Nicotine Use and Postpartum Depression: Comparison of E-Cigarette, Cigarette, and Dual Usage in Pregnancy

As e-cigarette use remains prevalent among women of reproductive age, understanding its implications for maternal mental health is increasingly important. Although research has found combustible cigarette use in pregnancy to be associated with a higher risk of maternal postpartum depressive symptoms, it is not clear whether risks are similar for those who use combustible and e-cigarettes simultaneously. This study examines the association between prenatal nicotine use (e-cigarette, combustible cigarette, and dual use) and postpartum depression symptoms. Additionally, we investigate maternal sociodemographic characteristics associated with use during pregnancy to inform public health interventions and policy.

Utilizing Phase 8 of the PRAMS survey, a national cross-sectional survey (N = 245,431), descriptive and χ² statistics examined associations among sociodemographic characteristics, maternal use practices, and birth complications. Multivariate logistic regressions examined associations between maternal use practices and postpartum depression symptoms.

E-cigarette and dual use in pregnancy was associated with greater odds of postpartum depression symptoms (odds ratio [OR] = 1.52 and 1.63, respectively) than combustible cigarettes alone (OR = 1.34). This relationship remained significant when accounting for relevant sociodemographic characteristics and prepartum depression (p< .001), which were also significant predictors in our model. Younger and less educated women were more likely to use e-cigarettes in pregnancy.

Women who utilize e-cigarettes in pregnancy may be at greater risk for developing postpartum depression. Findings underscore the need for targeted screening, prevention, and policy efforts to reduce prenatal nicotine exposure and address maternal mental health, particularly among those with less education.