Cigarette Smoking Abstinence Among Pregnant Individuals Using E-Cigarettes or Nicotine Replacement Therapy

Abstract

ImportanceSmoking cigarettes during pregnancy can impair maternal and child health, and pregnant individuals have increasingly used electronic cigarettes (e-cigarettes) for various reasons, including quitting smoking.ObjectiveTo assess smoking abstinence rates among pregnant individuals who used e-cigarettes compared with those who used nicotine replacement therapy (NRT).Design, Setting, and ParticipantsThis cohort study is a secondary data analysis of phase 8 of the US Pregnancy Risk Assessment Monitoring System, conducted between 2016 and 2020. Eligible participants included pregnant individuals who smoked combustible cigarettes within the 3 months before pregnancy and either used e-cigarettes or NRT during pregnancy. Data analysis was conducted from March 2022 to April 2023.ExposuresCombustible cigarette use within 3 months before pregnancy and use of either e-cigarettes or NRT during pregnancy.Main Outcomes and MeasuresThe primary outcome was the individual’s self-reported smoking abstinence status during the last 3 months of pregnancy. Weighted percentages were reported and weighted multivariable logistic regression models were used to examine the association of e-cigarette use vs NRT with smoking abstinence. A propensity score was used to control for confounding by sociodemographics, pregnancy characteristics, prepregnancy smoking intensity, depression, behavioral support, and hookah use.ResultsThe cohort included 1329 pregnant individuals (759 ≥25 years [60.2%]; 766 non-Hispanic White individuals [79.8%]) of whom 781 had an education level of high school or lower (61.4%), and 952 had an annual household income of $48 000 or less (81.5%). Of the 1329 individuals, 890 (unweighted percentage, 67.0%) were existing e-cigarette users, 67 (unweighted percentage, 5.0%) were new e-cigarette users, and 372 (unweighted percentage, 28.0%) were NRT users. Compared with individuals who used NRT during pregnancy, individuals who used e-cigarettes had a higher rate of smoking abstinence in late pregnancy (456 individuals [50.8%] vs 67 individuals [19.4%]; propensity score adjusted odds ratio [OR], 2.47; 95% CI, 1.17-5.20; P = .02). In the secondary analysis stratified by the timing of e-cigarette use initiation, existing users of e-cigarettes who initiated before pregnancy had a higher smoking abstinence rate than NRT users (446 users [53.1%] vs 67 users [19.4%]; adjusted OR, 2.61; 95% CI, 1.23-5.51; P = .01). However, new e-cigarette users who initiated use during pregnancy had a similar smoking abstinence rate in late pregnancy when compared with NRT users (10 users [20.6%] vs 67 users [19.4%]; adjusted OR, 1.13; 95% CI, 0.22-5.87; P = .88).Conclusions and RelevanceThese findings suggest that individuals who used e-cigarettes during pregnancy had a higher smoking abstinence rate in late pregnancy than individuals who used NRT, especially for those who initiated e-cigarette use before pregnancy, indicating that replacement of cigarettes with e-cigarettes during pregnancy may be a viable strategy for harm reduction.

Use and co-use of tobacco and cannabis before, during, and after pregnancy: A longitudinal analysis of waves 1–5 of the Population Assessment of Tobacco and Health (PATH) study.

“…Fifth, tobacco use included several products (i.e., cigarettes, electronic cigarettes, cigarillos, hookah, and cigars), and we were unable to examine use of individual products due to small cell sizes. Furthermore, although e-cigarettes have shown promise as a smoking cessation aid in pregnancy (Wen et al, 2023), in the current sample, prevalence of past 30-day e-cigarette use was small (e.g., 14% at prepregnancy). Future work should examine changes in use of individual products across pregnancy and postpartum, including whether pregnant individuals may transition to other products, such as e-cigarettes.…”

“…Indeed, our finding that tobacco-only use (vs. cannabis-only use) was also associated with greater likelihood of continuing to use either substance during pregnancy is consistent with the relative prevalence of tobacco versus cannabis use in pregnancy (National Institutes of Health, 2022). Emerging evidence also suggests that e-cigarettes may be a helpful tobacco cessation tool in pregnancy (e.g., Wen et al, 2023), and another possibility is that pregnant women might have transitioned to a less harmful nicotine product, potentially in an effort to quit or cut down combustible tobacco use. Notably, rates of e-cigarette use were relatively low in the sample compared to cigarette smoking (i.e., 19% e-cigarette use vs. 82% cigarette smoking among those who endorsed continued use in pregnancy) and majority of participants had resumed co-use of tobacco and cannabis in postpartum.…”

Error in Methods and Figure

“…In the Original Investigation titled “Cigarette Smoking Abstinence Among Pregnant Individuals Using E-Cigarettes or Nicotine Replacement Therapy,” 1 published September 12, 2023, there were errors in the Figure (35 930 should have been 35 390, and 30 378 should have been 29 838). In the Study Population and Sample subsection of the Methods, the word “marijuana” should have been “NRT” in this sentence: “Of note, the timing of NRT initiation was not available in the PRAMS questionnaire because the survey only questioned marijuana use during pregnancy.” This article has been corrected.…”

“…In the Study Population and Sample subsection of the Methods, the word “marijuana” should have been “NRT” in this sentence: “Of note, the timing of NRT initiation was not available in the PRAMS questionnaire because the survey only questioned marijuana use during pregnancy.” This article has been corrected. 1 …”