Electronic cigarette use during pregnancy and the risk of adverse birth outcomes: A cross-sectional surveillance study of the US Pregnancy Risk Assessment Monitoring System (PRAMS) population

Lin Ammar; Hilary A. Tindle; Angela M. Miller; Margaret A. Adgent; Hui Nian; Kelli K. Ryckman; Mulubrhan Mogos; Mariann R. Piano; Ethan Xie; Brittney M. Snyder; Abhismitha Ramesh; Chang Yu; Tina V. Hartert; Pingsheng Wu

doi:10.1371/journal.pone.0287348

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Electronic cigarette use during pregnancy and the risk of adverse birth outcomes: A cross-sectional surveillance study of the US Pregnancy Risk Assessment Monitoring System (PRAMS) population

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Electronic cigarette use during pregnancy and the risk of adverse birth outcomes: A cross-sectional surveillance study of the US Pregnancy Risk Assessment Monitoring System (PRAMS) population

Lin Ammar, Hilary A. Tindle, Angela M. Miller, Margaret A. Adgent, Hui Nian, Kelli K. Ryckman, Mulubrhan Mogos, Mariann R. Piano, Ethan Xie, Brittney M. Snyder, …

PloS one, Vol.18(10), e0287348

10/24/2023

DOI: 10.1371/journal.pone.0287348

PMCID: PMC10597477

PMID: 37874824

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Abstract

Background Research on health effects and potential harms of electronic cigarette (EC) use during pregnancy is limited. We sought to determine the risks of pregnancy EC use on pregnancy-related adverse birth outcomes and assess whether quitting ECs reduces the risks. Methods Women with singleton live births who participated in the US Pregnancy Risk Assessment Monitoring System (PRAMS) survey study 2016–2020 were classified into four mutually exclusive groups, by their use of ECs and combustible cigarettes (CCs) during pregnancy: non-use, EC only use, CC only use, and dual use. We determined the risk of preterm birth, low birth weight, and small-for-gestational-age (SGA) by comparing cigarette users to non-users with a modified Poisson regression model adjusting for covariates. In a subset of women who all used ECs prior to pregnancy, we determined whether quitting EC use reduces the risk of preterm birth, low birth weight, and SGA by comparing to those who continued its use. All analyses were weighted to account for the PRAMS survey design and non-response rate. Results Of the 190,707 women (weighted N = 10,202,413) included, 92.1% reported cigarette non-use, 0.5% EC only use, 6.7% CC only use, and 0.7% dual use during pregnancy. Compared with non-use, EC only use was associated with a significantly increased risk of preterm birth (adjusted risk ratio [aRR]: 1.29, 95% confidence interval [CI]: 1.00, 1.65) and low birth weight (aRR: 1.38, 95%CI: 1.09, 1.75), but not SGA (aRR: 1.04, 95%CI: 0.76, 1.44). Among 7,877 (weighted N = 422,533) women EC users, quitting use was associated with a significantly reduced risk of low birth weight (aRR: 0.76, 95%CI: 0.62, 0.94) and SGA (aRR: 0.77, 95%CI: 0.62, 0.94) compared to those who continued to use ECs during pregnancy. Conclusions Pregnancy EC use, by itself or dual use with CC, is associated with preterm birth and low birth weight. Quitting use reduces that risk. ECs should not be considered as a safe alternative nor a viable gestational smoking cessation strategy.

Details

Title: Subtitle: Electronic cigarette use during pregnancy and the risk of adverse birth outcomes: A cross-sectional surveillance study of the US Pregnancy Risk Assessment Monitoring System (PRAMS) population
Creators: Lin Ammar
Hilary A. Tindle - Vanderbilt University Medical Center
Angela M. Miller - Tennessee Department of Health
Margaret A. Adgent
Hui Nian
Kelli K. Ryckman - University of Iowa, Epidemiology
Mulubrhan Mogos - Vanderbilt University
Mariann R. Piano - Vanderbilt University
Ethan Xie
Brittney M. Snyder - Vanderbilt University Medical Center
Abhismitha Ramesh
Chang Yu
Tina V. Hartert
Pingsheng Wu
Resource Type: Journal article
Publication Details: PloS one, Vol.18(10), e0287348
DOI: 10.1371/journal.pone.0287348
PMID: 37874824
PMCID: PMC10597477
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Grant note: DOI: 10.13039/100000026, name: National Institute on Drug Abuse, award: R21 DA052026; DOI: 10.13039/100009633, name: Eunice Kennedy Shriver National Institute of Child Health and Human Development, award: R03 HD100708; DOI: 10.13039/100000050, name: National Heart, Lung, and Blood Institute, award: K01 HL161257; DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences, award: TL1 TR002244
Language: English
Date published: 10/24/2023
Academic Unit: Epidemiology
Record Identifier: 9984473206402771

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