Smoking abstinence in pregnancy more likely with e-cigarettes vs. nicotine replacement
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Key takeaways:
- E-cigarette use led to higher smoking abstinence vs. nicotine replacement therapy during pregnancy.
- E-cigarette initiation before pregnancy led to a higher abstinence rate vs. nicotine replacement therapy.
Pregnant women were more likely to abstain from smoking in late pregnancy with use of e-cigarettes compared with nicotine replacement, especially if e-cigarette use started before pregnancy, researchers reported in JAMA Network Open.
“The timing of initiation of e-cigarette use may be critical in the context of using these products as a smoking cessation aid because sufficient transition time is needed for some cigarette smokers to adjust to and overcome potential challenges,” Xiaozhong Wen, MD, PhD, associate professor of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at the State University of New York at Buffalo, and colleagues wrote. “Common challenges include perceived flaws of the e-cigarette technology, the taste and flavors, the sensation of vaping and the pricing. Initiation before pregnancy provides time to experiment with products and gain experience with using e-cigarettes prior to the dramatic physiologic changes that occur during pregnancy.”
Wen and colleagues conducted secondary analysis within phase 8 of the U.S. Pregnancy Risk Assessment Monitoring System (PRAMS) from 2016 to 2020. All 1,329 pregnant women (79.8% white) smoked combustible cigarettes within the 3 months before pregnancy and used e-cigarettes before pregnancy (n = 890), initiated e-cigarette use during pregnancy (n = 67) or used nicotine replacement therapy during pregnancy (n = 372).
The primary outcome was self-reported smoking abstinence status during the last 3 months of pregnancy.
Overall, 61.4% of women included in this study had a high school education or lower, and 81.5% had an annual household income of $48,000 or less. Women using e-cigarettes during pregnancy had a higher smoking abstinence rate in late pregnancy compared with women who used nicotine replacement therapy (50.8% vs. 19.4%; adjusted OR = 2.47; 95% CI, 1.17-5.2; P = .02).
In the secondary analysis where researchers stratified timing of e-cigarette initiation, women who initiated e-cigarette use before pregnancy had a higher smoking abstinence rate compared with nicotine replacement therapy users (53.1% vs. 19.4%; aOR = 2.61; 95% CI, 1.23-5.51; P = .01). Women who initiated e-cigarette use during their pregnancy had a similar smoking abstinence rate as those who started before becoming pregnant compared with nicotine replacement therapy users (20.6% vs. 19.4%; aOR = 1.13; 95% CI, 0.22-5.87; P = .88).
“These results from our observational research need to be interpreted cautiously and be confirmed in future randomized clinical trials to overcome the limitations of lack of data from most recent years, the incomplete exposure measures and residual confounding effects,” the researchers wrote. “Ultimately, e-cigarette products, if shown to have a lower health risk than combustible cigarette use during pregnancy, may support smoking cessation among pregnant individuals and lead to positive changes in clinical recommendations and public health policy.”