E-cigarette use increases among pregnant adolescents

Key takeaways:

• The rate of e-cigarette use among teens in late pregnancy increased from 0.8% in 2016 to 4.1% in 2021.
• The rate of exclusive cigarette use in pregnancy fell by two-thirds.

The rate of e-cigarette use increased more than fivefold among adolescents in late pregnancy from 2016 to 2021, according to a study published in JAMA Network Open.

Whereas traditional tobacco cigarettes are largely recognized as a risk to developing fetuses and their mothers, e-cigarettes are “noncombustible and do not generate some of the toxic chemicals present in tobacco smoke, including carbon monoxide,” the researchers wrote.

“For this reason, some pregnant people who smoke cigarettes before pregnancy use e-cigarettes as a smoking cessation aid to reduce nicotine intake and/or to reduce harm to the fetus,” they wrote. “However, average nicotine delivery from e-cigarettes is comparable to that of combustible cigarettes.”

The researchers studied data from the Pregnancy Risk Assessment Monitoring System on e-cigarette or cigarette use among 10,428 adolescents aged 10 to 19 years with a singleton birth of a small-for-gestational-age (SGA) infant.

They found that the weighted prevalence of exclusive e-cigarette use during late pregnancy increased from 0.8% in 2016 to 4.1% in 2021, whereas the prevalence of exclusive cigarette use decreased from 9.2% in 2017 to 3.2% in 2021.

Use of both e-cigarettes and tobacco cigarettes fluctuated, with rates ranging from 0.6% to 1.6%.

White pregnant adolescents were more likely to use e-cigarettes than those who self-identified as another race or ethnicity (2.7% vs. 1% for American Indian or Alaska Native adolescents, 0.8% for Asian or other race adolescents, 0.6% for Black adolescents, and 0.7% for multiracial adolescents).

Compared with those who did not use either product, adolescents who exclusively used e-cigarettes (16.8% vs. 12.9%; confounder-adjusted OR = 1.68; 95% CI, 0.89-3.18) or who used cigarettes and e-cigarettes (17.6% vs. 12.9%; aOR = 1.68; 95% CI, 0.79-3.53) had no statistically significant difference in risk for SGA birth. Adolescents who exclusively used cigarettes had a more than twofold higher risk for SGA birth (24.6% vs. 12.9%; aOR = 2.51; 95% CI, 1.79-3.52)

“This finding was consistent with previous research showing that maternal cigarette use during pregnancy was a risk factor for SGA birth,” the authors wrote.

Unlike cigarette use, e-cigarette use during late pregnancy was not statistically significantly associated with an increased risk for SGA birth among adolescents. The authors said future research could benefit from a larger sample size.