 with significance determined as p < 0.05. Results At enrollment, 48.6% of participants used only conventional cigarettes, 41.7% were dual users, and 10% used ENDS-only. While almost two-thirds of participants used the same tobacco product throughout pregnancy, 26% reported switching behaviors that were complex and not easily clustered. No differences were found in birth outcomes between switchers and no-switchers; however, a difference emerged in birth weight between no-switchers and quitters. Discussion Given the limited data on health effects of ENDS use, and the known harmful consequences of perinatal nicotine use, capturing and classifying product switching behaviors is imperative to inform public health, and remains a challenge requiring further research.
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Six studies verified only smoking status.
“six verified only smoking status (33,34,37,40,41,44]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [33]
One study found no significant differences in gestational age for those switching between exclusive-smoking, exclusive-vaping and dual-use during pregnancy.
“One study had inconclusive results, observing no significant differences in GA for those switching between exclusive-smoking, exclusive-vaping and dual-use during pregnancy [33].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [33]
One study found that those who switched from using any product to no product had infants who weighed significantly more.
“but found that those who switched from using any product to no product had infants who weighed significantly more [33].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [33]
One study found no significant differences in birth weight for those switching between exclusive-smoking, exclusive-vaping and dual-use during pregnancy.
“A further study found no significant differences in BW for those switching between exclusive-smoking, exclusive-vaping and dual-use during pregnancy”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [33]
One study observed no significant differences in admissions or infant respiratory distress for those switching between exclusive-vaping, dual-use and exclusive-smoking during pregnancy.
“The second observed no significant differences in admissions or infant respiratory distress for those switching between exclusive-vaping, dual-use and exclusive-smoking during pregnancy [33].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [33]
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References 25 · Cited by 15
Research works printed but not linked: 22
- Bhandari NR, Day KD, Payakachat N, Franks AM, McCain KR, & Ragland D. (2018). Use and Risk Perception of Electronic Nicotine Delivery Systems and Tobacco in Pregnancy. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 28(3), 251– 257. 10.1016/j.whi.2018.02.005 29588116 · DOI
- Blatt K, Moore E, Chen A, Van Hook J, & DeFranco EA (2015). Association of reported trimester-specific smoking cessation with fetal growth restriction. Obstetrics and Gynecology, 125(6), 1452– 1459. 10.1097/AOG.0000000000000679 26000517 PMC5215872 · DOI
- Cardenas VM, Fischbach LA, & Chowdhury P. (2019). The use of electronic nicotine delivery systems during pregnancy and the reproductive outcomes: A systematic review of the literature. Tobacco Induced Diseases, 17. 10.18332/tid/104724 PMC6770636 31582941 · DOI
- Chiang SC, Abroms LC, Cleary SD, Pant I, Doherty L, & Krishnanq N. (2019). Ecigarettes and smoking cessation: A prospective study of a national sample of pregnant smokers | EndNote Click. 19. https://kopernio.com/viewer?doi=10.1186%2Fs12889-019-7299-7&token=WzUxODg5NiwiMTAuMTE4Ni9zMTI4ODktMDE5LTcyOTktNyJd.ESXD09nyDevT-uv6XeNTu3bRDE PMC6637539 31319846 · DOI
- Coleman B, Rostron B, Johnson SE, Persoskie A, Pearson J, Stanton C, Choi K, Anic G, Goniewicz ML, Cummings KM, Kasza KA, Silveira ML, Delnevo C, Niaura R, Abrams DB, Kimmel HL, Borek N, Compton WM, & Hyland A. (2019). Transitions in electronic cigarette use among adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1 and 2 (2013–2015). Tobacco Control, 28(1), 50– 59. 10.1136/tobaccocontrol-2017-054174 29695458 PMC6202279 · DOI
- Committee on Underserved Women & Committee on Obstetric Practice. (2017). Committee Opinion No. 721: Smoking Cessation During Pregnancy. Obstetrics and Gynecology, 130(4), e200– e204. 10.1097/AOG.0000000000002353 28937573 · DOI
- De Genna NM, Goldschmidt L, Day NL, & Cornelius MD (2017). Maternal trajectories of cigarette use as a function of maternal age and race. Addictive Behaviors, 65, 33– 39. 10.1016/j.addbeh.2016.09.011 27716477 PMC5140727 · DOI
- Gaalema DE, Higgins ST, Bradstreet MP, Heil SH, & Bernstein IM (2011). Using NicAlert strips to verify smoking status among pregnant cigarette smokers. Drug and Alcohol Dependence, 119(1–2), 130– 133. 10.1016/j.drugalcdep.2011.05.014 21652155 PMC3205243 · DOI
- Hedeker D, Mermelstein RJ, & Demirtas H. (2007). Analysis of binary outcomes with missing data: Missing = smoking, last observation carried forward, and a little multiple imputation. Addiction (Abingdon, England), 102(10), 1564– 1573. 10.1111/j.1360-0443.2007.01946.x 17854333 · DOI
- Hengstler K, van ‘t Sant P, & Jira PE (2019). Carboxyhemoglobin in umbilical cord blood and maternal smoking. Journal of Perinatal Medicine, 47(7), 780– 784. 10.1515/jpm-2019-0004 31421045 · DOI
- Kapaya M, D’Angelo DV, Tong VT, England L, Ruffo N, Cox S, Warner L, Bombard J, Guthrie T, Lampkins A, King BA. Use of Electronic Vapor Products Before, During, and After Pregnancy Among Women with a Recent Live Birth - Oklahoma and Texas, 2015. MMWR Morb Mortal Wkly Rep. 2019 3 1; 68(8): 189– 194. doi: 10.15585/mmwr.mm6808a1. PMID: 30817748; PMCID: PMC6394383. 30817748 PMC6394383 · DOI
- Kasza KA, Borek N, Conway KP, Goniewicz ML, Stanton CA, Sharma E, Fong GT, Abrams DB, Coleman B, Schneller LM, Lambert EY, Pearson JL, Bansal-Travers M, Murphy I, Cheng Y-C, Donaldson EA, Feirman SP, Gravely S, Elton-Marshall T, … Hyland AJ (2018). Transitions in Tobacco Product Use by U.S. Adults between 2013–2014 and 2014–2015: Findings from the PATH Study Wave 1 and Wave 2. International Journal of Environmental Research and Public Health, 15(11). 10.3390/ijerph15112515 PMC6265905 30423998 · DOI
- Kondracki AJ (2019). Prevalence and patterns of cigarette smoking before and during early and late pregnancy according to maternal characteristics: The first national data based on the 2003 birth certificate revision, United States, 2016. Reproductive Health, 16(1), 142. 10.1186/s12978-019-0807-5 31519184 PMC6743116 · DOI
- Kurti AN, Bunn JY, Tang K, Nighbor T, Gaalema DE, Coleman-Cowger V, Coleman SRM, & Higgins ST (2020). Impact of electronic nicotine delivery systems and other respondent characteristics on tobacco use transitions among a U.S. national sample of women of reproductive age. Drug and Alcohol Dependence, 207, 107801. 10.1016/j.drugalcdep.2019.107801 PMC6981035 31855658 · DOI
- Liu B, Xu G, Rong S, Santillan DA, Santillan MK, Snetselaar LG, & Bao W. (2019). National Estimates of e-Cigarette Use Among Pregnant and Nonpregnant Women of Reproductive Age in the United States, 2014–2017. JAMA Pediatrics, 173(6), 600– 602. 10.1001/jamapediatrics.2019.0658 31034001 PMC6547070 · DOI
- McCubbin A, Fallin-Bennett A, Barnett J, & Ashford K. (2017). Perceptions and use of electronic cigarettes in pregnancy. Health Education Research, 32(1), 22– 32. 10.1093/her/cyw059 28158490 PMC5914445 · DOI · Paper page
- McCubbin A, Wiggins A, Barnett J, & Ashford K. (2020). Perceptions, Characteristics, and Behaviors of Cigarette and Electronic Cigarette Use among Pregnant Smokers. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 30(3), 221– 229. 10.1016/j.whi.2020.03.006 PMC7237300 32376187 · DOI
- Moore E, Blatt K, Chen A, Van Hook J, & DeFranco EA (2016). Relationship of trimester-specific smoking patterns and risk of preterm birth. American Journal of Obstetrics and Gynecology, 215(1), 109.e1–6. 10.1016/j.ajog.2016.01.167 PMC5344039 26827877 · DOI
- National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, & Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems. (2018). Public Health Consequences of E-Cigarettes. National Academies Press.
- Soneji S, & Beltrán-Sánchez H. (2019). Association of Maternal Cigarette Smoking and Smoking Cessation With Preterm Birth. JAMA Network Open, 2(4), e192514–e192514. 10.1001/jamanetworkopen.2019.2514 PMC6481448 31002320 · DOI
- Suter MA, Mastrobattista J, Sachs M, & Aagaard K. (2015). Is There Evidence for Potential Harm of Electronic Cigarette Use in Pregnancy? Birth Defects Research Part A: Clinical and Molecular Teratology, 103(3), 186– 195. 10.1002/bdra.23333 25366492 PMC4830434 · DOI
- Whittington JR, Simmons PM, Phillips AM, Gammill SK, Cen R, Magann EF, & Cardenas VM (2018). The Use of Electronic Cigarettes in Pregnancy: A Review of the Literature. Obstetrical & Gynecological Survey, 73(9), 544– 549. 10.1097/OGX.0000000000000595 30265741 · DOI · Paper page
- Authors
- Ashford, K., McCubbin, A., Barnett, J., Blair, L. M., Lei, F., Bush, H., & Breland, A.
- Affiliations
- University of Kentucky (US)
- Virginia Commonwealth University (US)
- Corresponding author
- McCubbin, Andrea
- ORCID
- Venue
- Maternal and Child Health Journal
- Published
- 2021-05-10
- Volume
- 25
- Issue
- 8
- Pages
- 1175-1181
- ISSN
- 1092-7875 (ISSN-L)
- 1573-6628
- PMC
- PMC8314381
- OpenAlex
- W3162085059
- Cited by
- 15
- References
- 25
- Citations by year
- 2026: 4 · 2024: 9 · 2023: 1 · 2021: 1
- FWCI
- 1.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Maternal and Child Health Journal (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA040694-01)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- prenatal tobacco use, electronic cigarettes, dual use of e-cigarettes and cigarettes, birth outcomes, birth weight, perinatal nicotine exposure, pregnancy, smoking cessation, preterm birth
- MeSH terms
- Adult, Female, Humans, Infant, Newborn, Longitudinal Studies, Pregnancy, Nicotiana, Premature Birth, Tobacco Products, Electronic Nicotine Delivery Systems
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