Associations between vaping during pregnancy and perinatal outcomes: A systematic review and meta-analysis

Despite numerous studies linking prenatal vaping to adverse perinatal outcomes, a systematic assessment for critical comparison remains absent. To investigate these associations, we conducted a systematic search of studies assessing perinatal outcomes in mothers and/or neonates exposed to vaping during pregnancy compared to those in women without prenatal vaping exposure through MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, PROSPERO, and Google Scholar until July 5, 2024. We performed inverse-variance random-effects meta-analyses for maternal and neonatal outcomes of 23 studies with a total of 924,376 participants with 7552 reporting vaping-only use during pregnancy. Prenatal vaping was associated with 53 % higher odds of an adverse maternal outcome (OR: 1.53; 95 % CI: 1.27-1.85; I² = 80 %), particularly with decreased breastfeeding (OR: 0.53; 95 % CI: 0.38-0.72; I² = 45 %) and reduced prevalence of adequate prenatal care (OR: 0.69; 95 % CI: 0.56-0.86; I² = 82 %). Prenatal vaping was also associated with a similarly 53 % higher odds of an adverse neonatal outcome (OR: 1.53; 95 % CI: 1.34-1.76; I² = 45 %), such as low birth weight (OR: 1.56; 95 % CI: 1.28-1.93; I²: 15 %), preterm birth (OR: 1.49; 955 CI: 1.27-1.76; I²: 0 %), and small for gestational age (OR: 1.48; 955 CI: 1.16-1.89; I²: 70 %). This is the first comprehensive systematic review and meta-analysis demonstrating vaping during pregnancy as a risk factor for increased odds of both maternal and neonatal outcomes and underscores the urgency to address awareness and regulations of vaping and its potential harms to both humans and the environment. REGISTRATION: PROSPERO CRD42023446266.