Associations between electronic nicotine delivery systems and birth outcomes
Abstract
Objectives Nicotine crosses the placenta and is a known teratogen. The use of electronic nicotine delivery systems (ENDS) has increased among pregnant women in the US, but there is limited knowledge about their effects on birth outcomes. We examined the associations between ENDS and cigarette use during pregnancy with birth outcomes.Methods We conducted a cross-sectional analysis of 57,046 respondents from 32 US states in the 2016–2017 Pregnancy Risk Assessment Monitoring System. Respondents self-reported use of ENDS and cigarettes during the last 3 months of pregnancy; this was linked with birth outcomes documented on the birth certificate, including birth weight, gestational age, small-for-gestational age, and preterm birth.Results During the last 3 months of pregnancy, 0.5% of women used ENDS only, 0.8% were dual users of ENDS and cigarettes, and 8.0% used cigarettes only. In adjusted models, infants of women who used ENDS only weighed 57.8 grams less (95% CI −134.2, 18.6; p = .14) and were born 0.21 weeks earlier (95% CI −0.45, 0.03; p = .09) than infants of non-users. Infants born to dual users were 193.9 grams less (95% CI −274.9, −112.8; p < .01) and had a 1.93 higher odds of being born small-for-gestational age (95% CI 1.31, 2.83; p < .01) than infants of non-users.Conclusions Our results provide some indication that prenatal ENDS use may adversely affect birth outcomes by reducing birth weight and gestational age. Estimates were imprecise, suggesting that larger samples of ENDS users with more detailed information about patterns of use are needed.
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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 [42]
Four studies reported no significant group differences for gestational age.
“and four reported no significant group differences for GA [40, 42, 46, 48].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [42]
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 [42]
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 [42]
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 [42]
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 [42]
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 [42]
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 [42]
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 [42]
Among eight studies comparing exclusive-vaping and non-use, four reported similar birth weight.
“Among eight studies comparing exclusive-vaping and non-use, four reported similar BW [34, 40, 42, 46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [42]
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 [42]
Four studies reported that exclusive-vaping did not have a significantly different risk of LBW/BW than non-use.
“In summary, for LBW/BW, four studies reported that exclusive-vaping did not have a significantly different risk than non-use [34, 40, 42, 46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [42]
Of three studies comparing dual-users and non-users, one revealed significantly lower weights for infants of dual-users.
“one revealed significantly lower weights for infants of dual-users [42]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [42]
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Vaping during pregnancy: A systematic review of health outcomesPreprint
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- Authors
- Hawkins, S. S., Wylie, B. J., & Hacker, M. R.
- Affiliations
- Boston College (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Hawkins, Summer Sherburne
- Venue
- The Journal of Maternal-Fetal & Neonatal Medicine
- Publisher
- Informa UK Limited
- Published
- 2021-05-24
- Volume
- 35
- Issue
- 25
- Pages
- 6868-6875
- ISSN
- 1476-4954 (ISSN-L)
- 1476-7058
- OpenAlex
- W3164681387
- Cited by
- 26
- References
- 36
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 10 · 2023: 3 · 2022: 4
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Maternal-Fetal & Neonatal 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
- electronic cigarettes, pregnancy, birth outcomes, birth weight, gestational age, small for gestational age, preterm birth, dual use of e-cigarettes and cigarettes, prenatal nicotine exposure, teratogenicity
- MeSH terms
- Birth Weight, Cross-Sectional Studies, Female, Humans, Infant, Newborn, Nicotine, Pregnancy, Premature Birth, Electronic Nicotine Delivery Systems
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