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Grand Rounds

Is E-Cigarette Use Linked to Adverse Pregnancy Outcomes?

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BACKGROUND AND PURPOSE:

  • Regan et al. (Obstetrics & Gynecology, 2021) evaluated the risk of adverse birth outcomes among adults who use e-cigarettes before and during pregnancy

METHODS:

  • Retrospective cohort study
  • Population
    • Individuals with a recent live birth
    • Data from the 2016-2018 PRAMS (Pregnancy Risk Assessment Monitoring System)
  • Exposure
    • E-cigarette use during the 3 months before pregnancy
    • E-cigarette use during the last 3 months of pregnancy
  • Study design
    • Multivariable logistic regression models used to develop adjusted prevalence ratios
    • Stratification: Prenatal combustible cigarette smoking | Frequency of e-cigarette use (daily or less than daily use)
  • Primary outcomes
    • Preterm birth
    • Small for gestational age (SGA)
    • Low birth weight (LBW)

RESULTS:

  • 79,176 individuals with a live birth
  • Use of e-cigarettes
    • 3 months before pregnancy: 2.7% (95% CI, 2.6 to 2.9)
    • During last 3 months of pregnancy: 1.1% (95% CI, 1.0 to 1.2%)
  • E-cigarette use before pregnancy was not associated with adverse birth outcomes
  • Using e-cigarettes during pregnancy was associated with increased prevalence of LBW
    • Non-use: 6.1%
    • Use during pregnancy: 6.1%
    • Adjusted prevalence ratio 1.33 (95% CI, 1.06 to 1.66)
  • Among respondents who did not smoke combustible cigarettes during pregnancy, e-cigarette use was associated with a higher prevalence of
    • LBW: 10.6%
      • Adjusted prevalence ratio 1.88 (95% CI, 1.38 to 2.57)
    • Preterm birth: 12.4%
      • Adjusted prevalence ratio 1.69 (95% CI, 1.20 to 2.39)
  • Stratification by frequency
    •  Associations were seen only for daily users

CONCLUSION:

  • Use of e-cigarettes during pregnancy was associated with LBW and preterm birth
  • Associations were especially pronounced among daily e-cigarettes users who were not also smoking combustible cigarettes
  • The authors state

…pregnant individuals should be directed toward evidence-based cessation strategies (eg, quitlines, cessation counseling, medications)

Results from this study further support guidance by the CDC stating that e-cigarettes are not safe to use during pregnancy

Learn More – Primary Sources:

Adverse Birth Outcomes Associated With Prepregnancy and Prenatal Electronic Cigarette Use

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Related ObG Topics:

What Are the Effects of Prenatal E-Cigarette Exposure on Infant Neurodevelopment?
Does Prenatal Smoking Increase the Risk of GDM?
Time for a Second Look: Are the “New Tobacco” Products Safer than in Years Past?

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