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Ussher M, Fleming J, Brose L. Vaping during pregnancy: a systematic review of health outcomes. BMC Pregnancy Childbirth 2024; 24:435. [PMID: 38902658 PMCID: PMC11191278 DOI: 10.1186/s12884-024-06633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Smoking during pregnancy is harmful to maternal and child health. Vaping is used for smoking cessation but evidence on health effects during pregnancy is scarce. We conducted a systematic review of health outcomes of vaping during pregnancy. METHODS We searched six databases for maternal/fetal/infant outcomes and vaping, including quantitative, English language, human studies of vaping during pregnancy, to November 10th, 2023. We assessed study quality with the Mixed-Methods Appraisal Tool. We focused on comparisons of exclusive-vaping with non-use of nicotine and tobacco products and with smoking. Presentation is narrative as the studies were of insufficient quality to conduct meta-analysis. RESULTS We included 26 studies, with 765,527 women, with one randomised controlled trial (RCT) comparing vaping and nicotine replacement therapy for smoking cessation, 23 cohort studies and two case-control studies. While the RCT met 4/5 quality criteria, the quality of the cohort studies and case-control studies was poor; none adequately assessed exposure to smoking and vaping. For studies comparing exclusive-vaping with 'non-use', more reported no increased risk for vaping (three studies) than reported increased risk for maternal pregnancy/postpartum outcomes (one study) and for fetal and infant outcomes (20 studies no increased risk, four increased risk), except for birth-weight and neurological outcomes where two studies each observed increased and no increased risk. When the RCT compared non-users with those not smoking but vaping or using NRT, irrespective of randomisation, they reported no evidence of risk for vaping/NRT. For studies comparing exclusive-vaping and exclusive-smoking, most studies provided evidence for a comparable risk for different outcomes. One maternal biomarker study revealed a lower risk for vaping. For small-for-gestational-age/mean-birth-centile equal numbers of studies found lower risk for vaping than for smoking as found similar risk for the two groups (two each). CONCLUSIONS While more studies found no evidence of increased risk of exclusive-vaping compared with non-use and evidence of comparable risk for exclusive-vaping and exclusive-smoking, the quality of the evidence limits conclusions. Without adequate assessment of exposure to vaping and smoking, findings cannot be attributed to behaviour as many who vape will have smoked and many who vape may do so at low levels. STUDY REGISTRATION https://osf.io/rfx4q/ .
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Affiliation(s)
- Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK.
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK.
| | - Joy Fleming
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK
| | - Leonie Brose
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8BB, UK
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Daiber A, Kuntic M, Oelze M, Hahad O, Münzel T. E-cigarette effects on vascular function in animals and humans. Pflugers Arch 2023:10.1007/s00424-023-02813-z. [PMID: 37084087 DOI: 10.1007/s00424-023-02813-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
Smoking tobacco cigarettes is a significant (cardiovascular) health risk factor. Although the number of tobacco cigarette users declined over the last decades, shisha smoking and e-cigarette vaping partially compensated for this health benefit. E-cigarettes may create highly addicted dual users (vaping and smoking). E-cigarettes seem not to represent a healthier alternative to tobacco smoking, although they may be less harmful. E-cigarette vaping causes oxidative stress, inflammation, endothelial dysfunction, and associated cardiovascular sequelae. This is primarily due to a significant overlap of toxic compounds in the vapor compared to tobacco smoke and, accordingly, a substantial overlap of pathomechanistic features between vaping and smoking. Whereas the main toxins in vapor are reactive aldehydes such as formaldehyde and acrolein, the toxic mixture in smoke is more complex, comprising particulate matter, reactive gases, transition metals, volatile organic compounds, and N-nitrosamines. However, it seems that both lifestyle drugs impair endothelial function to a quite similar extent, which may be due to the role of oxidative stress as the central pathomechanism to mediate endothelial dysfunction and vascular damage. Finally, the main selling argument for e-cigarette use that they help to quit smoking and get rid of nicotine addiction may be false because it seems that e-cigarettes instead trigger the opposite-younger entrance age and more frequent use. With our review, we summarize the adverse health impact of tobacco cigarettes and e-cigarettes, emphasizing the detrimental effects on endothelial function and cardiovascular health.
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Affiliation(s)
- Andreas Daiber
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany.
| | - Marin Kuntic
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany
| | - Matthias Oelze
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Omar Hahad
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany.
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Nanninga EK, Weiland S, Berger MY, Feijen-de Jong EI, Erwich JJHM, Peters LL. Adverse Maternal and Infant Outcomes of Women Who Differ in Smoking Status: E-Cigarette and Tobacco Cigarette Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032632. [PMID: 36768007 PMCID: PMC9915204 DOI: 10.3390/ijerph20032632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 05/12/2023]
Abstract
The electronic cigarette (e-cigarette) became commercially available around 2004, yet the characteristics of pregnant women who use these devices and their effects on maternal and infant health remain largely unknown. This study aimed to investigate maternal characteristics and pregnancy outcomes according to maternal smoking status. We conducted a cross-sectional study of Dutch women with reported pregnancies between February 2019 and May 2022, using an online questionnaire to collect data on smoking status and demographic, lifestyle, pregnancy, and infant characteristics. Smoking status is compared among non-smokers, tobacco cigarette users, e-cigarette users, and dual users (tobacco and e-cigarette). We report descriptive statistics and calculate differences in smoking status between women with the chi-square or Fisher (Freeman-Halton) test. Of the 1937 included women, 88.1% were non-smokers, 10.8% were tobacco cigarette users, 0.5% were e-cigarette users, and 0.6% were dual users. Compared with tobacco users, e-cigarette users more often reported higher education, having a partner, primiparity, and miscarriages. Notably, women who used e-cigarettes more often had small infants for gestational age. Despite including few women in the e-cigarette subgroup, these exploratory results indicate the need for more research to examine the impact of e-cigarettes on pregnancy outcomes.
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Affiliation(s)
- Eline K. Nanninga
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Stella Weiland
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Dirk Huizingastraat 3-5, 9713 GL Groningen, The Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Marjolein Y. Berger
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Esther I. Feijen-de Jong
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Dirk Huizingastraat 3-5, 9713 GL Groningen, The Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jan Jaap H. M. Erwich
- Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Lilian L. Peters
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Dirk Huizingastraat 3-5, 9713 GL Groningen, The Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Correspondence:
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Wang X, Lee NL, Burstyn I. Exposure-response analysis of the association of maternal smoking and use of electronic cigarettes (vaping) in relation to preterm birth and small-for-gestational-age in a national US sample, 2016-2018. GLOBAL EPIDEMIOLOGY 2022; 4:100079. [PMID: 37637017 PMCID: PMC10446111 DOI: 10.1016/j.gloepi.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The US experienced a surge in use of e-cigarettes. Smoking women may consider e-cigarettes during pregnancy as an alternative to smoking. E-cigarettes typically contain nicotine, an established cause of reduction in fetal growth in animal studies. Methods This cohort study included 99,201 mothers who delivered live singletons in 2016-2018 from the Pregnancy Risk Assessment Monitoring System. We created exposure categories based on self-reported number of cigarettes smoked per day and vaping frequency and evaluated their associations with preterm birth and small-for-gestational-age (SGA) birth (two established cigarette smoking-related risks). Results Dual users in late pregnancy were a heterogeneous group: 29% lightly smoked and occasionally vaped; 19% lightly smoked and frequently vaped; 36% heavily smoked and occasionally vaped; and 15% heavily smoked and frequently vaped. While dual users who heavily smoked and occasionally vaped had the highest adjusted OR for SGA (3.4, 95% CI 2.0, 5.7), all the dual users had, on average, about twice the odds of having SGA than non-users. While the risks of preterm birth were higher among sole light smokers (adjusted OR 1.3, 95% CI 1.1, 1.5) and sole heavy smokers (adjusted OR 1.5. 95% CI 1.2, 1.8) than non-users, the adjusted odds of preterm birth for dual users were not noticeably higher than those of non-users. Conclusion Relative to non-users, both smoking and vaping during pregnancy appear to increase risk of SGA, but excess risk of preterm birth appears to be primarily attributable to smoking alone. Higher levels of exposure tended to confer more risk.
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Affiliation(s)
- Xi Wang
- PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA
| | - Nora L. Lee
- Department of Epidemiology and Biostatistics, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
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Pisinger C, Rasmussen SKB. The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013687. [PMID: 36294263 PMCID: PMC9603628 DOI: 10.3390/ijerph192013687] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND A high prevalence of dual use of e-cigarettes and conventional cigarettes has been reported across the world. METHODS A systematic search was carried out. We included original articles on any topic relevant to health, excluding mental health, in all languages. The PRISMA guidelines were followed. Both reviewers independently screened and read all publications. We compared dual use with exclusive smoking of conventional cigarettes (ESCC). RESULTS Fifty-two publications (49 studies) were included. Thirteen papers/10 studies were prospective. There was great heterogeneity across studies. Many methodological weaknesses, such as inaccurate exposure measurement, lack of adjustment for former tobacco consumption, and lack of significance testing were identified. Most prospective studies found dual use to be at least as harmful as ESCC. The longest follow-up was six years. Most of the best available cross-sectional studies found dual use associated with the same and, in several studies, significantly higher risk of self-reported symptoms/disease than in ESCC. The intensity of cigarette smoking seems associated with worse health. CONCLUSION Existing studies indicate that dual use is at least as, or probably even more, harmful than ESCC. Due to the predominance of cross-sectional studies and the methodological weaknesses we judged the overall certainty of the evidence as "low certainty".
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, 2400 Copenhagen, Denmark
- Danish Heart Foundation, 1120 Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Sofie K. Bergman Rasmussen
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, 2400 Copenhagen, Denmark
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Shittu AAT, Kumar BP, Okafor U, Berkelhamer SK, Goniewicz ML, Wen X. Changes in e-cigarette and cigarette use during pregnancy and their association with small-for-gestational-age birth. Am J Obstet Gynecol 2022; 226:730.e1-730.e10. [PMID: 34864040 DOI: 10.1016/j.ajog.2021.11.1354] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/11/2021] [Accepted: 11/18/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite increased e-cigarette use, limited research has focused on changes in e-cigarette and combustible cigarette use around pregnancy and the subsequent effects on infant health. OBJECTIVE This study aimed to characterize changes in e-cigarette and cigarette use from before to during pregnancy and examine their associations with small-for-gestational-age birth. STUDY DESIGN This was a secondary data analysis of 2016-2018 data of the US Pregnancy Risk Assessment Monitoring System. We analyzed women aged ≥18 years who had a recent live birth (unweighted: n=105,438; weighted: n=5,446,900). Women were grouped on the basis of their self-reported e-cigarette and/or cigarette use 3 months before pregnancy (exclusive e-cigarette users, exclusive cigarette smokers, dual users, and nonusers) and change in e-cigarette and cigarette use during pregnancy (continuing use, quitting, switching, and initiating use). Small-for-gestational-age was defined as a birthweight below the 10th percentile for infants of the same sex and gestational age. We described the distributions of women's sociodemographic and pregnancy characteristics in both weighted and unweighted samples. We used multivariable log-binomial regression models to estimate the relative risks for the associations between changes in e-cigarette and cigarette use during pregnancy and risk of small-for-gestational-age, adjusting for significant covariates. RESULTS The rates of cessation during pregnancy were the highest among exclusive e-cigarette users (weighted percentage, 80.7% [49,378/61,173]), followed by exclusive cigarette users (54.4% [421,094/773,586]) and dual users (46.4% [69,136/149,152]). Among exclusive e-cigarette users, continued users of e-cigarettes during pregnancy had a higher risk of small-for-gestational-age than nonusers (16.5% [1849/11,206]) vs 8.8% [384,338/4,371,664]; confounder-adjusted relative risk, 1.52 [95% confidence interval, 1.45-1.60]), whereas quitters of e-cigarettes had a similar risk of small-for-gestational-age with nonusers (7.7% [3730/48,587] vs 8.8% [384,338/4,371,664]; relative risk, 0.84 [95% confidence interval, 0.82-0.87]). Among exclusive cigarette users, those who completely switched to e-cigarettes during pregnancy also had a similar risk of small-for-gestational-age with nonusers (7.6% [259/3412] vs 8.8% [384,338/4,371,664]; relative risk, 0.83 [95% confidence interval, 0.73-0.93]). Among dual users before pregnancy, the risk of small-for-gestational-age decreased from 23.2% (7240/31,208) (relative risk, 2.53 [95% confidence interval, 2.47-2.58]) if continuing use to 16.9% (6617/39,142) (relative risk, 1.88 [95% confidence interval, 1.83-1.92]) if only quitting e-cigarettes or 15.1% (1254/8289) (relative risk, 1.61 [95% confidence interval, 1.52-1.70]) if only quitting cigarettes and further to 11.2% (7589/67,880) (relative risk, 1.23 [95% confidence interval, 1.20-1.25]) if both quitting e-cigarettes and cigarettes during pregnancy, compared with nonusers. CONCLUSION Among exclusive e-cigarette users, quitting e-cigarettes during pregnancy normalized the risk of small-for-gestational-age. Among exclusive cigarette users, quitting smoking or completely switching to e-cigarettes normalized small for gestational age risk. Among dual users, smoking cessation has a greater effect than quitting e-cigarettes only, although discontinuing the use of both may lead to the greatest reduction in the risk of small-for-gestational-age.
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Coleman SRM, Bunn JY, Nighbor TD, Kurti AN, Bolívar HA, Tyndale RF, Higgins ST. Use of electronic nicotine delivery systems (ENDS) among U.S. women of reproductive age: Prevalence, reported reasons for use, and toxin exposure. Prev Med 2021; 152:106582. [PMID: 33930436 PMCID: PMC8545704 DOI: 10.1016/j.ypmed.2021.106582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Given the rapidly expanding marketplace for Electronic Nicotine Delivery Systems (ENDS), it is important to monitor patterns of use, particularly among vulnerable populations. This study examined ENDS prevalence, reasons for use (i.e., to help quit smoking and for appealing flavors), and toxin exposure among U.S. women of reproductive age using data from the Population Assessment of Tobacco and Health (PATH) Study (2013-17). Exclusive ENDS users, dual users of ENDS and cigarettes, and exclusive cigarette smokers were compared within and between pregnant and not-pregnant women. Among pregnant women, prevalence of exclusive ENDS and dual use was similar (0.8%; 95%CI = 0.4-1.2% vs. 1.4%; 95%CI = 0.9-2.0%, respectively), but exclusive ENDS use was less prevalent than dual use among not-pregnant women (1.1%; 95%CI = 0.9-1.4% vs. 3.7%; 95%CI = 3.3-4.0%, respectively). Most women reported ENDs were used to help quit smoking (66.5-90.0%) and for appealing flavors (57.6-87.4%), and endorsement rates did not differ by use pattern or pregnancy status. Except for metals, toxin exposure was substantially lower for exclusive ENDS users relative to dual users and exclusive cigarette smokers regardless of pregnancy status. Pregnant and not-pregnant U.S. women regularly report using ENDS for help with quitting smoking and for appealing flavors. Although no type or pattern of tobacco/nicotine use is safe, especially during pregnancy, using ENDS exclusively is consistent with lower overall toxin exposure for pregnant and not-pregnant women. This study advances understanding of ENDS use and toxin exposure in women of reproductive age, a population highly vulnerable to the effects of nicotine/tobacco consumption.
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Affiliation(s)
- Sulamunn R M Coleman
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America.
| | - Janice Y Bunn
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, University of Vermont, United States of America
| | - Allison N Kurti
- Vermont Center on Behavior and Health, University of Vermont, United States of America
| | - Hypatia A Bolívar
- Department of Psychology, University of Illinois Springfield, United States of America
| | - Rachel F Tyndale
- Centre for Addiction and Mental Health, Departments of Pharmacology & Toxicology, and Psychiatry, University of Toronto, Canada
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America; Department of Psychological Science, University of Vermont, United States of America
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DeVito EE, Fagle T, Allen AM, Pang RD, Petersen N, Smith PH, Weinberger AH. Electronic Nicotine Delivery Systems (ENDS) Use and Pregnancy II: Perinatal Outcomes Following ENDS Use During Pregnancy. CURRENT ADDICTION REPORTS 2021; 8:366-379. [PMID: 35368552 PMCID: PMC8974704 DOI: 10.1007/s40429-021-00381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
Purpose of Review This review examines the risk of adverse perinatal outcomes following electronic nicotine delivery system (ENDS) use during pregnancy, and considers whether there are sufficient data to support ENDS as a harm reduction approach during pregnancy. Recent Findings Seven papers assessed perinatal outcomes following ENDS use during pregnancy. There was evidence that ENDS use was associated with increased risk for some adverse perinatal outcomes (e.g., small for gestational age). However, the repeated use of data sets, insufficient data (e.g., timing of ENDS use, type of ENDS products used), and limited samples size, contributed to mixed findings on the degree to which ENDS use (alone or in combination with combustible cigarettes (CC)) impacts the risk of adverse perinatal outcomes relative to CC smoking alone. Summary The current data are still insufficient to support ENDS as a harm reduction approach, though findings do warrant concern and more detailed investigation of ENDS use during pregnancy. Future research directions, as well as implications for clinical recommendations and tobacco regulatory science are discussed.
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Affiliation(s)
- Elise E. DeVito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Tessa Fagle
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Alicia M. Allen
- Department of Family and Community Medicine, College of Medicine – Tucson, University of Arizona, Tucson, AZ, USA
| | - Raina D. Pang
- Department of Preventative Medicine, Keck School of Medicine of USC, and Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Nicole Petersen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philip H. Smith
- Department of Kinesiology, Nutrition and Health, College of Education, Health and Society, Miami University, Oxford, OH, USA
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University and Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Calder R, Gant E, Bauld L, McNeill A, Robson D, Brose LS. Vaping in Pregnancy: A Systematic Review. Nicotine Tob Res 2021; 23:1451-1458. [PMID: 33538828 PMCID: PMC8372638 DOI: 10.1093/ntr/ntab017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/26/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Smoking in pregnancy increases the risk of negative health outcomes. Vaping can be effective for smoking cessation in nonpregnant populations. We conducted a systematic review of vaping in pregnancy, covering prevalence, patterns of use, reasons for use, smoking cessation, and health effects. METHODS Five academic databases were searched on 17 February 2020. Studies reporting prevalence, patterns, reasons, cessation, or health effects of vaping in pregnancy were included; animal and in vitro studies were excluded. A narrative review was used, with risk of bias assessed using Hoy and colleague's tool, the Newcastle-Ottawa scale, and the Consolidated Criteria for reporting Qualitative Research. RESULTS Twenty-three studies were identified: 11 survey, 7 qualitative, 3 cohort, and 2 secondary analyses of randomized clinical trials. Prevalence of vaping in pregnancy (four studies) was between 1.2% and 7.0% overall, and <1% among nonsmokers. Twelve studies reported patterns of use, but findings were inconsistent. Twelve of 14 studies asking why pregnant women vaped reported that most vaped to reduce or quit smoking. Mixed findings were reported from six studies on smoking cessation. Of three studies with health-related outcomes, two were underpowered and one reported similar birthweights for babies born to nonsmokers and women who vaped, with both higher (p < .0001) than the birthweight of babies born to smokers. CONCLUSIONS There were insufficient data to draw conclusions about prevalence, patterns, and effects of vaping in pregnancy on smoking cessation. The limited literature suggests that vaping in pregnancy has little or no effect on birthweight. IMPLICATIONS Smoking causes many negative health outcomes for pregnant women and to babies born to people who smoke. There remains a paucity of research on the effects of vaping in pregnancy. There is, however, the potential for vaping products to reduce the negative health outcomes associated with smoking. More research is needed to develop an evidence base in this area.
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Affiliation(s)
- Robert Calder
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Eleanor Gant
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Debbie Robson
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Leonie S Brose
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
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Opondo C, Harrison S, Alderdice F, Carson C, Quigley MA. Electronic cigarette use (vaping) and patterns of tobacco cigarette smoking in pregnancy-evidence from a population-based maternity survey in England. PLoS One 2021; 16:e0252817. [PMID: 34086809 PMCID: PMC8177470 DOI: 10.1371/journal.pone.0252817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Exposure to tobacco products during pregnancy presents a potential harm to both mother and baby. This study sought to estimate the prevalence of vaping during pregnancy and to explore the factors and outcomes associated with vaping in pregnancy. SETTING England. PARTICIPANTS Women who gave birth between 15th and 28th October 2017. METHODS A cross-sectional population-based postal survey of maternal and infant health, the National Maternity Survey (NMS) 2018. The prevalence of vaping and patterns of cigarette smoking were estimated, and regression analysis was used to explore associations between maternal characteristics and vaping, and between vaping and birth outcomes. OUTCOME MEASURES Unweighted and weighted prevalence of vaping with 95% confidence intervals, and unadjusted and adjusted relative risks or difference in means for the association of participant characteristics and secondary outcomes with vaping. Secondary outcome measures were: preterm birth, gestational age at birth, birthweight, and initiation and duration of breastfeeding. RESULTS A total of 4,509 women responded to the survey. The prevalence of vaping in pregnancy was 2.8% (95%CI 2.4% to 3.4%). This varied according to the pattern of cigarette smoking in pregnancy: 0.3% in never-smokers; 3.3% in ex-smokers; 7.7% in pregnancy-inspired quitters; 9.5% in temporary quitters; and 17.7% in persistent smokers. Younger women, unmarried women, women with fewer years of formal education, women living with a smoker, and persistent smokers were more likely to vape, although after adjusting for pattern of cigarette smoking and maternal characteristics, persistent smoking was the only risk factor. We did not find any association between vaping and preterm birth, birthweight, or breastfeeding. CONCLUSIONS The prevalence of vaping during pregnancy in the NMS 2018 was low overall but much higher in smokers. Smoking was the factor most strongly associated with vaping. Co-occurrence of vaping with persistent smoking has the potential to increase the harms of tobacco exposure in pregnant women and their infants.
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Affiliation(s)
- Charles Opondo
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Siân Harrison
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Fiona Alderdice
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Claire Carson
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
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Bowker K, Lewis S, Phillips L, Orton S, Ussher M, Naughton F, Bauld L, Coleman T, Sinclair L, McRobbie H, Khan A, Cooper S. Pregnant women's use of e-cigarettes in the UK: a cross-sectional survey. BJOG 2021; 128:984-993. [PMID: 33012050 DOI: 10.1111/1471-0528.16553] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate prevalence of vaping in pregnancy. Compare characteristics and attitudes between exclusive smokers and vapers, and between exclusive vapers and dual users (smoke and vape). DESIGN Cross-sectional survey. SETTING Hospitals across England and Scotland. POPULATION Pregnant women attending antenatal clinics in 2017. METHODS Women at 8-24 weeks' gestation completed screening questions about their smoking and vaping. Current or recent ex-smokers and/or vapers completed a full detailed survey about vaping and smoking. MAIN OUTCOME MEASURES The prevalence of vaping, characteristics and attitudes of women who vape and/or smoke. RESULTS Of 3360 pregnant women who completed screening questions, 515 (15.3%, 95% CI 14.1-16.6) were exclusive smokers, 44 (1.3%, 95% CI 1.0-1.8) exclusive vapers and 118 (3.5%, 95% CI 2.9-4.2) dual users. In total, 867 (25.8%) women completed the full survey; compared with smokers (n = 434), vapers (n = 140) were more likely to hold higher educational qualifications (odds ratio [OR) 1.51, 95% CI 1.01-2.25). Compared with exclusive vapers (n = 33), dual users (n = 107) were younger (OR 0.91 95% CI 0.85-0.98) and less likely to hold high qualifications (OR 0.43, 95% CI 0.20-0.96). Compared with smokers, dual users were more likely to be planning to quit smoking (OR 2.27, 95% CI 1.24-4.18). Compared with smokers, vapers were more likely to think vaping was safer than smoking (78.6% versus 36.4%). CONCLUSIONS One in 20 pregnant women report vaping, and most also smoke. Dual users are more motivated towards stopping smoking than smokers. Where women have tried but cannot stop smoking, clinicians could encourage them to consider vaping for smoking cessation. TWEETABLE EXTRACT One in 20 women report vaping during pregnancy but of those that do vape, most also smoke, despite having intentions to quit.
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Affiliation(s)
- K Bowker
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Lewis
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - L Phillips
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Orton
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - M Ussher
- Population Health Research Institute, St George's, University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - F Naughton
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - L Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - T Coleman
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - L Sinclair
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - H McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - A Khan
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Cooper
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
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12
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Ishizaki A, Kataoka H. Online In-Tube Solid-Phase Microextraction Coupled to Liquid Chromatography-Tandem Mass Spectrometry for the Determination of Tobacco-Specific Nitrosamines in Hair Samples. Molecules 2021; 26:2056. [PMID: 33916743 PMCID: PMC8038370 DOI: 10.3390/molecules26072056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
Active and passive smoking are serious public health concerns Assessment of tobacco smoke exposure using effective biomarkers is needed. In this study, we developed a simultaneous determination method of five tobacco-specific nitrosamines (TSNAs) in hair by online in-tube solid-phase microextraction (SPME) coupled to liquid chromatography-tandem mass spectrometry (LC-MS/MS). TSNAs were extracted and concentrated on Supel-Q PLOT capillary by in-tube SPME and separated and detected within 5 min by LC-MS/MS using Capcell Pak C18 MGIII column and positive ion mode multiple reaction monitoring systems. These operations were fully automated by an online program. The calibration curves of TSNAs showed good linearity in the range of 0.5-1000 pg mL-1 using their stable isotope-labeled internal standards. Moreover, the limits of detection (S/N = 3) of TSNAs were in the range of 0.02-1.14 pg mL-1, and intra-day and inter-day precisions were below 7.3% and 9.2% (n = 5), respectively. The developed method is highly sensitive and specific and can easily measure TSNA levels using 5 mg hair samples. This method was used to assess long-term exposure levels to tobacco smoke in smokers and non-smokers.
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Affiliation(s)
| | - Hiroyuki Kataoka
- School of Pharmacy, Shujitsu University, Nishigawara, Okayama 703-8516, Japan;
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13
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Hunter A, Yargawa J, Notley C, Ussher M, Bobak A, Murray RL, Nath S, Cooper S. Healthcare Professionals' Beliefs, Attitudes, Knowledge, and Behavior Around Vaping in Pregnancy and Postpartum: A Qualitative Study. Nicotine Tob Res 2021; 23:471-478. [PMID: 32621745 PMCID: PMC7885779 DOI: 10.1093/ntr/ntaa126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/02/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Finding effective ways to help pregnant women quit smoking and maintain long-term abstinence is a public health priority. Electronic cigarettes (ie, vaping) could be a suitable cessation tool in pregnancy for those who struggle to quit; however, healthcare professionals (HCP) must be informed about these devices to offer appropriate advice. This study used the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Theoretical Domains Framework (TDF) to explore HCP attitudes towards vaping in pregnancy and postpartum; beliefs about the health risks of vaping; perceived barriers and facilitators of vaping in pregnancy; knowledge of current guidelines and policies; and training needs. METHODS Interviews (n = 60) were conducted with midwives (n = 17), health visitors (n = 10), general practitioners (n = 15) and stop smoking specialists (n = 18) across the United Kingdom. Interview transcriptions were analyzed thematically using the framework approach and the COM-B. RESULTS Discussing vaping as a tool for quitting smoking in pregnancy was prevented by a lack of capability (limited knowledge of vaping, lack of training in smoking cessation); lack of opportunity (restricted by organizational policies and guidelines, lack of time and financial issues impacting on training), and negative social influences (sensationalist media and stigma associated with vaping in pregnancy); and lack of motivation (fear of future litigation and comebacks should adverse effects from vaping arise). CONCLUSIONS Factors related to capability, opportunity, and motivation were identified that influence HCPs attitudes and behaviors towards vaping in pregnancy. Gaps in knowledge and training needs were identified, which could inform the development of targeted vaping training. IMPLICATIONS Vaping could be suitable in pregnancy for those struggling to quit smoking. However, HCPs must be informed about these devices to offer appropriate advice. These data extend our knowledge of factors influencing HCP attitudes and behaviors towards vaping in pregnancy. Generally, vaping was perceived as safer than cigarettes, but a perceived lack of evidence, health and safety risks, dependency, and regulation issues were concerning. Considering our findings, greater efforts are needed to ensure HCPs are sufficiently informed about vaping and guidelines available. More importance should be placed on training for all HCPs who have contact with pregnant women.
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Affiliation(s)
- Abby Hunter
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Judith Yargawa
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Caitlin Notley
- Addiction Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Michael Ussher
- Institute of Social Marketing and Health, University of Stirling, Stirling and Population Health Research Institute, St George’s, University of London, London, UK
| | - Alex Bobak
- Alex Bobak, GP Specialist in Smoking Cessation, Wandsworth Medical Centre, London, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Srabani Nath
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, University Park, Nottingham, UK
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14
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Ford A, Uny I, Lowes J, Naughton F, Cooper S, Coleman T, Hajek P, Przulj D, Myers Smith K, Bauld L, Sinclair L, Walton R, Clark M, Ussher M. A Qualitative Study of Factors Influencing Adherence among Pregnant Women Taking Part in a Trial of E-Cigarettes for Smoking Cessation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E430. [PMID: 33430407 PMCID: PMC7827544 DOI: 10.3390/ijerph18020430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
Use of e-cigarettes (vaping) has potential to help pregnant women stop smoking. This study explored factors influencing adherence among participants in the vaping arm of the first trial of vaping for smoking cessation in pregnancy. We conducted semi-structured telephone interviews (n = 28) with women at three-months postpartum. Interviews were analysed using thematic analysis, informed by the Theoretical-Domains Framework, Necessity-Concerns Framework and Perceptions and Practicalities Approach. Interviewees generally reported high levels of vaping. We found that: (1) intervention adherence was driven by four necessity beliefs-stopping smoking for the baby, and vaping for harm reduction, smoking cessation or as a last resort; (2) necessity beliefs outweighed vaping concerns, such as dependence and safety; (3) adherence was linked to four practicalities themes, acting as barriers and facilitators to vaping-device and e-liquid perceptions, resources and support, whether vaping became habitual, and social and environmental factors; and (4) intentional non-adherence was rare; unintentional non-adherence was due to device failures, forgetting to vape, and personal circumstances and stress. Pregnant smokers provided with e-cigarettes, and with generally high levels of vaping, had positive beliefs about the necessity of vaping for smoking cessation which outweighed concerns about vaping. Non-adherence was mainly due to unintentional factors.
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Affiliation(s)
- Allison Ford
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK; (I.U.); (J.L.); (M.U.)
| | - Isabelle Uny
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK; (I.U.); (J.L.); (M.U.)
| | - Judith Lowes
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK; (I.U.); (J.L.); (M.U.)
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (T.C.); (M.C.)
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (T.C.); (M.C.)
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; (P.H.); (D.P.); (K.M.S.); (R.W.)
| | - Dunja Przulj
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; (P.H.); (D.P.); (K.M.S.); (R.W.)
| | - Katie Myers Smith
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; (P.H.); (D.P.); (K.M.S.); (R.W.)
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK; (L.B.); (L.S.)
| | - Lesley Sinclair
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK; (L.B.); (L.S.)
| | - Robert Walton
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; (P.H.); (D.P.); (K.M.S.); (R.W.)
| | - Miranda Clark
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (T.C.); (M.C.)
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK; (I.U.); (J.L.); (M.U.)
- Population Health Research Institute, St George’s University of London, London SW17 ORE, UK
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15
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Mescolo F, Ferrante G, La Grutta S. Effects of E-Cigarette Exposure on Prenatal Life and Childhood Respiratory Health: A Review of Current Evidence. Front Pediatr 2021; 9:711573. [PMID: 34513764 PMCID: PMC8430837 DOI: 10.3389/fped.2021.711573] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/30/2021] [Indexed: 01/23/2023] Open
Abstract
In the last decade, widespread use of E-cigarettes (EC) has occurred all over the world. Whereas, a large amount of evidence on harm to children from conventional cigarette exposure is available, data on health effects in this population throughout different vulnerability windows are still a matter of concern. Exposure to EC during pregnancy may compromise placental function, resulting in fetal structural abnormalities. Specifically, this may cause physio-pathologic changes in the developing lung, which in turn may impair respiratory health later in life. Furthermore, there is evidence that using EC can cause both short- and long-term respiratory problems in the pediatric population and there is great concern for future young people with nicotine addiction. The low parental perception of the risks connected to EC exposure for children increases their susceptibility to harmful effects from passive vaping. This minireview aims to summarize the current evidence focusing on: (i) prenatal effects of EC passive exposure; (ii) post-natal respiratory effects of EC exposure in youth; (iii) parental attitudes toward EC use and perception of children's health risks connected to EC exposure; and (iv) addressing gaps in our current evidence.
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Affiliation(s)
- Federica Mescolo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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16
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Nagpal TS, Green CR, Cook JL. Vaping During Pregnancy: What Are the Potential Health Outcomes and Perceptions Pregnant Women Have? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:219-226. [PMID: 33187893 DOI: 10.1016/j.jogc.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022]
Abstract
The prevalence of electronic nicotine delivery systems, such as vaping, is a growing public health concern, and there is limited information on the use of these devices during pregnancy. The objective of this rapid review was to summarize the available literature on human studies of the potential maternal or fetal health effects of vaping or women's perceptions of vaping during pregnancy. A systematic search was completed in the following databases: Medline, EMBASE, Scopus, Web of Science, and CINAHL. A search strategy was developed combining the terms pregnancy and vaping. Findings were divided into two groups and summarized as: 1) Health outcomes following vaping during pregnancy; and 2) Perceptions pregnant women have related to vaping during pregnancy. A total of 760 articles were retrieved and, after applying the inclusion/exclusion criteria and screening, 19 studies were included. Five included studies provided evidence on potential health outcomes and 14 were focused on perceptions. There is emerging evidence that vaping during pregnancy may increase the risk of small for gestational age newborns. Pregnant women generally report that they used vaping products during pregnancy for smoking cessation and perceived that this was a healthier alternative to traditional cigarettes. Overall, there was consensus that there is a lack of information on maternal and fetal health outcomes following vaping during pregnancy. Based on the findings of this rapid review, there is an urgent need for high-quality studies in pregnant women to evaluate the potential in utero and long-term effects of exposure to prenatal vaping.
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Affiliation(s)
- Taniya S Nagpal
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON; Department of Human Kinetics, University of Ottawa, Ottawa, ON.
| | - Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON; Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON
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Cardenas VM, Ali MM, Fischbach LA, Nembhard WN. Dual use of cigarettes and electronic nicotine delivery systems during pregnancy and the risk of small for gestational age neonates. Ann Epidemiol 2020; 52:86-92.e2. [PMID: 32805398 DOI: 10.1016/j.annepidem.2020.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to estimate the effect of cigarette smoking and electronic nicotine delivery systems (ENDS) use during pregnancy on small for gestational age (SGA). METHODS We used data from the 2016-2017 Arkansas Pregnancy Risk Assessment Monitoring System, estimated the risk ratio (RR) for SGA for maternal prenatal cigarette smoking-only use, cigarette smoking, and ENDS use (i.e., dual use), with no prenatal tobacco use as referent, accounting for the complex survey design. We also explored these effects for women who stopped smoking cigarettes during pregnancy among cigarette smokers and dual users. RESULTS Estimated adjusted RR for SGA for cigarette-only users was 1.7 (95% confidence interval [CI]: 1.1, 2.7), and 1.8 (95% CI: 1.0, 3.4) for dual users. These RR estimates increased after correcting for tobacco use misclassification. Women who were dual users (cigarette smokers and ENDS users) and continued using ENDS but stopped smoking cigarettes had an increased risk for SGA compared with nontobacco users, 3.2 (95% CI: 1.5, 6.6). CONCLUSIONS Our results in a population representative sample are consistent with the hypothesis that exposure to both maternal cigarette smoking and ENDS use increased the risk of SGA. Dual users still had an elevated risk of SGA after smoking cessation.
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Affiliation(s)
- Victor Manuel Cardenas
- Department of Epidemiology, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock.
| | - Mir Murtuza Ali
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock
| | - Lori Ann Fischbach
- Department of Epidemiology, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock
| | - Wendy Nicole Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock; Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock
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18
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Obisesan OH, Osei AD, Uddin SMI, Dzaye O, Cainzos-Achirica M, Mirbolouk M, Orimoloye OA, Sharma G, Al Rifai M, Stokes A, Bhatnagar A, El Shahawy O, Benjamin EJ, DeFilippis AP, Blaha MJ. E-Cigarette Use Patterns and High-Risk Behaviors in Pregnancy: Behavioral Risk Factor Surveillance System, 2016-2018. Am J Prev Med 2020; 59:187-195. [PMID: 32362509 PMCID: PMC8349302 DOI: 10.1016/j.amepre.2020.02.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The prevalence of e-cigarette use has increased dramatically in the last decade in the U.S. Understanding the prevalence, patterns of use, and risk factor associations of e-cigarette use in pregnant women is particularly important, as this could have potential health implications for the mother and the developing child. METHODS Using Behavioral Risk Factor Surveillance System Survey data from 2016 to 2018, adult women of reproductive age (18-49 years) who reported being pregnant (n=7,434) were studied. Self-reported current e-cigarette use was the main exposure. Other measures included combustible cigarette smoking status and high-risk behaviors (including other tobacco, marijuana, or heavy alcohol use; binge drinking; and others). All analyses were done in 2019. RESULTS Approximately 2.2% of pregnant women reported current e-cigarette use, of whom 0.6% reported daily use. The highest prevalence of e-cigarette use was observed in the youngest age group of pregnant women (3.2%), with 41.7% of all pregnant current e-cigarette users being aged 18-24 years. There was a marked increase in the prevalence of current use of e-cigarettes among pregnant women from 1.9% in 2016 to 3.8% in 2018. Approximately 46% of pregnant current e-cigarette users reported concomitant cigarette smoking. Compared with pregnant never e-cigarette users, pregnant current e-cigarette users had a higher prevalence of other tobacco product use, marijuana use, heavy alcohol intake, binge drinking, and other high-risk behaviors. CONCLUSIONS These findings underscore the need to strengthen prevention and policy efforts, specifically in the vulnerable subgroup of pregnant women.
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Affiliation(s)
- Olufunmilayo H Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Albert D Osei
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - S M Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | | | - Olusola A Orimoloye
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Andrew Stokes
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Global Health, Boston University, Boston, Massachusetts
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Omar El Shahawy
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Section on Tobacco, Alcohol and Drug Use, Department of Population Health, School of Medicine, New York University, New York, New York; Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Emelia J Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, Boston University, Boston, Massachusetts
| | - Andrew P DeFilippis
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas.
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Raj AT, Sujatha G, Muruganandhan J, Kumar SS, Bharkavi SI, Varadarajan S, Patil S, Awan KH. Reviewing the oral carcinogenic potential of E-cigarettes using the Bradford Hill criteria of causation. Transl Cancer Res 2020; 9:3142-3152. [PMID: 35117678 PMCID: PMC8798817 DOI: 10.21037/tcr.2020.01.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/07/2019] [Indexed: 11/06/2022]
Abstract
The past decade has seen a surge in the use of e-cigarettes, which has prompted the medical community to assess any associated potential health hazards. A major concern was the risk of cancer. Chemical analysis of e-cigarettes has shown the presence of volatile organic compounds with the potential for carcinogenicity. Comparative toxicology analysis has shown e-cigarette to have relatively lower dosages of toxins than conventional combustible cigarettes. Based on comparative analysis, e-cigarettes have been increasingly advocated as a safe alternative to conventional cigarettes. It is vital to recognize that presence of relatively lower toxin level does not preclude carcinogenic potential. The nicotine present in the e-cigarette was presumed to be the major cytotoxic agents, thus nicotine-free e-cigarette was considered as inert. On the contrary, experimental studies on oral cell lines have shown DNA strand breaks on exposure to e-cigarette vapors with or without nicotine. In addition, dysregulations of genes associated with carcinogenic pathways have also been demonstrated in oral tissues exposed to e-cigarette vapors. Despite alarming molecular data, the oral carcinogenic potential of e-cigarette remains unclear, which can be attributed to the lack of long-term prospective and large-scale case-control studies. As e-cigarette users often have other well-established risk factors (conventional cigarette smoking, alcohol, etc.) as associated habits, it is difficult to assess e-cigarette as an independent risk factor for oral cancer. Thus, the present manuscript aims to review the published literature using the Brad Ford Hill criteria of causation to determine the oral carcinogenic potential of e-cigarettes.
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Affiliation(s)
- A Thirumal Raj
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, India
| | - Govindarajan Sujatha
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, India
| | - Jayanandan Muruganandhan
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, India
| | | | - Sk Indu Bharkavi
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, India
| | - Saranya Varadarajan
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, India
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Kamran Habib Awan
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
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Desai N. Smoking and pregnancy: The era of electronic nicotine delivery systems. Obstet Med 2020; 13:154-158. [PMID: 33343691 DOI: 10.1177/1753495x19893224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022] Open
Abstract
Electronic nicotine delivery systems have been commercially available in the United States since 2007. Despite a decrease in combustible cigarette use, electronic nicotine delivery systems use has dramatically increased among both adults and adolescents. These devices have been marketed as smoking cessation aids, although data on their efficacy are scarce. Pregnant women are an especially vulnerable population susceptible to claims of safety and efficacy, and the medical community remains inadequately informed on how to counsel these women. The purpose of this article is to review known literature regarding the use of electronic nicotine delivery systems in pregnancy, to understand the differences between cigarettes and electronic nicotine delivery systems use in pregnancy, and to further guide clinicians on how to advise the pregnant woman on their use.
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Affiliation(s)
- Nikita Desai
- Respiratory Institute, Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
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Cardenas VM, Cen R, Clemens MM, Moody HL, Ekanem US, Policherla A, Fischbach LA, Eswaran H, Magann EF, Delongchamp RR, Boysen G. Use of Electronic Nicotine Delivery Systems (ENDS) by pregnant women I: Risk of small-for-gestational-age birth. Tob Induc Dis 2019; 17:44. [PMID: 31516487 PMCID: PMC6662791 DOI: 10.18332/tid/106089] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The 2016 US Surgeon General's Report suggests that the use of electronic nicotine delivery systems (ENDS) is a fetal risk factor. However, no previous study has estimated their effect on adverse pregnancy outcomes. We assessed the prevalence of current ENDS use in pregnant women and explored the effect on birth weight and smallness-for-gestational-age (SGA), correcting for misclassification from nondisclosure of smoking status. METHODS We conducted a cohort study with 248 pregnant women using questionnaire data and biomarkers (salivary cotinine, exhaled carbon monoxide, and hair nicotine). We evaluated the association between birth weight and the risk of SGA by applying multivariate linear and log-binomial regression to reproductive outcome data for 232 participants. Participants who did not disclose their smoking status were excluded from the referent group. Sensitivity analysis corrected for misclassification of smoking/ENDS use status. RESULTS The prevalence of current ENDS use among pregnant women was 6.8% (95% CI: 4.4-10.2%); most of these (75%) were concurrent smokers. Using self-reports, the estimated risk ratio of SGA for ENDS users was nearly two times the risk in the unexposed (RR=1.9, 95% CI: 0.6-5.5), and over three times that for ENDS-only users versus the unexposed (RR=3.1, 95% CI: 0.8-11.7). Excluding from the referent group smokers who did not disclose their smoking status, the risk of SGA for ENDS-only use was 5 times the risk in the unexposed (RR=5.1, 95% CI: 1.1- 22.2), and almost four times for all types of ENDS users (RR=3.8, 95% CI: 1.3-11.2). SGA risk ratios for ENDS users, corrected for misclassification due to self-report, were 6.5-8.5 times that of the unexposed. CONCLUSIONS Our data suggest that ENDS use is associated with an increased risk of SGA.
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Affiliation(s)
- Victor M. Cardenas
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Ruiqi Cen
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Melissa M. Clemens
- The Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, United States
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Heather L. Moody
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Uwemedimbuk S. Ekanem
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
- Department of Community Health, Faculty of Clinical Sciences, University of Uyo, Uyo, Nigeria
| | - Anuradha Policherla
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Lori A. Fischbach
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Everett F. Magann
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Robert R. Delongchamp
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
- Arkansas Department of Health, Little Rock, United States
| | - Gunnar Boysen
- The Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, United States
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
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