E-cigarette use does not raise risk for small neonates among pregnant teens

Key takeaways:

• No significant difference in small for gestational age birth risk was observed between e-cigarette users and non-smokers.
• Cigarette users had double the risk for small for gestational age birth vs. non-smokers.

Among adolescents, e-cigarette use during late pregnancy was not statistically significantly associated with an increased small for gestational age birth risk, but cigarette use was, researchers reported in JAMA Network Open.

“E-cigarettes are noncombustible and do not generate some of the toxic chemicals present in tobacco smoke, including carbon monoxide. 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,” Xiaozhong Wen, MD, PhD, associate professor in the division of behavioral medicine, department of pediatrics, at the Jacobs School of Medicine and Biomedical Sciences at the State University of New York at Buffalo, and colleagues wrote. “However, average nicotine delivery from e-cigarettes is comparable to that of combustible cigarettes. In addition, despite being one to two orders of magnitude lower than levels from combustible cigarette products, trace levels of certain toxicants, including formaldehyde, acetaldehyde, nickel and lead, are present in e-cigarettes.”

Wen and colleagues conducted a cohort study with data from 10,428 pregnant adolescent females in the U.S. aged 10 to 19 years utilizing existing data from the 2016 to 2021 Pregnancy Risk Assessment Monitoring System. All adolescents had a singleton birth with complete data on e-cigarette or cigarette use and small for gestational age birth.

Researchers assessed adolescent reported e-cigarette and cigarette use during the last 3 months of pregnancy and the likelihood of small for gestational age births as determined via birth certificates.

Most adolescents included in this study were aged 18 to 19 years (72.7%) and self-identified as white (58.9%). From 2016 to 2021, the weighted prevalence of exclusive e-cigarette use during late pregnancy rose from 0.8% to 4.1%. The prevalence of exclusive cigarette use decreased from 9.2% in 2017 to 3.2% in 2021.

Researchers noted fluctuations in dual use of both e-cigarettes and cigarettes, ranging from 0.6% to 1.6%.

White pregnant adolescents were 2.7% more likely to use e-cigarettes compared with adolescents who self-identified as American Indian or Alaska Native (1%), Asian (0.8%), Black (0.6%) or multiracial (0.7%).

Researchers observed no statistically significant difference in small for gestational age birth risk between nonusers and those who used only e-cigarettes (16.8% vs. 12.9%; adjusted OR = 1.68; 95% CI, 0.89-3.18) or who used both e-cigarettes and cigarettes (17.6% vs. 12.9%; aOR = 1.68; 95% CI, 0.79-3.53).

Researchers observed a more than twofold higher risk for small for gestational age birth among pregnant adolescents who used only cigarettes compared with nonusers (24.6% vs. 12.9%; aOR = 2.51; 95% CI, 1.79-3.52).

“Exclusive e-cigarette use and dual use of cigarettes and e-cigarettes did not seem to be statistically significantly associated with small for gestational age birth in our analysis, but this finding should be interpreted with caution given the low prevalence of use and the limited sample size,” the researchers wrote. “Considering the uncertainty of this nonsignificant association, future research using a larger sample size may be beneficial.”