Electronic cigarettes may not be a “safer alternative” of conventional cigarettes during pregnancy: evidence from the nationally representative PRAMS data

Abstract

Background Conventional cigarette (CC) smoking is one of the most preventable causes of adverse birth outcomes. Although electronic cigarettes (ECs) are considered to be safer than CCs during pregnancy, the evidence is yet to be presented. This study examines the effects of prenatal EC use on neonatal birth outcomes compared to those of CC smokers and complete tobacco abstainers. Methods Data was extracted from 55,251 pregnant women who participated in the Phase 8 survey of the Pregnancy Risk Assessment Monitoring System between 2016 and 2018. Participants were classified into three groups based on their smoking behaviors in the third trimester: complete tobacco abstinence, exclusive CC smoking, or exclusive EC use. Adverse outcomes included infants being small-for-gestational-age (SGA), having low birthweight (LBW), and being born at preterm. EC users were matched to complete abstainers and CC smokers who share the same baseline characteristics in race/ethnicity, age, educational attainment, income, prenatal care adequacy, and first- and second-trimester CC smoking statuses. The association between EC use and adverse birth outcomes were examined by survey-weighted logistic regression analyses in the matched population. Results Among participants, 1.0% of women reported having used ECs during the third trimester, 60% of which reported using ECs exclusively. Neonates of EC users were significantly more likely to be SGA (OR 1.76; 95% CI 1.04, 2.96), have LBW (OR 1.53; 95% CI 1.06, 2.22), or be born preterm (OR 1.86; 95% CI 1.11, 3.12) compared to tobacco abstainers. However, odds of EC users’ pregnancies resulting in SGA (OR 0.67; 95% CI 0.30, 1.47), LBW (OR 0.71; 95% CI 0.37, 1.37), or preterm birth (OR 1.06; 95% CI 0.46, 2.48) were not significantly lower than those of CC smokers. Conclusions Even after accounting for shared risk factors between prenatal tobacco use and adverse birth outcomes, EC use remains an independent risk factor for neonatal complications and is not a safer alternative to CC smoking during pregnancy. Until further research is completed, all pregnant women are encouraged to abstain from all tobacco products including ECs.

Exposure-response analysis of the association of maternal smoking and use of electronic cigarettes (vaping) in relation to preterm birth and small-for-gestational-age in a national US sample, 2016-2018

“…3 One recent study by Kim and Oancea (2020) evaluated the association between vaping and pregnancy outcomes in the same data as we did. 9 However, our work has methodological advantages that shed additional light on the problem. First, we retained about 95% of all women in the 2016-2018 PRAMS and our final study sample included 89,908 non-users, 8,164 sole smokers, and 723 sole vapers during pregnancy, allowing us to apply weights of the PRAMS sampling scheme.…”

“…In contrast, Kim and Oancea discarded the majority of the initial PRAMS population due to inability to match on propensity scores, leaving only 28,939 non-users, 450 sole smokers, and 331 sole vapers in their final analytic dataset. 9 This compromised the generalizability of their results and leaves them more vulnerable to chance findings due to loss of power. Additionally, the proportion of dual users is substantial: 63% of vapers in our sample also smoked traditional cigarettes concurrently, and in a study using 2014-2017 NHIS data, 14 39% of pregnant women who smoked also used e-cigarettes concurrently.…”

“…Unfortunately, published analysis of the most comprehensive dataset able to inform the issue in the US excluded dual users. 9 Importantly, dual users are not a homogeneous group when it comes to relative exposures from smoking versus vaping, because they include both habitual heavy smokers who occasionally vape and vapers who only occasionally smoke. Due to the well-known dose-response relationship between smoking and the risks of fetal and neonatal morbidities, it is reasonable to examine whether the intensity of smoking and vaping relates to pregnancy outcomes in a manner consistent with exposure-response, one of the elements in evaluating causation.…”

Effects of E-Cigarette Exposure on Prenatal Life and Childhood Respiratory Health: A Review of Current Evidence

“…Dual users who continued using ENDS but stopped smoking cigarettes had an increased risk for SGA compared with non-tobacco users [3.2 (95% CI: 1.5, 6.6)] (19). Furthermore, data from 55,251 pregnant women who participated in the Phase 8 survey of the Pregnancy Risk Assessment Monitoring System between 2016 and 2018 confirmed that EC use cannot be considered a safer alternative to conventional cigarette (CC) smoking during pregnancy, as EC and CC users showed not significantly different risk on SGA, low birth weight and preterm birth (20). Lastly, with regard to the effects of the chemical components of e-vapors, they have not been thoroughly defined in human studies so far, but it has been suggested that certain populations, including pregnant women, could process PG differently to the general population, being prone to PG accumulation (21).…”

Hvor smart er det å tillate salg av e-sigaretter?

“…Effekten på svangerskapsutfall er sannsynligvis i stor grad knyttet til egenskaper ved nikotin og vil derfor vaere overførbart også til andre nikotinprodukter. Nylig er det vist i en stor befolkningsundersøkelse fra USA at e-sigaretter representerer en uavhengig risikofaktor for neonatale komplikasjoner og at det ikke er et trygt alternativ til røyketobakk i svangerskapet (15).…”