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Child Psychiatrist /Adult Psychiatrist

Increased Prevalence of E-Cigarette Use During Late Pregnancy Among Adolescents

Updated: 4 days ago

The prevalence of e-cigarette use during late pregnancy among US adolescents has significantly increased, but does not elevate small-for-gestational-age birth risk.

The prevalence of e-cigarette use during late pregnancy has increased among adolescents from 2016 to 2021, according to study results published in JAMA Network Open.


Particularly, White adolescents were the most likely to use e-cigarettes during pregnancy, relative to other races/ethnicities. However, unlike combustible cigarettes, e-cigarette use did not significantly elevate the risk for small-for-gestational-age (SGA) births.

Although the popularity of e-cigarettes has increased among adolescents in the United States, little is known about the prevalence of e-cigarette use among pregnant adolescents. Thus, researchers conducted a cohort study of data from the 2016 to 2021 Pregnancy Risk Assessment Monitoring System (PRAMS). This dataset used a mixed-mode approach to collect information on maternal behaviors, attitudes, and experiences throughout the perinatal period and covers approximately 83% of all US births. Participants self-reported their e-cigarette and combustible cigarette use. The researchers then categorized participants into the following groups: adolescents who abstained from both, exclusive e-cigarette users, exclusive combustible cigarette users, and individuals who engaged in dual use of both cigarette types. Additionally, SGA birth was defined as a weight below the 10th percentile for the corresponding sex and gestational duration, in accordance with the established criteria by the World Health Organization.

A total of 10,428 adolescents, aged 10 to 19 years, who were pregnant between 2016 to 2021 were included in the final analysis. At baseline, 27.3% of individuals were aged 10 to 17 years and 72.7% were aged 18 to 19 years. By self-reported race/ethnicity, 58.9% of individuals identified as White, 23.3% as Black, and 69.8% as non-Hispanic.

The researchers observed a significant increase in the weighted prevalence of pregnant women exclusively using e-cigarettes during late pregnancy (the last 3 months of gestation), from 0.8% in 2016 to 4.1% in 2021 (P =.001). In contrast, the prevalence of exclusive combustible cigarette use declined from 9.2% in 2017 to just 3.2% in 2021(P <.001). Dual use of both cigarette types did not significantly differ across the time period, fluctuating between 0.6% and 1.6% (P =.38).

In 2021, the prevalence of cigarette use during late pregnancy among adolescents was highest for exclusive e-cigarette use (4.1%), then exclusive cigarette use (3.2%), and lastly dual use of both cigarette types (1.1%). Further, White adolescents had the highest prevalence of exclusive e-cigarette use (2.7%) and exclusive cigarette use (9.8%), compared to other race/ethnicity groups.

Relative to pregnant adolescents who did not use cigarettes, the risk for SGA birth was not significantly elevated among adolescents who solely used e-cigarettes during late pregnancy (adjusted odds ratio [aOR], 1.68; 95% CI, 0.89-3.18) or adolescents who had dual use of both cigarette types (aOR, 1.68; 95% CI, 0.79-3.53). However, adolescents with exclusive use of combustible cigarettes had double the risk for SGA birth compared to nonusers (24.6% vs 12.9%; aOR, 2.51; 95% CI, 1.79-3.52).

Study authors concluded, “In this cohort study of US pregnant adolescents, there was an increase in e-cigarette use and a decrease in cigarette use during late pregnancy from 2016 to 2021.”

These study findings may be limited by recall bias, the potential confounding factors when distinguishing between cannabis and nicotine inhalation devices, and a lack of information on secondhand smoke exposure during pregnancy.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor

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