Cited by 72Smoking Behavior and CessationPrenatal Substance Exposure EffectsPregnancy and preeclampsia studies

Use of Electronic Nicotine Delivery Systems (ENDS) by pregnant women I: Risk of small-for-gestational-age birth

Open access
Cardenas, Victor, Cen, Ruiqi, Clemens, Melissa, Moody, Heather, Ekanem, Uwemedimbuk, Policherla, Anuradha, Fischbach, Lori, Eswaran, Hari +3 more·2019·Tobacco Induced Diseases

Abstract

INTRODUCTION: The 2016 US Surgeon General's Report suggests that the use of electronic nicotine delivery systems (ENDS) is a fetal risk factor. However, no previous study has estimated their effect on adverse pregnancy outcomes. We assessed the prevalence of current ENDS use in pregnant women and explored the effect on birth weight and smallness-for-gestational-age (SGA), correcting for misclassification from nondisclosure of smoking status. METHODS: We conducted a cohort study with 248 pregnant women using questionnaire data and biomarkers (salivary cotinine, exhaled carbon monoxide, and hair nicotine). We evaluated the association between birth weight and the risk of SGA by applying multivariate linear and log-binomial regression to reproductive outcome data for 232 participants. Participants who did not disclose their smoking status were excluded from the referent group. Sensitivity analysis corrected for misclassification of smoking/ENDS use status. RESULTS: The prevalence of current ENDS use among pregnant women was 6.8% (95% CI: 4.4-10.2%); most of these (75%) were concurrent smokers. Using self-reports, the estimated risk ratio of SGA for ENDS users was nearly two times the risk in the unexposed (RR=1.9, 95% CI: 0.6-5.5), and over three times that for ENDS-only users versus the unexposed (RR=3.1, 95% CI: 0.8-11.7). Excluding from the referent group smokers who did not disclose their smoking status, the risk of SGA for ENDS-only use was 5 times the risk in the unexposed (RR=5.1, 95% CI: 1.1- 22.2), and almost four times for all types of ENDS users (RR=3.8, 95% CI: 1.3-11.2). SGA risk ratios for ENDS users, corrected for misclassification due to self-report, were 6.5-8.5 times that of the unexposed. CONCLUSIONS: Our data suggest that ENDS use is associated with an increased risk of SGA.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.18332/tid/106089

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Six 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 [34]

    The Introduction (page unavailable) says the study aimed to assess the validity of self-reported ENDS use and cigarette smoking using biomarkers. The Results section reports biomarker comparisons for both ENDS users and smokers, contrary to describing this study as verifying only smoking status. This paper alone cannot establish the citing sentence’s count of six studies. (LLM, conf=0.82)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured
  • Two recent epidemiological studies in humans have associated e-cigarette use with an increased risk for low birthweight and fetal growth restriction.

    “Two recent epidemiological studies in humans have associated e-cigarette use with an increased risk for low birthweight and fetal growth restriction [173–175].”

    From Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits (2023) · cites this paper as [173]

    The Results (Birth weight outcomes and ENDS use/smoking status; page not available) report an increased risk of small-for-gestational-age birth among ENDS users after excluding misclassified tobacco users, supporting the fetal-growth portion of the claim. The paper does not report an increased risk of low birthweight as a separate outcome; it says the birth-weight z-score difference was significant only for cigarette smokers. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • 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 [34]

    The Results (Birth weight outcomes and ENDS use/smoking status) report that the self-report-based comparison of SGA risk for ENDS-only users versus unexposed non-users was not statistically significant. But the same section reports a significant increase after excluding misclassified tobacco users from the comparison group. This single study also cannot establish the claim’s count of eight out of ten studies. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • One study revealed that 51% of those reporting being non-users, and not having exposure to second-hand smoke or vaping, were subsequently found to have salivary cotinine or CO levels compatible with tobacco use.

    “one study revealed that 51% of those reporting being non-users, and not having exposure to second-hand smoke or vaping, were subsequently found to have salivary cotinine or CO levels compatible with tobacco use [34].”
  • 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]”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 44 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [42]Kleinbaum DG Kupper LL Morgenstern H Epidemiologic Research: Principles and Quantitative Methods 1982 Mishawaka, IN Wiley and Sons

Cited by

Sorted by citations

Authors
Cardenas, V., Cen, R., Clemens, M., Moody, H., Ekanem, U., Policherla, A., Fischbach, L., Eswaran, H., Magann, E., Delongchamp, R., & Boysen, G.
Affiliations
  • University of Arkansas for Medical Sciences (US)
  • University of Uyo (NG)
  • Arkansas Department of Health (US)
Corresponding author
Cardenas, Victor
Venue
Tobacco Induced Diseases
Published
2019-05-21
Volume
17
Issue
May
Pages
44-44
ISSN
1617-9625 (ISSN-L)
OpenAlex
W2945642065
Cited by
72
References
44
Citations by year
2026: 3 · 2025: 5 · 2024: 10 · 2023: 8 · 2022: 15 · 2021: 18 · 2020: 12 · 2019: 1
FWCI
7.89
Type
journal article
Language
en
Open access
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
  • National Institutes of Health (UL1TR000039)
  • Medical Research Council
  • National Center for Advancing Translational Sciences
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, small-for-gestational-age birth, birth weight, fetal risk factors, salivary cotinine, exhaled carbon monoxide, hair nicotine, adverse pregnancy outcomes

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review