Patterns of combustible and electronic cigarette use during pregnancy and associated pregnancy outcomes
Open accessAbstract
Although pregnant smokers may perceive electronic cigarettes (e-cigarettes) as safe alternatives to smoking combustible cigarettes, few studies have evaluated perinatal e-cigarette use and its associated health effects. We analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS, 2016–2018) for 16,022 women who recently gave birth and reported smoking combustible cigarettes prior to pregnancy. Using average marginal predictive values from multivariable logistic regression to produce adjusted prevalence ratios (aPRs), we estimated the prevalence of combustible cigarette smoking during pregnancy and adverse birth outcomes associated with e-cigarette use. In total, 14.8% of smoking women reported using e-cigarettes prior to pregnancy. There was no association between e-cigarette use prior to pregnancy and combustible cigarette smoking during pregnancy (aPR 0.95; 95% CI 0.88, 1.02); however, e-cigarette use during pregnancy was associated with higher prevalence of combustible cigarette smoking during pregnancy (aPR 1.65; 95% CI 1.52, 1.80). In this sample, we did not observe evidence to support reduced risk of preterm birth, small-for-gestational age and low birthweight compared to combustible cigarette smoking during pregnancy. The prevalence of LBW was higher for those who used e-cigarettes, even exclusively, compared to women who quit smoking cigarettes entirely. These results suggest that e-cigarettes should not be considered a safe alternative to combustible cigarette smoking during pregnancy.
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The finding for one of the studies comparing risk of preterm birth for exclusive-vaping and exclusive-smoking should be treated with caution because it also reported no absolute risk for preterm birth.
“The finding for one of the latter studies should be treated with caution as they also reported no absolute risk for PTB [50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
Table 3 in the Results (“Association with birth outcomes”) reports preterm-birth prevalence for both e-cigarette-only users and current smokers, including adjusted estimates of 9.2% and 10.8%, respectively. The Discussion cautions that the study had limited power to detect a difference, but the claim that it reported no absolute preterm-birth risk is contrary to the table. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredTwo studies reported no significant difference in SGA/MBC between exclusive-vaping and exclusive-smoking.
“and two reported no significant difference for these two groups [43, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
The Results (Association with birth outcomes; page unavailable) report no significant difference in SGA between e-cigarette-only users and current smokers. The paper also reports low birthweight, but our copy does not identify or report an outcome called MBC, so it does not support that part of the claim. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe 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 [50]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSix 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 [50]
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 [50]
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 [50]
Two studies observed a similar risk of preterm birth for exclusive-vaping and exclusive-smoking.
“and two observed a similar risk of PTB for exclusive-vaping and exclusive-smoking [43, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
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 [50]
Three studies comparing dual-use and exclusive-smoking reported similar preterm birth prevalence.
“and PTB prevalence [49, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
Two studies reported similar SGA rates for exclusive-vaping and exclusive-smoking.
“The other two studies reported similar SGA rates for the two groups [43, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
Among eight studies comparing exclusive-vaping and non-use, four observed a higher likelihood of LBW for infants of exclusive-vapers.
“and four observed a higher likelihood of LBW for infants of exclusive-vapers [32, 43, 49, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
Among four studies comparing dual-use and exclusive-smoking, two observed a similar risk of SGA.
“Among four studies comparing dual-use and exclusive-smoking, two observed a similar risk of SGA [49, 50]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
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 [50]
The 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 [50]
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 [50]
There are conflicting findings for the five PRAMS studies for LBW/BW comparisons.
“For the latter comparisons, as for PTB/GA and SGA/MBC, there are conflicting findings for the five ‘PRAMS’ studies [32, 42, 43, 49, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
Three studies found similar risk of LBW for dual-users and exclusive-smokers.
“Three found similar risk of LBW for dual-users and exclusive-smokers [46, 49, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
Among three studies comparing exclusive-vaping and exclusive-smoking, two reported similar LBW risk for the two groups.
“and two reported similar LBW risk for the two groups [43, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
Two studies reported no significant difference in LBW/BW between exclusive-vaping and exclusive-smoking.
“and two reported no significant difference between exclusive-vaping and exclusive-smoking [43, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
Four studies reported that exclusive-vaping had a significantly higher risk of LBW/BW than non-use.
“and four reported that exclusive-vaping had a significantly higher risk [32, 43, 49, 50].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [50]
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USO DE CIGARROS ELETRÔNICOS DURANTE A GESTAÇÃO E SUAS IMPLICAÇÕES PARA A SAÚDE MATERNO-FETAL
Cavalcanti, P. L. D. L. E. S., Bervig, S. P., & Lima, R. D. F. (2026) · Revista Brasileira de Saúde · doi:10.22533/at.ed.82082202629103
- Authors
- Regan, A. K., & Pereira, G.
- Affiliations
- University of California, Los Angeles (US)
- Norwegian Institute of Public Health (NO)
- Corresponding author
- Regan, Annette K.
- Venue
- Scientific Reports
- Published
- 2021-06-29
- Volume
- 11
- Issue
- 1
- Pages
- 13508-13508
- ISSN
- 2045-2322 (ISSN-L)
- PMC
- PMC8241992
- OpenAlex
- W3176573805
- Cited by
- 43
- References
- 31
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 16 · 2023: 8 · 2022: 9
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Scientific Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eSpace (Curtin University) (submittedVersion, cc-by)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
- Funders
- National Health and Medical Research Council (GNT1099655)
- Norges Forskningsråd (262700)
- 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
- electronic cigarettes, combustible cigarette smoking, pregnancy, preterm birth, small for gestational age, low birth weight, birth outcomes, smoking cessation, Pregnancy Risk Assessment Monitoring System
- MeSH terms
- Vaping, Cigarette Smoking, Adult, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Infant, Small for Gestational Age, Prevalence, Risk Assessment, Premature Birth, Tobacco Products, Electronic Nicotine Delivery Systems
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