Exposure-response analysis of the association of maternal smoking and use of electronic cigarettes (vaping) in relation to preterm birth and small-for-gestational-age in a national US sample, 2016–2018
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Abstract
Abstract We aimed to estimate exposure-response associations between smoking or vaping, and preterm and small-for-gestational age (SGA) births. We included 99,201 mothers who delivered live singletons in 2016-2018 from the Pregnancy Risk Assessment Monitoring System. We created exposure categories based on participants’ self-reported average number of cigarettes smoked per day and vaping frequency. Dual users in late pregnancy were a heterogeneous group: 36% heavily smoked and occasionally vaped; 29% lightly smoked and frequently vaped; 19% lightly smoked and frequently vaped; and 15% both heavily smoked and frequently vaped. While dual users who heavily smoked and occasionally vaped had the highest adjusted OR for SGA (3.4, 95% CI 1.7-6.6), all the dual users were on average at about twice the odds of having SGA than non-users. While the risks of preterm birth were higher among sole light smokers (adjusted OR 1.3, 95% CI 1.1-1.5) and sole heavy smokers (adjusted OR 1.4. 95 CI 1.2-1.8) than non-users, the adjusted odds of preterm births for dual users were not noticeably higher than those of non-users, unless they were also heavy smokers. Excess of preterm births among heavy vapers was suggested. Among younger non-Hispanic white women (where vaping is most common), only excess risk of SGA, not preterm, with vaping was apparent. Relative to non-users, both smoking and vaping during pregnancy appear to increase risk of SGA, but excess risk of preterm births appears to be primarily attributable to smoking alone. Higher levels of exposure tended to confer more risk. Highlights No observable change in prevalence of vaping during pregnancy from 2016 to 2018 Both smoking and vaping during pregnancy appear to increase risk of SGA births Excess risk of preterm births appears to be primarily attributable to smoking alone
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The finding for the latter two PRAMS studies is inconsistent with five of the above PRAMS studies which found no difference between the groups.
“The finding for the latter two PRAMS studies is inconsistent with five of the above PRAMS studies which found no difference between the groups [32, 42, 50, 53, 54].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [54]
The Discussion reports similar preterm-birth risk for late-pregnancy sole vapers, especially occasional vapers, and non-users. But the Conclusion says sole frequent vapers may have increased preterm-birth risk, while dual users appear to have higher risk of small-for-gestational-age birth than non-users. Thus, this study does not support an unqualified claim of no difference between groups. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe finding for the latter two PRAMS studies is inconsistent with six of the above PRAMS studies which found no group differences.
“Similar to the findings for PTB/GA, the finding for the latter two ‘PRAMS’ studies is inconsistent with six of the above PRAMS studies which found no group differences [32, 35, 42, 50, 53, 54].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [54]
The Results (page not provided) report no material difference in adjusted SGA odds between vapers and non-vapers within smoking strata, supporting a no-difference finding for that comparison. But the same section reports substantially higher SGA odds for dual users than non-users, so the unqualified statement that this PRAMS study found no group differences is too broad. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn one study, the finding of no significant difference in SGA or MBC between exclusive-vapers and non-users held irrespective of the frequency of vaping.
“In one of these studies, this was the finding irrespective of the frequency of vaping [54].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [54]
In the Results (Tables 4 and 5; page unavailable), the adjusted estimates for SGA among both occasional and frequent sole vapers have confidence intervals spanning 1, supporting no statistically significant difference from non-users at either frequency. The paper examines SGA and preterm birth, but our copy does not identify or report an outcome called MBC, so that part of the claim is unsupported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn one study, no significant group differences in preterm birth were observed irrespective of the frequency of vaping.
“In one study this was the case irrespective of the frequency of vaping [54].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [54]
Six studies observed no significant group differences in preterm birth rates between exclusive-vapers and non-users.
“Six of these studies observed no significant group differences in PTB rates [32, 42, 48, 50, 53, 54]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [54]
Eight studies reported that exclusive-vaping did not have a significantly different risk of preterm birth than non-use.
“To summarise the findings for PTB/GA, eight studies reported that exclusive-vaping did not have a significantly different risk than non-use [32, 40, 42, 46, 48, 50, 53, 54]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [54]
Five studies observed no significant differences in preterm birth rates between dual-users and non-users.
“Five studies observed no significant differences in PTB rates between dual-users and non-users [32, 42, 50, 53, 54]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [54]
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 [54]
Eight of ten studies comparing SGA or MBC prevalence between exclusive-vapers and non-users reported no significant differences.
“Eight of ten studies comparing SGA or MBC prevalence between exclusive-vapers and non-users reported no significant differences [32, 34, 35, 42, 46, 50, 53, 54].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [54]
The findings of similar risk of exclusive-smoking and exclusive-vaping for six studies, for some outcomes, need to be treated with caution, as they simultaneously found no significantly increased risk for exclusive-vaping compared with non-use.
“The findings of similar risk of exclusive-smoking and exclusive-vaping for six studies, for some outcomes, need to be treated with caution, as they simultaneously found no significantly increased risk for exclusive-vaping compared with non-use [40, 45–47, 50, 54].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [54]
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- Authors
- Wang, X., Lee, N. L., & Burstyn, I.
- Affiliations
- Children's Hospital of Philadelphia (US)
- Drexel University (US)
- Corresponding author
- Burstyn, Igor
- Venue
- Global Epidemiology
- Publisher
- Elsevier BV
- Published
- 2022-12
- Volume
- 4
- Pages
- 100079
- ISSN
- 2590-1133 (ISSN-L)
- PMC
- PMC10446111
- OpenAlex
- W4283265192
- Cited by
- 16
- References
- 36
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 5 · 2022: 1 · 2021: 2
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Update notices
- Open access
- gold
- doi.org
- Licence
- Locations
- Global Epidemiology (publishedVersion, cc-by-nc-nd)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Centers for Disease Control and Prevention
- 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
- maternal smoking, electronic cigarettes, vaping, preterm birth, small for gestational age, dual tobacco use, exposure-response relationship, fetal growth restriction, pregnancy risk, Pregnancy Risk Assessment Monitoring System
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