Pre-pregnancy depression, prenatal care, and e-cigarette/cigarette use during late pregnancy among adolescents

Although robust evidence shows a link between depression and tobacco use among adolescents, little information exists concerning pregnant adolescents. As such, we examined: 1) the association between pre-pregnancy depression and e-cigarette/cigarette use during late pregnancy, and 2) whether prenatal care visit frequency moderates this association.

We analyzed data from 10 363 adolescents (ages 19 or younger) in the U.S. Pregnancy Risk Assessment Monitoring System (2016-2021), a national cross-sectional survey supplemented with birth certificates. Participants reported pre-pregnancy depression and e-cigarette and cigarette use in the last 3 months of pregnancy. Multivariable logistic regression models estimated 1) associations of depression with e-cigarette/cigarette use and 2) the interaction between depression and prenatal care visit frequency, adjusting for sociodemographic and pregnancy-related confounders.

Adolescents with pre-pregnancy depression were as likely to use e-cigarettes exclusively during late pregnancy as those without pre-pregnancy depression (3.21% vs. 1.66%; confounder-adjusted odds ratio [aOR], 1.33 [95% CI, 0.78-2.27]). However, those with pre-pregnancy depression were more likely to use cigarettes exclusively (12.72% vs. 4.81%; 1.94 [1.44-2.61]) or use both e-cigarettes and cigarettes (3.50% vs. 0.59%; 4.62 [2.18-9.81]) during late pregnancy. The association between pre-pregnancy depression and exclusive cigarette use was weaker (interaction p < 0.05) among adolescents with 9-11 prenatal care visits (1.38 [0.82-2.32]) and ≥ 12 prenatal care visits (1.77 [1.10-2.84]) compared to those with ≤8 prenatal care visits (3.86 [2.23-6.67]).

Pre-pregnancy depression was associated with cigarette smoking and dual use of e-cigarettes and cigarettes, but not exclusive e-cigarette use, in pregnant adolescents. Frequent prenatal care seemed to partially buffer the elevated risk of cigarette use associated with pre-pregnancy depression in this observational research.