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Cited by 34Smoking Behavior and CessationPrenatal Substance Exposure EffectsPregnancy and Medication Impact

E-cigarette use during pregnancy and its association with adverse birth outcomes in the US

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Lin, Shuo-yu, Wang, Liang, Zhou, Weiyu, Kitsantas, Panagiota, Wen, Xiaozhong, Xue, Hong·2023·Preventive Medicine
DOI 10.1016/j.ypmed.2022.107375PMC PMC9888444
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Abstract

The popularity of e-cigarette use among young adults is a growing concern. However, little is known about factors associated with e-cigarette use in pregnant women and birth outcomes. In this retrospective cohort study, we evaluated the influence of several factors on behavioral changes in e-cigarette use before and during pregnancy, and assessed the association between e-cigarette use and subsequent birth outcomes among pregnant women. The Population Assessment of Tobacco and Health (PATH) study, a government-sponsored national longitudinal study based in the US, Waves 1 through 4 (2013-2018) were used. Multivariate logistic regressions were conducted to estimate behavioral changes in e-cigarette use during pregnancy and subsequent influence on high-risk birth (e.g., preterm birth, low birth weight, birth defects, etc.) and fetal death. Although pregnant women who quit vaping before pregnancy (OR = 1.14, 95% CI 0.54-2.40) or had any use during pregnancy (OR = 1.19, 95% CI 0.38-3.73) showed non-differential risk of having a high-risk birth in comparison to women who did not initiate vaping, we observed that the usage of mint/menthol flavor was correlated with higher risk of fetus death (OR = 3.27, 95% CI 1.17-9.19). Healthcare providers should encourage e-cigarette users to quit prior to and during early pregnancy.

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  • One study found no significant difference in the rates of fetal death between a group combining exclusive-vapers and dual-users versus non-users, controlling for smoking status.

    “Lin et al. found no significant difference in the rates of fetal death between a group combining exclusive-vapers and dual-users vs non-users, controlling for smoking status [45].”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [45]

    The Methods describe an “any use during pregnancy” vaping group compared with non-users and include smoking status as a covariate. The Clinical Implications discussion says e-cigarette use was not significantly associated with adverse birth outcomes, but the quoted Results do not specifically report a nonsignificant fetal-death comparison for that group or identify it as combined exclusive-vapers and dual-users. No page numbers are available in our copy. (LLM, conf=0.77)

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  • Menthol/mint was not associated with a composite of adverse birth outcomes.

    “This study also observed that, compared with ‘other vaping flavours’, menthol/mint was significantly associated with fetal death but was not associated with a composite of adverse birth outcomes; however, rates of smoking in the different flavour groups were not considered.”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [45]

    The Results (Associations between Birth Outcomes and Smoking/Vaping Behavior; page unavailable) report significantly higher odds of fetal death for mint/menthol users than for users of other flavors. They do not state that mint/menthol was unassociated with the composite high-risk-birth outcome. The reported nonsignificant composite result compares vaping-use groups with non-users, not flavor groups. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Two 'PATH' studies reported no significant difference in composite measures of adverse birth outcomes for a combination of exclusive-vapers and dual-users compared with non-users.

    “Two ‘PATH’ studies reported no significant difference in composite measures of adverse birth outcomes for a combination of exclusive-vapers and dual-users compared with non-users [38, 45], (one study did not control for smoking status [38]) and another found no difference for such a composite when comparing babies of exclusive-vapers, exclusive-smokers, dual-users and non-users, as a whole [47].”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [45]

    The Results (Associations between Birth Outcomes and Smoking/Vaping Behavior; page not specified) report no statistically significant difference in the composite high-risk-birth outcome for women with any e-cigarette use during pregnancy. The Methods (Measures; page not specified) group participants by vaping behavior and account for cigarette smoking separately. Thus, the paper supports the null finding for any vaping versus no vaping, but does not identify the comparison as combined exclusive-vapers and dual-users versus people who used neither product. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • 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 [45]

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  • In 17 studies it was not assessed whether any of those counted as vaping used non-nicotine vapes.

    “and in 17 studies it was not assessed whether any of those counted as vaping used non-nicotine vapes [32, 35, 36, 38, 42, 43, 45, 46, 48–56].”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [45]

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Research works printed but not linked: 36

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Cited by

Sorted by citations

Authors
Lin, S.-Y., Wang, L., Zhou, W., Kitsantas, P., Wen, X., & Xue, H.
Affiliations
  • George Mason University (US)
  • Baylor University (US)
  • University at Buffalo, State University of New York (US)
Corresponding author
  • Wen, Xiaozhong
  • Xue, Hong
ORCID
Venue
Preventive Medicine
Publisher
Elsevier BV
Published
2023-01
Volume
166
Pages
107375
ISSN
0091-7435 (ISSN-L)
DOI
10.1016/j.ypmed.2022.107375
PMC
PMC9888444
OpenAlex
W4311420298
Cited by
34
References
3
Citations by year
2026: 6 · 2025: 15 · 2024: 13
FWCI
4.33
Type
journal article
Language
en
Open access
Licence
Locations
  • Preventive Medicine (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21HD091515, R21 DA053638)
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
vaping, birth outcomes, preterm birth, low birth weight, congenital malformations, fetal death, menthol flavors, tobacco cessation, PATH Study, pregnant women
MeSH terms
Vaping, Female, Flavoring Agents, Humans, Infant, Newborn, Longitudinal Studies, Pregnancy, Pregnancy Complications, Retrospective Studies, Premature Birth, Young Adult, Tobacco Products, Electronic Nicotine Delivery Systems

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