Use of electronic nicotine delivery systems by pregnant women II: Hair biomarkers for exposures to nicotine and tobacco-specific nitrosamines
Open accessAbstract
INTRODUCTION: Public awareness of electronic nicotine delivery systems (ENDS) has increased over time, and the perception that ENDS offer a safer alternative to cigarettes may lead some pregnant women to use them to reduce cigarette smoking during pregnancy. No previous studies have used metabolite levels in hair to measure nicotine exposure for ENDS users during pregnancy. We aimed to measure and compare levels of nicotine, cotinine, and tobacco-specific nitrosamines (TSNAs) in hair samples from pregnant women who were current ENDS users, current smokers, and current non-smokers. We also aimed to estimate the association between ENDS use/smoking and smallness for gestational age (SGA). METHODS: We used hair specimens from pregnant women who were dual users (ENDS and cigarettes), smokers, and non-smokers from a prospective cohort study to estimate exposure to nicotine, cotinine, and TSNAs. The exposure biomarkers and self-reports of smoking and ENDS use were used in log-binomial regression models to estimate risk ratios (RRs) for SGA among offspring. RESULTS: Nicotine concentrations for pregnant dual users were not significantly different from those for smokers (11.0 and 10.6 ng/mg hair, respectively; p=0.58). Similarly, levels of cotinine, and TSNAs for pregnant dual users were not lower than those for smokers. The RR for SGA was similar for dual users and smokers relative to nonsmokers, (RR=3.5, 95% CI: 0.8-14.8) and (RR=3.3, 95% CI: 0.9-11.6), respectively. Using self-reports confirmed by hair nicotine, the RR values for dual ENDS users and smokers were 8.3 (95% CI: 1.0-69.1) and 7.3 (95% CI:1.0-59.0), respectively. CONCLUSIONS: We did not observe lower levels of nicotine, cotinine, and TSNAs for current dual users compared to smokers during pregnancy. The risk of SGA for offspring of pregnant dual users was similar to that for offspring of pregnant smokers. Future studies are needed to further estimate the magnitude of the association between ENDS use and smallness for gestational age.
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Two studies examined maternal exposure to biomarkers of toxicants and carcinogens during pregnancy and neither reported evidence of increased risk of vaping.
“Two studies examined maternal exposure to biomarkers of toxicants and carcinogens during pregnancy and neither reported evidence of increased risk of vaping (see Table 5) [37, 39].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [37]
The Results examine biomarkers in pregnant women, but the Discussion reports that the estimated risk of smallness for gestational age among confirmed dual users was over eight times that of confirmed non-smokers. The Conclusions also say dual users had the same or greater exposure to NNK, a carcinogen, as smokers, raising concerns about adverse effects. These findings contradict the claim that this study reported no evidence of increased risk, although they do not isolate the effect of vaping from concurrent smoking. (LLM, conf=0.84)
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Experimental — accuracy not yet measuredThe other study reported that hair biomarkers of carcinogens were not significantly different among dual-users, non-users and exclusive-smokers but did not include exclusive-vapers.
“The other study reported that hair biomarkers of carcinogens were not significantly different among dual-users, non-users and exclusive-smokers [37] but did not include exclusive-vapers [37].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [37]
In Results, Table 1 shows no significant NNK difference between dual users and smokers (p=0.18), but NNK differs significantly between non-users and both dual users (p=0.03) and smokers (p=0.002). The Limitations and strengths section confirms that the sole exclusive ENDS user was excluded. Thus, the claim is correct about excluding exclusive vapers but not about a lack of significant differences across all three groups. (LLM, conf=0.90)
Experimental — accuracy not yet measuredSix studies verified only smoking status.
“six verified only smoking status (33,34,37,40,41,44]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [37]
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Vaping during pregnancy: A systematic review of health outcomesPreprint
USSHER, M. H., Fleming, J., & Brose, L. S. (2024) · Research Square · doi:10.21203/rs.3.rs-4234553/v1
Additional file 1 of Vaping during pregnancy: a systematic review of health outcomes
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- Authors
- Clemens, M., Cardenas, V., Fischbach, L., Cen, R., Siegel, E., Eswaran, H., Ekanem, U., Policherla, A., Moody, H., Magann, E., & Boysen, G.
- Affiliations
- University of Arkansas for Medical Sciences (US)
- University of Uyo (NG)
- Corresponding author
- Fischbach, Lori
- ORCID
- Venue
- Tobacco Induced Diseases
- Publisher
- E.U. European Publishing
- Published
- 2019-06-06
- Volume
- 17
- Issue
- June
- Pages
- 50-50
- ISSN
- 1617-9625 (ISSN-L)
- PMC
- PMC6662780
- OpenAlex
- W2948556849
- Cited by
- 31
- References
- 39
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 3 · 2022: 3 · 2021: 8 · 2020: 7 · 2019: 1
- FWCI
- 3.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Tobacco Induced Diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Arkansas
- Georgia Clinical and Translational Science Alliance (KL2TR000063, UL1TR000039)
- National Institutes of Health (UL1TR000039, KL2TR000063, UL1TR000039 and KL2TR000063)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- electronic cigarettes, pregnant women, hair biomarkers, nicotine exposure, cotinine, tobacco-specific nitrosamines, dual use of e-cigarettes and cigarettes, small for gestational age, fetal growth restriction, prenatal tobacco exposure
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