The Association Between Electronic Cigarette Use During Pregnancy and Unfavorable Birth Outcomes

Introduction and objective While the use of electronic cigarettes (e-cigarettes) continues to gain popularity amongst consumers, literature focusing on the safety and risks of e-cigarette usage remains scarce. Literature focused on the potential effects of e-cigarette use on fetal development is particularly limited. The objective of this study is to investigate the association between the use of e-cigarettes during pregnancy and unfavorable birth outcomes. Methods A retrospective cohort using secondary data analysis was conducted from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2017 Phase 8 survey. This database contains both state-specific and population-based information on maternal attitudes and experiences before, during, and shortly after pregnancy. Female participants in the study were initially found through each state's birth certificate file. Eligible women included those who have had a recent live birth. Data collection procedures and instruments were standardized to allow comparisons between states. The independent variable was self-reported use of any e-cigarette products during pregnancy. The dependent variable was dichotomized into the presence of at least one unfavorable birth outcome (preterm birth, low birth weight, or extended postnatal hospital stay for the newborn) or the absence of all. Binary logistic regression analysis was used to calculate adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI). Results A total of 71,940 women were included in our study. After adjusting for age, race, ethnicity, insurance, maternal education, prenatal care, physical abuse during pregnancy, and complications during pregnancy, the odds of unfavorable birth outcomes increase by 62% among women who reported e-cigarette use during pregnancy versus women who did not (aOR 1.62, 95%CI 1.16-2.26, p-value 0.005). Conclusions/implications Moving forward, it is imperative for consumers to understand the implications of using e-cigarettes, such as the increased risk of unfavorable birth outcomes associated with use during pregnancy. Moreover, healthcare providers, particularly obstetricians, should be encouraged to communicate this novel information to at-risk patients. Overall, researchers must continue to study the long-term effects of e-cigarettes, including those on fetal development, as there is still much to be uncovered.