Electronic cigarettes and obstetric outcomes: a prospective observational study
Open accessAbstract
Objective: To compare the obstetric outcomes and socio‐demographic factors in electronic cigarette (EC) users with cigarette smokers and non‐smokers in pregnancy. Design: Prospective observational cohort study. Setting: A large urban maternity hospital delivering almost 8500 infants per year. Population: Pregnant women attending for antenatal care. Methods: Electronic cigarette users at time of booking history were prospectively identified. Maternal and neonatal outcomes were compared with those of pregnant smokers and non‐smokers. Multiple logistic regression analysis was performed to estimate the association between the explanatory variables and birthweight. Main outcomes measures: Infant birthweight, gestation at delivery, incidence of low birthweight. Results: A total of 218 women with exclusive EC use and 195 women with dual use of both cigarettes and EC, had a live birth during the study period. EC users were of higher socio‐economic status than smokers. Infants born to EC users had a mean birthweight of 3470 g (± 555 g), which was similar to that of non‐smokers (3471 ± 504 g, P = 0.97) and significantly greater than that of smokers (3166 ± 502 g, P < 0.001). The mean birth centile of EC users was similar to non‐smokers (51st centile versus 47th centile, P = 0.28) and significantly greater than that of smokers (27th centile, P < 0.001). Dual users had a mean birthweight and birth centile similar to that of smokers. Conclusion: The birthweight of infants born to EC users is similar to that of non‐smokers, and significantly greater than cigarette smokers. Dual users of both cigarettes and EC have a birthweight similar to that of smokers. Tweetable extract: Birthweight of infants born to electronic cigarette users appears to be similar to that of non‐smokers.
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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 [46]
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 [46]
One study comparing exclusive-vaping and dual-use reported similar gestational age.
“One study compared exclusive-vaping and dual-use and reported similar GA [46].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
One study observed similar gestational age for dual-users and non-users.
“and one observed similar GA for these groups [46].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
One study observed a lower risk of gestational age for exclusive-vaping compared with exclusive-smoking.
“Three studies compared exclusive-vaping and exclusive-smoking; one observed a lower risk of GA for exclusive-vaping [46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
One study reported that exclusive-vaping had a significantly lower risk of preterm birth than exclusive-smoking.
“One study reported that exclusive-vaping had a significantly lower risk than exclusive-smoking [46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
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 [46]
Three studies comparing dual-use and exclusive-smoking reported similar gestational age.
“Three studies compared dual-use and exclusive-smoking and reported similar GA [46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
Among four studies comparing dual-use and exclusive-smoking, one observed comparable MBCs.
“one observed comparable MBCs [46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
Two studies reported a significantly lower risk of SGA/MBC for exclusive-vaping than for exclusive-smoking.
“Two studies reported a significantly lower risk for exclusive-vaping than for exclusive-smoking [46, 52]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
One study observed significantly higher mean birth centile for exclusive-vapers compared with exclusive-smokers.
“The first study observed (healthily) significantly higher MBC for exclusive-vapers [46].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
One study compared exclusive-vaping and dual-use and reported a lower mean birth weight for dual-users.
“One study compared exclusive-vaping and dual-use and reported a lower MBW for dual-users [46].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
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 [46]
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 [46]
One study reported significantly lower birth weight for exclusive-smokers than for exclusive-vapers.
“One study reported significantly lower BW for exclusive-smokers than for exclusive-vapers [46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
Among three studies comparing exclusive-vaping and exclusive-smoking, one found lower birth weight for exclusive smokers.
“Among three studies comparing exclusive-vaping and exclusive-smoking, one found lower BW for exclusive smokers [46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
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 [46]
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 [46]
One study showed that babies of dual-users had significantly lower birth weight than exclusive-vapers.
“One study showed that babies of dual-users had significantly lower BW than exclusive-vapers [46].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
There was no evidence of an increased risk of exclusive-vaping compared with non-use for NICU admissions, APGAR scores, hospital admissions, fetal death, composite measures of adverse birth outcomes, or infant head circumferences.
“In summary, there was no evidence of an increased risk of exclusive-vaping compared with non-use for NICU admissions [46] or APGAR scores [46], hospital admissions [47], fetal death [45], a composite measures of adverse birth outcomes [47] or infant head circumferences [40].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
One study found that APGAR scores were identical for babies of exclusive-vapers, dual-users, exclusive-smokers and non-users.
“One study found that APGAR scores were identical for babies of exclusive-vapers, dual-users, exclusive-smokers and non-users [46].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
There was evidence of similar risk for exclusive-vaping and exclusive-smoking for NICU admissions, APGAR scores, hospital admissions, composite measures of adverse birth outcomes, and infant head circumferences.
“There was evidence of similar risk for exclusive-vaping and exclusive-smoking for NICU admissions and APGAR scores [46], hospital admissions [47], a composite measures of adverse birth outcomes [47] and infant head circumferences [40].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
For three studies, the evidence is questionable because they simultaneously found no increased risk for exclusive-vaping compared with non-use and found similar risk for exclusive-vaping and exclusive-smoking, for the same outcomes.
“Notably, for three of these studies [40, 46, 47] the evidence is questionable as they simultaneously found no increased risk for exclusive-vaping compared with non-use and found similar risk for exclusive-vaping and exclusive-smoking, for the same outcomes.”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
One study observed similar NICU admissions for babies of exclusive-vapers, dual-users, exclusive-smokers, and non-users.
“Among three studies assessing neonatal intensive care unit (NICU) admissions [16, 33, 46], one observed similar admissions for babies of exclusive-vapers, dual-users, exclusive-smokers, and non-users [46].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [46]
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 [46]
Cites
Infant Morbidity and Mortality Attributable to Prenatal Smoking in the U.S.
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Dhalwani, N. N., Szatkowski, L., Coleman, T., Fiaschi, L., & Tata, L. J. (2019) · Nicotine & Tobacco Research · doi:10.1093/ntr/nty019 · Cited by 15 · see citing works
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Hajek, P., Przulj, D., Pesola, F., Griffiths, C., Walton, R., McRobbie, H., Coleman, T., Lewis, S., Whitemore, R., Clark, M., et al. (2022) · Nature Medicine · doi:10.1038/s41591-022-01808-0 · Cited by 85 · see citing works
Pregnant women’s use of e‐cigarettes in the UK: a cross‐sectional survey
Bowker, K., Lewis, S., Phillips, L., Orton, S., Ussher, M., Naughton, F., Bauld, L., Coleman, T., Sinclair, L., McRobbie, H., et al. (2021) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.16553 · Cited by 28 · see citing works
Opondo, C., Harrison, S., Alderdice, F., Carson, C., & Quigley, M. A. (2021) · PLOS ONE · doi:10.1371/journal.pone.0252817 · Cited by 29 · see citing works
Vaping during pregnancy: a systematic review of health outcomes.
Ussher, M., Fleming, J., & Brose, L. (2024) · BMC pregnancy and childbirth · doi:10.1186/s12884-024-06633-6 · Cited by 27 · see citing works
“Comparisons Nine studies compared outcomes for all four groups key groups: exclusive-smokers, exclusive-vapers, dual-users and non-users [32, 34, 35, 42, 44, 46, 47, 53, 55].”
BackgroundInfluentialAssociations between electronic nicotine delivery systems and birth outcomes
Hawkins, S. S., Wylie, B. J., & Hacker, M. R. (2022) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2021.1929156 · Cited by 26 · see citing works
Use of e-cigarettes in pregnancy: A systematic review of evidence published from 2020-2022
Bell, L., Whelan, M., Thomas, L., Edwards, E., Lycett, D., Hayward, K., Wilson, K., Harrison, R., & Patel, R. (2025) · Journal of Public Health · doi:10.1007/s10389-023-02026-9 · Cited by 23 · see citing works
- Authors
- McDonnell, B., Dicker, P., & Regan, C.
- Affiliations
- Coombe Women and Infants University Hospital Dublin Ireland
- Royal College of Surgeons in Ireland (IE)
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2020-02-09
- Volume
- 127
- Issue
- 6
- Pages
- 750-756
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W3004452511
- Cited by
- 59
- References
- 2
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 10 · 2023: 6 · 2022: 14 · 2021: 13 · 2020: 6
- FWCI
- 5.87
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by-nc-sa)
- Funders
- Friends of the Coombe
- 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 weight, low birth weight, gestational age, cigarette smoking, dual use, neonatal outcomes, maternal smoking, socioeconomic status
- MeSH terms
- Vaping, Cigarette Smoking, Adult, Birth Weight, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prenatal Care, Prospective Studies, Urban Population, Incidence, Logistic Models
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