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Cited by 29Smoking Behavior and CessationPrenatal Substance Exposure EffectsPregnancy and Medication Impact

Electronic cigarette use (vaping) and patterns of tobacco cigarette smoking in pregnancy–evidence from a population-based maternity survey in England

Open access
Opondo, Charles, Harrison, Siân, Alderdice, Fiona, Carson, Claire, Quigley, Maria A.·2021·PLOS ONE
DOI 10.1371/journal.pone.0252817PMC PMC8177470
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Abstract

Objectives: Exposure to tobacco products during pregnancy presents a potential harm to both mother and baby. This study sought to estimate the prevalence of vaping during pregnancy and to explore the factors and outcomes associated with vaping in pregnancy. Setting: England. Participants: Women who gave birth between 15 th and 28 th October 2017. Methods: A cross-sectional population-based postal survey of maternal and infant health, the National Maternity Survey (NMS) 2018. The prevalence of vaping and patterns of cigarette smoking were estimated, and regression analysis was used to explore associations between maternal characteristics and vaping, and between vaping and birth outcomes. Outcome measures: Unweighted and weighted prevalence of vaping with 95% confidence intervals, and unadjusted and adjusted relative risks or difference in means for the association of participant characteristics and secondary outcomes with vaping. Secondary outcome measures were: preterm birth, gestational age at birth, birthweight, and initiation and duration of breastfeeding. Results: A total of 4,509 women responded to the survey. The prevalence of vaping in pregnancy was 2.8% (95%CI 2.4% to 3.4%). This varied according to the pattern of cigarette smoking in pregnancy: 0.3% in never-smokers; 3.3% in ex-smokers; 7.7% in pregnancy-inspired quitters; 9.5% in temporary quitters; and 17.7% in persistent smokers. Younger women, unmarried women, women with fewer years of formal education, women living with a smoker, and persistent smokers were more likely to vape, although after adjusting for pattern of cigarette smoking and maternal characteristics, persistent smoking was the only risk factor. We did not find any association between vaping and preterm birth, birthweight, or breastfeeding. Conclusions: The prevalence of vaping during pregnancy in the NMS 2018 was low overall but much higher in smokers. Smoking was the factor most strongly associated with vaping. Co-occurrence of vaping with persistent smoking has the potential to increase the harms of tobacco exposure in pregnant women and their infants.

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Crossref · 10.1371/journal.pone.0252817

Cites

54 of 54 references verified0 citation errors · 0 not checkable

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  • One study reported a significantly higher prevalence of LBW for exclusive-vapers than for a group combining exclusive-smokers and non-users, irrespective of whether vaping was daily or less than daily.

    “One of the studies reported a significantly higher prevalence of LBW for exclusive-vapers than for a group combining exclusive-smokers and non-users, irrespective of whether vaping was daily or less than daily [48].”

    From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [48]

    The Discussion (page unavailable) says the study found no association between vaping and birthweight, contrary to the claimed significant increase in low birthweight. Table 4 in the Results (page unavailable) likewise reports no significant birthweight difference between women who vaped and those who did not. It does not present the claimed exclusive-vaper comparison by daily versus less-than-daily vaping. (LLM, conf=0.86)

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  • 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 [48]

    The Results (Table 4; page not provided) report no statistically significant difference in preterm birth between women who vaped and women who did not (adjusted p = 0.403). But those groups are not exclusive vapers and non-users: the paper includes women with differing cigarette-smoking patterns in its vaping comparison. This source supports the no-significant-difference finding, not the specified group comparison. (LLM, conf=0.88)

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  • 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 [48]

    The Results (Table 4; page not provided) report no statistically significant difference in preterm-birth risk between women who vaped and women who did not. But those groups were not restricted to exclusive vapers and non-users of both vaping and cigarettes, respectively; the study therefore does not establish the specific comparison attributed to it. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • 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 [48]

  • 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 [48]

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Cites

Flagged first, then by citations

2 of the 56 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [25]Harrison S. E., Alderdice F., Henderson J., and Quigley M. A., “ You and your baby: a national survey of health and care,” Oxford, 2019.
  2. [27]Redshaw M., Rowe R., Hockley C., and Brocklehurst P., “ Recorded delivery: a national survey of women’s experience of maternity care 2006,” Oxford, 2007.
  3. [46]National Academies of Science Engineering and Medicine, Public Health Consequences of E-Cigarettes. Washington, DC: National Academies Press, 2018. 29894118

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Authors
Opondo, C., Harrison, S., Alderdice, F., Carson, C., & Quigley, M. A.
Affiliations
National Institute for Health and Care Research (GB)
Corresponding author
Opondo, Charles
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2021-06-04
Volume
16
Issue
6
Pages
e0252817
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0252817
PMC
PMC8177470
OpenAlex
W3165685472
Cited by
29
References
56
Citations by year
2026: 5 · 2025: 2 · 2024: 12 · 2023: 6 · 2022: 4
FWCI
3.46
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institute for Health Research (NIHR) Policy Research Programme (PR-PRU-1217-21202)
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, persistent smoking, preterm birth, birth weight, breastfeeding, maternal characteristics
MeSH terms
Vaping, Cigarette Smoking, Adolescent, Adult, Cross-Sectional Studies, England, Female, Humans, Infant, Newborn, Mothers, Pregnancy, Surveys and Questionnaires, Nicotiana, Prevalence, Premature Birth, Young Adult, Electronic Nicotine Delivery Systems

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