Background Smoking during pregnancy has adverse health consequences for the mother and fetus. E-cigarettes could aid with smoking cessation but there is limited research on the prevalence and patterns of e-cigarette use, and their association with smoking cessation among pregnant smokers. Methods We conducted a secondary analysis of a randomized controlled trial of a text-messaging program for smoking cessation among a U.S. national cohort of pregnant smokers ( n = 428). Outcomes assessed were trajectories of e-cigarettes use from baseline to one-month follow-up, and longitudinal association between e-cigarette use at baseline and smoking cessation at one-month follow-up. Results At baseline, 74 (17.29%) pregnant smokers used e-cigarettes in the past 30 days and 36 (8.41%) used e-cigarettes in the past 7 days. The primary reason stated for using e-cigarettes during pregnancy was for quitting. E-cigarette use between baseline and 1-month was inconsistent. Of 36 dual-users at baseline, 20 (55.56%) stopped using e-cigarettes by the 1-month follow-up and 14 initiated e-cigarette use. There was no evidence of an association between e-cigarette use at baseline and the primary smoking cessation outcome, 7-day point prevalence abstinence [adjusted odds ratio = 0.79, 95% confidence intervals = 0.33–1.92]. Conclusions A secondary analysis of a national sample of pregnant smokers indicates that use of e-cigarettes is inconsistent and is not associated with improved smoking cessation outcomes. There is an urgent need to further examine the risk and benefits of e-cigarette use, especially during pregnancy. Electronic supplementary material The online version of this article (10.1186/s12889-019-7299-7) contains supplementary material, which is available to authorized users.

OBJECTIVE: To compare risks of maternal and perinatal outcomes by completed week of gestation from 39 weeks in low-risk nulliparous patients undergoing expectant management. METHODS: We conducted a secondary analysis of a multicenter randomized trial of elective induction of labor at 39 weeks of gestation compared with expectant management in low-risk nulliparous patients. Participants with nonanomalous neonates, who were randomized to and underwent expectant management and attained 39 0/7 weeks of gestation, were included. Delivery gestation was categorized by completed week: 39 0/7–39 6/7 (39 weeks), 40 0/7–40 6/7 (40 weeks), and 41 0/7–42 2/7 (41–42 weeks) (none delivered after 42 2/7). The coprimary outcomes were cesarean delivery and a perinatal composite (death, respiratory support, 5-minute Apgar score 3 or less, hypoxic ischemic encephalopathy, seizure, sepsis, meconium aspiration syndrome, birth trauma, intracranial or subgaleal hemorrhage, or hypotension requiring vasopressor support). Other outcomes included a maternal composite (blood transfusion, surgical intervention for postpartum hemorrhage, or intensive care unit admission), hypertensive disorders of pregnancy, peripartum infection, and neonatal intermediate or intensive care unit admission. For multivariable analysis, P<.0125 was considered to indicate statistical significance for the coprimary outcomes. RESULTS: Of 2,502 participants who underwent expectant management, 964 (38.5%) delivered at 39 weeks of gestation, 1,111 (44.4%) at 40 weeks, and 427 (17.1%) at 41–42 weeks. The prevalence of medically indicated delivery was 37.9% overall and increased from 23.8% at 39 weeks of gestation to 80.3% at 41–42 weeks. The frequency of cesarean delivery (17.3%, 22.0%, 37.5%; P<.001) and the perinatal composite (5.1%, 5.9%, 8.2%; P=.03) increased with 39, 40, and 41–42 weeks of gestation, respectively, and hypertensive disorders of pregnancy decreased (16.4%, 12.1%, 10.8%, P=.001). The adjusted relative risk, 95% CI (39 weeks as referent) was significant for cesarean delivery at 41–42 weeks of gestation (1.93, 1.61–2.32) and for hypertensive disorders of pregnancy at 40 weeks (0.71, 0.58–0.88) and 41–42 weeks (0.61, 0.45–0.82). None of the other outcomes were significant. CONCLUSION: In expectantly managed low-risk nulliparous participants, the frequency of medically indicated induction of labor, and the risks of cesarean delivery but not the perinatal composite outcome, increased significantly from 39 to 42 weeks of gestation.

ImportanceA short cervix as assessed by transvaginal ultrasound is an established risk factor for preterm birth. Study findings for a cervical pessary to prevent preterm delivery in singleton pregnancies with transvaginal ultrasound evidence of a short cervix have been conflicting.ObjectiveTo determine if cervical pessary placement decreases the risk of preterm birth or fetal death prior to 37 weeks among individuals with a short cervix.Design, Setting, and ParticipantsWe performed a multicenter, randomized, unmasked trial comparing a cervical pessary vs usual care from February 2017 through November 5, 2021, at 12 centers in the US. Study participants were nonlaboring individuals with a singleton pregnancy and a transvaginal ultrasound cervical length of 20 mm or less at gestations of 16 weeks 0 days through 23 weeks 6 days. Individuals with a prior spontaneous preterm birth were excluded.InterventionsParticipants were randomized 1:1 to receive either a cervical pessary placed by a trained clinician (n = 280) or usual care (n = 264). Use of vaginal progesterone was at the discretion of treating clinicians.Main Outcome and MeasuresThe primary outcome was delivery or fetal death prior to 37 weeks.ResultsA total of 544 participants (64%) of a planned sample size of 850 were enrolled in the study (mean age, 29.5 years [SD, 6 years]). Following the third interim analysis, study recruitment was stopped due to concern for fetal or neonatal/infant death as well as for futility. Baseline characteristics were balanced between participants randomized to pessary and those randomized to usual care; 98.9% received vaginal progesterone. In an as-randomized analysis, the primary outcome occurred in 127 participants (45.5%) randomized to pessary and 127 (45.6%) randomized to usual care (relative risk, 1.00; 95% CI, 0.83-1.20). Fetal or neonatal/infant death occurred in 13.3% of those randomized to receive a pessary and in 6.8% of those randomized to receive usual care (relative risk, 1.94; 95% CI, 1.13-3.32).Conclusions and RelevanceCervical pessary in nonlaboring individuals with a singleton gestation and with a cervical length of 20 mm or less did not decrease the risk of preterm birth and was associated with a higher rate of fetal or neonatal/infant mortality.Trial RegistrationClinicalTrials.gov Identifier: NCT02901626

Anaemia affects 42% of pregnancies worldwide and is associated with a number of adverse maternal and neonatal pregnancy outcomes including postpartum haemorrhage, preterm delivery, stillbirth and reduced offspring birthweight. (1,2) Whilst iron deficiency is the most common nutritional cause of anaemia in pregnancy, low status of the B vitamin, riboflavin, may also be implicated due to its role in iron metabolism, (specifically in the flavin-dependent release of stored iron for erythropoiesis), but this is rarely investigated in human studies. (3) Low or deficient riboflavin status occurs more commonly among women of reproductive age than is generally recognised, and studies to date investigating the association between riboflavin status and haemoglobin (Hb) in pregnancy have been largely confined to low-middle income populations. (4) The aim of this study was to examine the associations of riboflavin with Hb, and to determine the role of riboflavin as a predictor of anaemia during pregnancy.Data for this analysis were obtained from healthy pregnant women in Northern Ireland and the Republic of Ireland, enrolled on the ongoing Optimal Nutrition for the Prevention of Hypertension in Pregnancy using a Personalised Approach (OptiPREG) study. Detailed health, dietary and lifestyle information, along with a blood sample for analysis of B vitamin biomarkers and haematological measures, were obtained from all participants at the 12th gestational week (GW) (n = 2,153) and at the 36th GW (in a subset of mothers; n = 372). Riboflavin status was determined by the functional assay, erythrocyte glutathione reductase activation coefficient (EGRac), whereby higher values indicate lower riboflavin status.Biomarker analysis showed that 68% of pregnant women had low or deficient riboflavin status. Linear regression analysis found riboflavin status to be a significant determinant of Hb at the 12th GW (β=−0.128, P = 0.001), whilst the odds of developing anaemia at the 12th GW increased with decreasing riboflavin status (β=2.4, OR:10.9, CI:2.2-53.3, P = 0.003). Hb was 0.32g/dl lower at 12th GW (P = 0.026), and 0.64g/dl lower at the 36th GW (P = 0.036), among riboflavin deficient (EGRac ≥ 1.4) women compared to women with optimal riboflavin status (EGRac ≤ 1.26), after controlling for known confounders. Furthermore, among women with riboflavin deficiency, compared to those sufficient in riboflavin at the 12th GW, a significantly higher percentage went on to develop anaemia by the 36th GW (4.6% vs 10.6%, P = 0.032).Riboflavin deficiency is more common in pregnancy than previously recognised. Maintenance of an optimal riboflavin status in pregnancy, through improved diet or supplementation, may improve Hb concentrations and reduce the risk of anaemia, however randomised trials with riboflavin are required, including the ongoing OptiPREG intervention study.