Adverse Maternal and Infant Outcomes of Women Who Differ in Smoking Status: E-Cigarette and Tobacco Cigarette Users
Open accessAbstract
The electronic cigarette (e-cigarette) became commercially available around 2004, yet the characteristics of pregnant women who use these devices and their effects on maternal and infant health remain largely unknown. This study aimed to investigate maternal characteristics and pregnancy outcomes according to maternal smoking status. We conducted a cross-sectional study of Dutch women with reported pregnancies between February 2019 and May 2022, using an online questionnaire to collect data on smoking status and demographic, lifestyle, pregnancy, and infant characteristics. Smoking status is compared among non-smokers, tobacco cigarette users, e-cigarette users, and dual users (tobacco and e-cigarette). We report descriptive statistics and calculate differences in smoking status between women with the chi-square or Fisher (Freeman–Halton) test. Of the 1937 included women, 88.1% were non-smokers, 10.8% were tobacco cigarette users, 0.5% were e-cigarette users, and 0.6% were dual users. Compared with tobacco users, e-cigarette users more often reported higher education, having a partner, primiparity, and miscarriages. Notably, women who used e-cigarettes more often had small infants for gestational age. Despite including few women in the e-cigarette subgroup, these exploratory results indicate the need for more research to examine the impact of e-cigarettes on pregnancy outcomes.
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There was no evidence of increased risk for exclusive-vaping compared with non-use for a composite of adverse outcomes (or for individual outcomes of hypertensive disorders, gestational diabetes or postpartum haemorrhage).
“or for a composite of adverse outcomes (or for individual outcomes of hypertensive disorders, gestational diabetes or postpartum haemorrhage) [47]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
The Discussion (page unavailable) reports no statistically significant differences in composite adverse maternal outcomes by smoking status, supporting the composite part of the claim. The Statistical Analysis section (page unavailable) identifies hypertensive disorders, gestational diabetes and postpartum hemorrhage as components of that composite, but the passages available do not report separate comparisons for each outcome between exclusive e-cigarette users and non-smokers. (LLM, conf=0.81)
Experimental — accuracy not yet measuredThere was greater risk for exclusive-vaping for miscarriage compared with exclusive-smoking.
“and greater risk for exclusive-vaping for miscarriage [47].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
The Results (§3.3) report miscarriages in 30% of e-cigarette users versus 5.7% of tobacco-cigarette users, supporting the observed comparison. The Discussion (§4) cautions that the e-cigarette group was small, the finding may be incidental, and no firm conclusions can be drawn; the unqualified claim of greater risk overstates that evidence. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThere was evidence of similar risk for exclusive-vaping vs exclusive-smoking for a composite of adverse outcomes (and for individual outcomes).
“and for a composite of adverse outcomes (and for individual outcomes) [47]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
The Discussion (page unavailable) reports no statistically significant differences in composite adverse maternal or infant outcomes across smoking-status groups. But the Results, §3.3 (page unavailable), report a higher proportion of miscarriages among e-cigarette users than tobacco cigarette smokers (30% versus 5.7%). The paper therefore does not support a general claim of similar risk for individual outcomes, and a nonsignificant difference does not establish equal risk. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOne study comparing exclusive-vapers, exclusive-smokers, dual-users and non-users as a whole found no significant difference in preterm birth rates.
“Finally, one study compared exclusive-vapers, exclusive-smokers, dual-users and non-users, as a whole, and found no significant difference in PTB rates [47].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
The Methods (§2.4) include preterm birth in a composite adverse infant outcome, and the Discussion (§4) reports no statistically significant difference in that composite across smoking-status groups. The available passages do not report a separate statistical comparison of preterm birth rates, so the claim is more specific than the finding shown. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOne study reported a significant difference in rates of SGA when comparing exclusive-vapers, exclusive-smokers, dual-users and non-users as a whole, although pairwise comparisons were not reported.
“A further study reported a significant difference in rates of SGA when comparing exclusive-vapers, exclusive-smokers, dual-users and non-users, as a whole, although pairwise comparisons were not reported [47].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
Results §3.3 and the Discussion report higher proportions of SGA infants in the three smoking groups than among non-smokers. Statistical Analysis §2.4 describes tests across smoking-status groups, but the passages in our copy do not give an SGA-specific significance result or establish whether pairwise comparisons were reported. (LLM, conf=0.78)
Experimental — accuracy not yet measured
One study examined hospital admissions in the first year of life when comparing babies born to exclusive-vapers, exclusive-smokers, dual-users and non-users as a whole, and reported no significant difference.
“Nanninga and colleagues examined hospital admissions in the first year of life when comparing babies born to exclusive-vapers, exclusive-smokers, dual-users and non-users, as a whole, and reported no significant difference [47].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
Methods §2.3 says the study collected hospital admissions within one year and compared four smoking-status groups. The Discussion reports no statistical difference for a composite adverse neonatal outcome, which includes hospital admission, but our copy does not report a separate no-significant-difference finding for hospital admissions. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThere 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 [47]
The Discussion reports no statistically significant differences in composite adverse neonatal outcomes by smoking status, supporting the composite-outcome portion of the claim. The Methods include hospital admission in that composite, but the available Results passages do not establish a separate comparison of hospital admissions between exclusive e-cigarette and tobacco-cigarette users. The paper also cautions that its e-cigarette subgroup was small; the other outcomes in the citing sentence are attributed to different citations. (LLM, conf=0.83)
Experimental — accuracy not yet measuredFor 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 [47]
The Discussion (page not available) reports no statistically significant differences in composite adverse maternal or neonatal outcomes across smoking-status groups, which supports the two comparisons for those outcomes. It does not establish that vaping and smoking carry similar risks: the study was too small for adjusted analyses, and the Results report more miscarriages among e-cigarette users than among either non-smokers or tobacco smokers. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOne study stated that those counted as vaping included those using non-nicotine vapes.
“One study stated that those counted as vaping included those using non-nicotine vapes [47]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
There was increased risk of miscarriage for exclusive-vaping compared with non-use, possibly a spurious finding due to a sample size of only 10, with three using non-nicotine vapes.
“and increased risk of miscarriage (possibly a spurious finding due to a sample size of only 10, with three using non-nicotine vapes) [47].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
Six studies examined specific maternal pregnancy or postpartum outcomes.
“Six studies examined specific maternal pregnancy or postpartum outcomes [16,36,47,51,55,56, see Table 4].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
Another study found no difference for a composite of adverse birth outcomes when comparing babies of exclusive-vapers, exclusive-smokers, dual-users and non-users as a whole.
“Two ‘PATH’ studies reported no significant difference in composite measures of adverse birth outcomes for a combination of exclusive-vapers and dual-users compared with non-users [38, 45], (one study did not control for smoking status [38]) and another found no difference for such a composite when comparing babies of exclusive-vapers, exclusive-smokers, dual-users and non-users, as a whole [47].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [47]
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 [47]
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 [47]
Citation [40] is attached only to the claim about infant head circumference. The Methods (§2.3–2.4) list the infant outcomes assessed but do not include head circumference, and searches for “head circumference” and “head size” found no passage reporting that comparison. The Discussion’s finding about composite neonatal outcomes does not establish the head-circumference claim. (LLM, conf=0.76)
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Cited by
Sorted by citations
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].”
BackgroundInfluential
- Authors
- Nanninga, E. K., Weiland, S., Berger, M. Y., Feijen-de Jong, E. I., Erwich, J. J. H. M., & Peters, L. L.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- University Medical Center Groningen (NL)
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Corresponding author
- Peters, Lilian L.
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2023-02-01
- Volume
- 20
- Issue
- 3
- Pages
- 2632
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC9915204
- OpenAlex
- W4318814369
- Cited by
- 19
- References
- 6
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 9 · 2023: 3
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Dutch institute ZonMW (531 003018)
- 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, smoking, pregnancy outcomes, birth weight, small for gestational age, miscarriage, primiparity, maternal characteristics
- MeSH terms
- Vaping, Cross-Sectional Studies, Female, Humans, Infant, Pregnancy, Smoking, Tobacco Products, Electronic Nicotine Delivery Systems
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