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Cited by 32Smoking Behavior and CessationPrenatal Substance Exposure EffectsPregnancy and Medication Impact

Changes in e-cigarette and cigarette use during pregnancy and their association with small-for-gestational-age birth

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Shittu, Abdal Aziz T., Kumar, Brinda P., Okafor, Ugonna, Berkelhamer, Sara K., Goniewicz, Maciej L., Wen, Xiaozhong·2022·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2021.11.1354PMC PMC10329371
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Abstract

Background Despite increased e-cigarette use, limited research has focused on changes in e-cigarette and combustible cigarette use around pregnancy and the subsequent effects on infant health. Objective This study aimed to characterize changes in e-cigarette and cigarette use from before to during pregnancy and examine their associations with small-for-gestational-age birth. Study design This was a secondary data analysis of 2016-2018 data of the US Pregnancy Risk Assessment Monitoring System. We analyzed women aged ≥18 years who had a recent live birth (unweighted: n=105,438; weighted: n=5,446,900). Women were grouped on the basis of their self-reported e-cigarette and/or cigarette use 3 months before pregnancy (exclusive e-cigarette users, exclusive cigarette smokers, dual users, and nonusers) and change in e-cigarette and cigarette use during pregnancy (continuing use, quitting, switching, and initiating use). Small-for-gestational-age was defined as a birthweight below the 10th percentile for infants of the same sex and gestational age. We described the distributions of women's sociodemographic and pregnancy characteristics in both weighted and unweighted samples. We used multivariable log-binomial regression models to estimate the relative risks for the associations between changes in e-cigarette and cigarette use during pregnancy and risk of small-for-gestational-age, adjusting for significant covariates. Results The rates of cessation during pregnancy were the highest among exclusive e-cigarette users (weighted percentage, 80.7% [49,378/61,173]), followed by exclusive cigarette users (54.4% [421,094/773,586]) and dual users (46.4% [69,136/149,152]). Among exclusive e-cigarette users, continued users of e-cigarettes during pregnancy had a higher risk of small-for-gestational-age than nonusers (16.5% [1849/11,206]) vs 8.8% [384,338/4,371,664]; confounder-adjusted relative risk, 1.52 [95% confidence interval, 1.45-1.60]), whereas quitters of e-cigarettes had a similar risk of small-for-gestational-age with nonusers (7.7% [3730/48,587] vs 8.8% [384,338/4,371,664]; relative risk, 0.84 [95% confidence interval, 0.82-0.87]). Among exclusive cigarette users, those who completely switched to e-cigarettes during pregnancy also had a similar risk of small-for-gestational-age with nonusers (7.6% [259/3412] vs 8.8% [384,338/4,371,664]; relative risk, 0.83 [95% confidence interval, 0.73-0.93]). Among dual users before pregnancy, the risk of small-for-gestational-age decreased from 23.2% (7240/31,208) (relative risk, 2.53 [95% confidence interval, 2.47-2.58]) if continuing use to 16.9% (6617/39,142) (relative risk, 1.88 [95% confidence interval, 1.83-1.92]) if only quitting e-cigarettes or 15.1% (1254/8289) (relative risk, 1.61 [95% confidence interval, 1.52-1.70]) if only quitting cigarettes and further to 11.2% (7589/67,880) (relative risk, 1.23 [95% confidence interval, 1.20-1.25]) if both quitting e-cigarettes and cigarettes during pregnancy, compared with nonusers. Conclusion Among exclusive e-cigarette users, quitting e-cigarettes during pregnancy normalized the risk of small-for-gestational-age. Among exclusive cigarette users, quitting smoking or completely switching to e-cigarettes normalized small for gestational age risk. Among dual users, smoking cessation has a greater effect than quitting e-cigarettes only, although discontinuing the use of both may lead to the greatest reduction in the risk of small-for-gestational-age.

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  • Two studies reported a significantly lower risk of SGA/MBC for exclusive-vaping than for exclusive-smoking.

    “Two studies reported a significantly lower risk for exclusive-vaping than for exclusive-smoking [46, 52]”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [52]

    The Results section (‘Continuous use of e-cigarettes and cigarettes during pregnancy’; page unavailable) reports a lower SGA rate for continuous exclusive vaping than for continuous exclusive smoking (16.5% versus 20.0%). But it reports adjusted risks relative to non-users, not a statistical test directly comparing exclusive vaping with exclusive smoking, so the claimed significance of that comparison is not established. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Among four studies comparing dual-use and exclusive-smoking, one found that switching from exclusive-smoking to dual-use had little effect on SGA risk.

    “and one found that switching from exclusive-smoking to dual-use had little effect on SGA risk [52].”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [52]

  • Two studies observed that exclusive-vaping had a higher risk of SGA/MBC than non-use.

    “and two observed that exclusive-vaping had a higher risk [43, 52].”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [52]

  • Six of nine studies comparing dual-use and non-use reported a significantly higher prevalence of SGA for dual-users.

    “Of nine studies comparing dual-use and non-use [32, 34–36, 42, 50, 52–54], six reported a significantly higher prevalence of SGA for dual-users [32, 42, 50, 52–54].”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [52]

  • Two studies observed a significantly higher SGA risk for exclusive-vapers compared with non-users.

    “Two studies observed a significantly higher SGA risk for exclusive-vapers [43, 52].”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [52]

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Authors
Shittu, A. A. T., Kumar, B. P., Okafor, U., Berkelhamer, S. K., Goniewicz, M. L., & Wen, X.
Affiliations
  • University at Buffalo, State University of New York (US)
  • University of Washington (US)
  • Roswell Park Comprehensive Cancer Center (US)
Corresponding author
Wen, Xiaozhong
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2022-05
Volume
226
Issue
5
Pages
730.e1-730.e10
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2021.11.1354
PMC
PMC10329371
OpenAlex
W4200587112
Cited by
32
References
31
Citations by year
2026: 8 · 2025: 5 · 2024: 10 · 2023: 7 · 2022: 2
FWCI
2.98
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Food and Drug Administration
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development
  • National Cancer Institute (U54CA238110)
  • Department of Pediatrics, University of Florida
  • Pfizer
  • Johnson and Johnson
  • National Institutes of Health (3R21HD091515-02S1)
  • University at Buffalo
  • National Center for Advancing Translational Sciences (UL1TR001412)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
Keywords
cigarette smoking during pregnancy, small-for-gestational-age birth, birth weight, smoking cessation during pregnancy, dual tobacco use
MeSH terms
Vaping, Smokers, Adolescent, Adult, Female, Humans, Pregnancy, Smoking Cessation, Tobacco Products, Electronic Nicotine Delivery Systems

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