Joint and Independent Effects of E-cigarette and Traditional Cigarette Use on Preterm Birth among Women with a Recent Singleton Live Birth, PRAMS 2016-2017 Open Access

Prakash Asrani, Radhika (Spring 2020)

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Introduction: With the introduction of e-cigarettes in 2006, tobacco and nicotine use during pregnancy now includes both traditional cigarettes and e-cigarettes. While the association between traditional cigarette use and preterm birth is well established, little is known about the association between the use of e-cigarettes during pregnancy and preterm birth. The purpose of this study is to estimate the joint and independent effects of e-cigarette and traditional cigarette use  on preterm birth, using data from the 2016-17 Pregnancy Risk Assessment Monitoring System (PRAMS).

Methods: This study includes PRAMS respondents from all participating sites whose pregnancies resulted in a live singleton birth between 2016 and 2017 (n = 56,455). Both e-cigarette and traditional cigarette use in the last 3 months of pregnancy were ascertained via self-report, and preterm birth (live birth occurring prior to 37 completed weeks’ gestation) was ascertained via birth certificates. We estimated the independent and joint effects of both e-cigarettes and traditional cigarettes on preterm birth, while controlling for maternal demographic and pregnancy characteristics.

Results: The prevalence of both traditional and e-cigarettes in the last three months of pregnancy was low, with 7.6% of women reporting only using traditional cigarettes, 0.4% reporting only using e-cigarettes, and 0.7% of women reporting dual use of both e-cigarettes and traditional cigarettes. Women who exclusively used either e-cigarettes or traditional cigarettes had an increased prevalence of preterm birth compared to non-users, with prevalence ratios of 1.29 (95% CI: 0.77, 2.16) and 1.28 (95% CI: 1.08, 1.50), respectively. Dual users had a decreased prevalence of preterm birth compared to non-users (PR = 0.83 95% CI: 0.51, 1.34).

Conclusions: This study suggests that the effect of e-cigarette use on preterm birth is similar to that of traditional cigarette use, though the estimate for e-cigarettes is less precise due to a much smaller sample size. The finding that women who used both e-cigarettes and traditional cigarettes did not have an increased prevalence of preterm birth should be interpreted with caution as this might be due to bias. Healthcare providers should counsel pregnant patients on the risks of both traditional and e-cigarette use.

Table of Contents

Background 1

Introduction 7

Methods 9

Results 12

Discussion 15

Conclusion 18

Tables 19

References 21

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