Stressful life events and electronic cigarette use during pregnancy

Smoking during pregnancy poses a significant health risk for infant well-being. Prior research has linked experiencing stressful life events (SLEs) during pregnancy to prenatal smoking. However, extant research has not assessed whether SLEs experienced during pregnancy are a risk factor for prenatal electronic cigarette use.

This study investigates the association between SLEs and electronic cigarette use during the third trimester of pregnancy.

We employ data on 70,626 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic and multinomial logistic regression models were used to examine the association between SLEs and electronic cigarette use during the third-trimester of pregnancy.

The prevalence of electronic cigarette use increased alongside an accumulating history of SLEs (0 SLEs = 0.4%; 1-2 SLEs = 0.9%; 3-5 SLEs = 1.9%; 6+ SLEs = 5.0%). Logistic regression models found 6 or more SLEs were associated with 4.7 times higher odds of electronic cigarette use relative to 0 SLEs after adjusting for demographic and socioeconomic characteristics (AOR = 4.705, 95% CI = 2.960, 7.479). Study findings also showed that women who experienced greater levels of SLEs had a higher prevalence of using any nicotine products (i.e., exclusive electronic cigarette user, exclusive cigarette user, dual user), relative to being a non-smoker. Findings from multinomial logistic regression models revealed that a higher number of SLEs was associated with an increased relative risk of all smoking outcomes. Still, these associations were particularly pronounced in the case of exclusive electronic cigarette user (ARR = 8.485, 95% CI = 4.900, 14.692) and dual-use (ARR = 8.348, 95% CI = 4.113, 16.945) when participants experienced 6 or more SLEs (relative to 0 SLEs).

Considering the potentially harmful ramifications of electronic cigarette use during pregnancy there is a need for interventions that reduce stressful experiences and decrease smoking during pregnancy.