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Cited by 86Smoking Behavior and CessationPrenatal Substance Exposure EffectsMaternal and Neonatal Healthcare

Smoking and use of electronic cigarettes (vaping) in relation to preterm birth and small-for-gestational-age in a 2016 U.S. national sample

Wang, Xi, Lee, Nora L., Burstyn, Igor·2020·Preventive Medicine
DOI 10.1016/j.ypmed.2020.106041
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Abstract

Women who smoke may be motivated to switch to vaping (use electronic cigarettes, e-cigs) around pregnancy in seeking to alleviate known hazards of smoking. E-cigs typically contain nicotine but either eliminates or greatly reduces exposure to the combustion products of tobacco. We studied a U.S.-wide representative sample of 31,973 live singleton births in 2016. In the three months before pregnancy, 5029 (14%) mothers exclusively smoked tobacco ("sole smokers") and 976 (3%) used both tobacco and e-cigs ("dual-users"). Among pre-pregnancy sole smokers, 44% continued to only smoke while 1% became dual-users in late pregnancy. Logistic regression models were used to assess the adjusted odds ratios (aOR) for preterm and small-for-gestational-age (SGA) by reported smoking or vaping in late pregnancy. Compared to women who used neither product ("non-users"), late-pregnancy sole smokers had increased risks for preterm birth (aOR 1.6, 95% CI 1.2-2.0) and SGA (aOR 2.4, 95% CI 1.8-2.9), after adjusting for their pre-pregnancy smoking or vaping status and other confounders. The adjusted models also showed that late-pregnancy sole vapers had similar risk of preterm birth as non-users (aOR 1.2, 95% CI 0.5-2.7). Late-pregnancy dual-users also had similar risk of preterm birth as non-users (aOR 1.3, 95% CI 0.8-2.3). However, late-pregnancy sole vapers and dual-users had increased risk of SGA compared to non-users (aOR 2.4, 95% CI 1.0-5.7 for sole vapers, and aOR 2.3 95% CI 1.3-4.1 for dual-users). These findings suggest that vapers during pregnancy had similar risk of preterm as non-users but still had elevated risk for restricted fetal growth.

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  • Two recent epidemiological studies in humans have associated e-cigarette use with an increased risk for low birthweight and fetal growth restriction.

    “Two recent epidemiological studies in humans have associated e-cigarette use with an increased risk for low birthweight and fetal growth restriction [173–175].”

    From Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits (2023) · cites this paper as [174]

  • 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 [53]

  • 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 [53]

  • 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 [53]

  • 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 [53]

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Authors
Wang, X., Lee, N. L., & Burstyn, I.
Affiliations
  • Children's Hospital of Philadelphia (US)
  • Drexel University (US)
Corresponding author
Wang, Xi
ORCID
Venue
Preventive Medicine
Publisher
Elsevier BV
Published
2020-05
Volume
134
Pages
106041
ISSN
0091-7435 (ISSN-L)
DOI
10.1016/j.ypmed.2020.106041
OpenAlex
W3007863338
Cited by
86
References
47
Citations by year
2026: 10 · 2025: 5 · 2024: 20 · 2023: 10 · 2022: 20 · 2021: 15 · 2020: 6
FWCI
7.69
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
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
smoking during pregnancy, electronic cigarettes, vaping, preterm birth, small for gestational age, fetal growth restriction, nicotine
MeSH terms
Vaping, Tobacco Smoking, Adult, Female, Humans, Infant, Newborn, Infant, Small for Gestational Age, Mothers, Pregnancy, Pregnancy Outcome, United States, Maternal Exposure, Premature Birth, Electronic Nicotine Delivery Systems

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